Malignant transformation of endometriosis is an infrequent complication. Clear cell carcinoma from endometriosis is very rare in the paraovarian cyst. To date no cases have been reported. We report a case of clear cell carcinoma arising from endometriosis of the paraovarian cyst with a brief review of literature.
Endometriosis ; Female

Risk-reducing surgery is known as the most powerful preventive strategy for BRCA mutation carriers. This current case report represents the first documentation of the contralateral prophylactic mastectomy (CPM) and bilateral salphingo-oophorectomy (BSO) in a carrier of BRCA mutation in Korea. The patient was a 39-year-old woman who was seen in at a genetic counseling clinic for discussing of risk-reducing strategies for the breast and ovarian cancer. She presented at the age of 38 year with a 1.5 cm sized, grade 3, and ER/PR/HER2 negative infiltrating ductal carcinoma of the right breast. She was treated with wide local excision of the right breast and sentinel lymph node biopsy of the axilla. She was then treated with CAF (Cyclophosphamide+Doxorubicin+5-Fluorouracil) chemotherapy and radiation therapy. She was initially counseled at the time of surgery due to the family history of her mother, who suffered with breast cancer at the age of 58. After the completion of chemotherapy, we received the genetic test results and it was positive for the BRCA1 mutation (3746_3747insA). After a long discussion of cancer surveillance and risk-reducing options, she decided to undergo ipsilateral mastectomy and CPM and BSO. Before surgery, psychiatric consultation was done and questionnaires evaluating her depression, anxiety, body image, quality of life, and psychological distress were filled out. After discussion with the plastic surgeon, she decided to undergo delayed reconstruction of the breast. We performed endoscopic bilateral skin-sparing mastectomy and a laparoscopic bilateral salphingo-oophorectomy. There was no complication after surgery and the pathologic examination revealed no evidence of cancer in both breasts and ovaries. We think that CPM and BSO are feasible risk-reducing options for the breast cancer patients with the BRCA mutation in Korea.
Adult ; Anxiety ; Axilla ; Body Image ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Depression ; Female ; Genetic Counseling ; Humans ; Korea ; Mastectomy ; Mothers ; Nitriles ; Ovarian Neoplasms ; Ovary ; Pyrethrins ; Quality of Life ; Sentinel Lymph Node Biopsy ; Surveys and Questionnaires

OBJECTIVE: To investigate the effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients. METHODS: A retrospective review was performed on the 207 patients who had taken tamoxifen or anastrozole, as adjuvant hormonal therapy after breast cancer surgery between January 2003 and December 2006. Gynecologic surveillance constituted of ultrasonographic exam of the endometrial thickness and ovarian cyst formation. The patients were classified into three groups and analyzed; premenopausal/postmenopausal women receiving tamoxifen and women receiving anastrozole. RESULTS: Mean duration of follow up was 20.6+/-6.6 months. There was no difference of mean endometrial thickness before hormonal therapy among the three groups (p=0.327). In women receiving tamoxifen, the endometrium was continuously thickened in proportion to the duration of the therapy irrespective of menopausal status while it remained unchanged in women receiving anastrozole (p<0.05). Endometrial biopsies were performed in 28 patients receiving tamoxifen. The most common histologic finding was proliferative endometrium in premenopausal women (7/21) and atrophic endometrium in postmenopausal women (6/7). There was no case of endometrial cancer in both groups. Ovarian cyst was found in 32 women and the most were developed in premenopausal women receiving tamoxifen (30/32). All of them showed benign nature on transvaginal ultrasonographic findings. CONCLUSION: Women undergoing adjuvant hormonal therapy after breast cancer surgery exhibited changes in the endometrium and ovary. However most changes were not a serious problem in this study and frequent gynecologic surveillance in these patients needs further investigation.
Biopsy ; Breast ; Breast Neoplasms ; Endometrial Neoplasms ; Endometrium ; Female ; Follow-Up Studies ; Humans ; Nitriles ; Ovarian Cysts ; Ovary ; Retrospective Studies ; Tamoxifen ; Triazoles

OBJECTIVE: To investigate the effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients. METHODS: A retrospective review was performed on the 207 patients who had taken tamoxifen or anastrozole, as adjuvant hormonal therapy after breast cancer surgery between January 2003 and December 2006. Gynecologic surveillance constituted of ultrasonographic exam of the endometrial thickness and ovarian cyst formation. The patients were classified into three groups and analyzed; premenopausal/postmenopausal women receiving tamoxifen and women receiving anastrozole. RESULTS: Mean duration of follow up was 20.6+/-6.6 months. There was no difference of mean endometrial thickness before hormonal therapy among the three groups (p=0.327). In women receiving tamoxifen, the endometrium was continuously thickened in proportion to the duration of the therapy irrespective of menopausal status while it remained unchanged in women receiving anastrozole (p<0.05). Endometrial biopsies were performed in 28 patients receiving tamoxifen. The most common histologic finding was proliferative endometrium in premenopausal women (7/21) and atrophic endometrium in postmenopausal women (6/7). There was no case of endometrial cancer in both groups. Ovarian cyst was found in 32 women and the most were developed in premenopausal women receiving tamoxifen (30/32). All of them showed benign nature on transvaginal ultrasonographic findings. CONCLUSION: Women undergoing adjuvant hormonal therapy after breast cancer surgery exhibited changes in the endometrium and ovary. However most changes were not a serious problem in this study and frequent gynecologic surveillance in these patients needs further investigation.
Biopsy ; Breast ; Breast Neoplasms ; Endometrial Neoplasms ; Endometrium ; Female ; Follow-Up Studies ; Humans ; Nitriles ; Ovarian Cysts ; Ovary ; Retrospective Studies ; Tamoxifen ; Triazoles

Recently, a case of cervical cancer on the mucosal surface of a pedunculated cervical leiomyoma had been reported. We experienced a similar but distinct case of microinvasive squamous cell carcinoma on the mucosal surface of a pedunculated submucous leiomyoma. A 45-year-old Korean woman underwent type I hysterectomy for heavy bleeding from pedunculated submucous leiomyoma. Histopathological examination revealed that the leiomyoma of which mucosa was covered focally by microinvasive squamous cell carcinoma. During the management of pedunculated leiomyoma protruding through cervix, caution must be taken because of, although rare instance, a possible coexisting malignancy.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Leiomyoma* ; Middle Aged ; Mucous Membrane ; Uterine Cervical Neoplasms

OBJECTIVE: Menorrhagia is defined as a complaint of heavy cyclical menstrual bleeding occurring over several consecutive cycles and approximately 30% of women suffer from it. Recently uterine balloon ablation therapy (UBT) system has been used widely as a safe and easy surgical option for this cumbersome symptom. The aims of this study were to determine the safety and the efficacy of UBT system in the management of menorrhagia, and to identify the possible factors for a successful outcome. METHODS: From August 2003 to May 2004, 77 patients with menorrhagia were enrolled. Demographic information, diary score for menorrhagia, and size of uterus were checked before treatment. All patients were treated with UBT system under IV anesthesia at day-surgery unit and followed up post-operatively. The change of diary score, and the change of hemoglobin/hematocrit were recorded. And the change of quality of life was assessed. RESULTS: Medical records of 73 patients who completed scheduled follow up were analyzed. Mean age was 43.7 years old, pre-operative mean diary score was 255.9+/-98.0 and pre-operative mean hemoglobin was 10.67+/-1.67. After the operation, the diary score significantly decreased to 53.3+/-27.5, and the hemoglobin significantly increased to 12.67+/-1.53. Multiple logistic regression analysis showed that success of treatment was influenced by the indication of UBT, patient age, uterine depth, and adequate intra-operative balloon pressure. An improvement in self-reported quality of life scores was also observed. CONCLUSION: The UBT system is a safe and effective method to treat menorrhagia and can be easily done under outpatient basis. Thus, it is a good alternative to hysterectomy or hysteroscopic endometrial ablation with a comparable success rate and minimal risk.
Anesthesia ; Endometrial Ablation Techniques ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hysterectomy ; Logistic Models ; Medical Records ; Menorrhagia* ; Outpatients ; Quality of Life ; Uterus

OBJECTIVE: We performed prospective longitudinal study to establish reference range for cervical length and evaluate the change in cervix throughout pregnancy in twin pregnancy. METHODS: Fifty-four women of twin pregnancy without history of preterm labor, preterm delivery, cervix cerclage, that delivered at or after 36 weeks were included in this study. Serial measurements of cervical lengths by transvaginal ultrasound exam were performed at 20 weeks of gestation and every 4 weeks (until 28 weeks), every two weeks (until 36 weeks) and every week until delivery. Linear regression analysis was done for statistical analysis. RESULTS: The reference range for cervical length in twin pregnancy was presented as mean, standard deviation and 95% confidence interval of the mean. Cervical length gradually decreased as the gestational age progressed. There was a significant correlation between cervical length measurements and gestational age (Y=71.361-1.336X, r2=0.384, p<0.05). CONCLUSION: We presented the reference range for cervical length in twin pregnancy and evaluated the association between gestational age and cervical length. These results can be used as reference guideline in consecutive assessments of cervical lengths during twin pregnancy.
Cervical Length Measurement ; Cervix Uteri ; Female ; Gestational Age ; Humans ; Linear Models ; Longitudinal Studies ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy, Twin* ; Prospective Studies ; Reference Values* ; Ultrasonography*

OBJECTIVE: The purpose of this study was to establish the effect of oligohydramnios and intrauterine infection on fetal and umbilical blood flows in patients with preterm premature rupture of membranes (PPROM). METHODS: Pulsed-wave Doppler imaging was used to determine the pulsatility index (PI) in the fetal renal, descending aorta, middle cerebral and umbilical arteries in 62 patients with PPROM. Amniocentesis was performed in 38 patients with PPROM. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for mycoplasma. The patients with PPROM were divided into two groups according to the presence (n=21) or absence (n=41) of oligohydramnios and the presence (n=14) or absence (n=24) of intrauterine infection. Oligohydramnios was defined as the largest single pocket that measured <2 cm in the vertical plane. Data was expressed as multiples of the median (MOM) adjusted for gestational age, and statistical analysis was conducted with nonparametric statistics. RESULTS: 1) Fetuses with the presence of oligohydramnios had significantly lower MOM of PI of the fetal renal artery and higher MOM of PI of the fetal descending aorta than those without this condition (MOM of PI of the fetal renal artery: median [range]; 0.030 [-0.532, 0.404] vs. 0.167 [-0.357, 2.81] p=0.03. MOM of PI of the fetal decending aorta: median [range]; 0.085 [-0.160, 0.470] vs. -0.120 [-0.587, 0.548] p=0.004). 2) There was a significantly negative relationship between the largest single vertical pocket and MOM of PI of the fetal descending aorta (r=-0.283, p=0.03). 3) There were no significant differences in the MOM of PI of the fetal middle cerebral artery and umbilical artery between the two groups of patients. 4) Amniotic fluid culture was positive in 37% (14/38). 5) There were no significant differences in the MOM of PI of the fetal middle cerebral, renal artery, descending aorta and umbilical arteries between patients with and without the intrauterine infection. CONCLUSION: Blood flow of the fetal renal artery and descending aorta, but not the middle cerebral and umbilical arteries, were affected by oligohydramnios in patients with PPROM but intrauterine infection did not affect the blood flow of the fetal and umbilical arteries in fetuses with PPROM.
Amniocentesis ; Amniotic Fluid ; Aorta ; Aorta, Thoracic ; Bacteria, Anaerobic ; Female ; Fetal Blood* ; Fetus ; Gestational Age ; Humans ; Membranes* ; Middle Cerebral Artery ; Mycoplasma ; Oligohydramnios* ; Pregnancy ; Renal Artery ; Rupture* ; Umbilical Arteries*

OBJECTIVE: The aim of this study was to evaluate the effectiveness of GnRH agonist therapy prior to the planned myomectomy for the women who want to preserve their fertility. METHODS: We reviewed 20 patients who had GnRH agonist therapy prior to the planned myomectomy from October 2003 to September 2004. RESULTS: Mean age of the patients was 37.8+/-4.5 y and nulliparous women were 7 (35%) among 20. Average 3.05 (range 1-4) times of GnRH agonist injection was done prior to a surgery. Indications of myomectomy were menorrhagia (13/20, 65%), dysmenorrhea (7/20, 35%), and palpable pelvic mass (6/20, 30%). Average of the longest diameter of the largest myoma was 79.8 mm at first visit ultrasonography, and reduced to 60.8 mm after the completion of GnRH agonist treatment. This means that average 55.8% of volume reduction was achieved by GnRH agonist. Among 20 patients, 18 (90%) had laparoscopic myomectomy and 2 (10%) had laparotomy. Of the 2 patients who had laparotomy, one had severe adhesion caused by prior pelvic surgery and another had very large myoma which was refractory to the GnRH agonist therapy. The global mean operative time was 125+/-51 min. Average hemoglobin drop after operation was 1.6 g/dL and no patient had transfusion. Total hospital stay was 3.9+/-1.1 days for patients who had laparoscopic myomectomy and 8.5+/-2.1 days for patients who had laparotomy. CONCLUSION: The use of GnRH agonist prior to the planned myomectomy was effective in reducing myoma volume and it enables surgeons to choose less invasive surgical approach.
Dysmenorrhea ; Female ; Fertility ; Gonadotropin-Releasing Hormone* ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Menorrhagia ; Myoma ; Operative Time ; Ultrasonography

OBJECTIVE: The aim of this study is to clarify the relationship between COX expressions and radioresistance in cervical cancer. METHODS: Patients with cervical cancer treated by primary radiotherapy were selected from the tumor registry of our institution. According to the response to radiotherapy during and after a month of radiation, poor responder and good responder was defined. Immunohistochemical staining was performed by the ABC method using formalin-fixed, paraffin-embedded tissue sections and monoclonal anti-COX-1,2 antibodies. Correlation of COX expression and response to radiation was analyzed. Cell lines derived from human cervical tumors were used: HeLa, HT3, and C33A. Using western blot, COX-1,2 expressions were identified in each cell line. The sensitivity of the cervix cancer cells to radiation was measured using a clonogenic assay. RESULTS: COX-1 and COX-2 expressions were higher in poor responders than good responders. The difference of COX-1 expression between two groups had marginal statistical significance (p=0.099, Fisher's exact test) and COX-2 expression was significantly higher in poor responders (p=0.034, Fisher's exact test). In the clonogenic assay, survival fraction of HeLa and HT-3 cell lines, which have COX-1 and COX-2 activity, was significantly higher than C33A cell line which has no COX activity (p<0.001). CONCLUSION: Our results suggest that the expression of COX in cervical cancer might be deeply associated with the effect of radiation therapy.
Antibodies ; Blotting, Western ; Cell Line ; Cervix Uteri* ; Female ; Humans ; Prostaglandin-Endoperoxide Synthases* ; Radiotherapy ; Uterine Cervical Neoplasms