Hye-Yon Cho

CA19-9 elevation in ovarian mature cystic teratoma: Discrimination from ovarian cancer – CA19-9 level in teratoma

Background We aimed to identify clinical characteristics of ovarian mature cystic teratoma (MCT) in association with CA19-9 elevation, and to determine if CA19-9 is a useful marker in discrimination of MCT from ovarian cancer (OC). Material/Methods Medical records of 322 women with pathologically-confirmed MCT or OC (stage 1 or 2) were reviewed retrospectively. The relationships between the characteristics of MCT (mean diameter, bilaterality, and pathologic components) and elevated CA19-9 were evaluated. Tumor markers in MCT were compared to those in OC. Results MCTs with CA19-9 elevation were correlated with a larger diameter (8.53±3.84 cm vs. 6.95±3.97 cm, p=0.002) and presence of fat component (67.1% vs. 32.9%, p<0.001), compared to those with normal CA 19-9. Although the incidence of CA19-9 elevation was not different between patients with MCT and OC (p=0.700), the mean value of CA19-9 was higher in those with OC (114.66±20.66 U/mL vs. 508.58±261.63 U/mL, p=0.013). In addition, simultaneous elevation of CA125 and CA19-9 was associated with a higher probability of malignant neoplasm (p<0.001; odds ratio: 23.7; 95% confidence interval: 8.863–63.576) than single elevation of CA 19-9. Conclusions CA19-9 could be an important tool in the diagnosis of ovarian mature cystic teratoma. CA19-9, in combination with CA125, might be a useful marker in discrimination of MCT from cancer.

Creutzfeldt-Jakob disease with the V203I mutation and M129V polymorphism of the prion protein gene (PRNP) and a 17 kDa prion protein fragment

Human prion diseases are fatal neurodegenerative disorders that include kuru, Gerstmann-Sträussler-Scheinker disease, fatal familial insomnia and Creutzfeldt-Jakob disease (CJD). They are characterized by the accumulation of an abnormal protease-resistant isoform of the prion protein, PrP, spongiform neurodegeneration, astrogliosis and neuronal cell loss [1]. CJD occurs in sporadic, genetic, infectious and iatrogenic forms. About 85% of all CJD cases are sporadic. Approximately 10–15% of CJD cases are inherited, and less than 1% are acquired by transmission. Human prion protein contains 253 amino acids encoded by the prion protein gene (PRNP), located on chromosome 20p12 in humans. PRNP plays an important role in conferring susceptibility or resistance to prion disease. A number of point or insertional mutations in the open reading frame of PRNP are linked to the genetic forms of CJD [2]. In addition to pathogenic mutations, polymorphisms at codons 129 or 219 of PRNP influence susceptibility to prion diseases and determine disease phenotype [3]. A CJD patient with a point mutation at codon 203 of PRNP, yielding the substitution of Val by Ile (V203I) and Met/Met homozygosity at codon 129 was reported previously [4]. Here we report the first analysis of a CJD case with V203I mutation and codon 129 Met/Val (M129V) heterozygosity. A 66-year-old Korean woman, with no family history of prion diseases, developed gait disturbance and rapidly progressive cognitive dysfunction. Three weeks after the onset, she was admitted to our hospital. She was alert, and her score on the Mini-Mental State Examination was 29 points. She showed dystonic posturing of both hands, leftside dominant resting and postural tremor, mild bradykinesia, cogwheel rigidity and incontinence of urine. Brain magnetic resonance imaging (MRI) revealed no specific findings (Figure 1A,C). Cerebrospinal fluid (CSF) study did not show any signs of infection of the central nervous system. Three days after admission, she had severe voiding difficulty. To investigate the possibility of hydrocephalus, cisternography was done; evidence of hydrocephalus was not seen. One month after onset, she had myoclonic jerks. Her mental and neurologic disturbances gradually worsened. Five weeks after onset, she had frequent myoclonus, dysphonation, aggravation of dysphagia and quadriparesis. Repeat MRI examination at that time revealed gyriform hyperintensity in the cerebral cortex on diffusion-weighted images (Figure 1B) and T2-weighted images (Figure 1D). Six weeks after onset, she began to have dyspnoea. The patient’s condition deteriorated rapidly to reach a stuporous state with impaired comprehension. The patient died 2 months after onset of clinical signs. An autopsy was performed. Total brain weight was 1450 g. One half of the autopsy brain was immediately frozen, the other half was used for neuropathological examination. Formalin-fixed, paraffinembedded tissue blocks from frontal and temporal lobes as well as basal ganglia and cerebellum were processed for haematoxylin and eosin staining and immunohistochemistry. The immunohistochemical staining was performed with either monoclonal anti-PrP 3F4 antibody or polyclonal antibody for glial fibrillary acidic protein. Post mortem neuropathological examination revealed moderate spongiform degeneration and vacuoles in the frontal cortex (Figure 1E). Slight neuronal loss and moderate astrogliosis were also observed in the frontal cortex (Figure 1F). Immunohistochemical staining for PrP using 3F4 antibody showed patterns of synaptic deposition and patchy deposits in the frontal lobes and temporal lobes (Figure 1G,H). Intraand peri-neuronal deposits were seen in the basal ganglia (Figure 1I). Punctuate deposits of PrP were seen in the granular layer of the cerebellum (Figure 1J). No plaque-like deposits of PrP were detected. In addition, mild spongiform degeneration and large vacuoles were observed in all regions analysed. After obtaining informed consent, blood samples were collected from the patient with the mutation at codon 203, from 240 sporadic CJD patients and from 543 healthy Koreans [5,6]. The study was approved by the Institutional Review Board of Hallym University Sacred Heart Hospital. Genomic DNA was extracted from blood

Surgical outcome and cost comparison between total vaginal hysterectomy and laparoscopic hysterectomy for uteri weighing >500 g.

STUDY OBJECTIVE To compare surgical outcomes and overall costs of less invasive methods of hysterectomy to treat benign disease including total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH) in women with a uterus weighing >500 g. DESIGN Retrospective review of medical records (Canadian Task Force classification III). SETTING University-associated hospital. PATIENTS One hundred three women with a uterus weighing >500 g who had undergone either total vaginal hysterectomy (TVH) (n = 52) or total laparoscopic hysterectomy (TLH) (n = 51). MEASUREMENTS AND MAIN RESULTS Cost data were extracted from the hospital billing system. Patient characteristics, surgical outcomes, and hospital costs were compared between the 2 groups. Patient characteristics were similar in both groups except for a history of surgery (TVH 11.5%, and TLH 37.3%; p = .01). Insofar as surgical outcomes, mean (SD) operative time was shorter in the TVH group compared with the TLH group (110.00 [28.68] minutes vs 180.47 [51.32] minutes; p < .001), and hospital stay was longer (8.08 [0.68] days vs 7.45 [1.03] days; p < .001). Other surgical outcomes including estimated blood loss (p = .20) and decrease in hemoglobin (p = .12) did not differ between the 2 groups. Total hospital costs (converted from Korean won to US dollars) were significantly lower in the TVH group than in the TLH group (

Serum CA19-9 as a Predictor of Malignancy in Primary Ovarian Mucinous Tumors: A Matched Case-Control Study

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Factors Determining Conversion to Laparotomy in Patients Undergoing Total Laparoscopic Hysterectomy

666.58] vs

Comparison of clinical effects between total vaginal hysterectomy and total laparoscopic hysterectomy on large uteruses over 300 grams

2744.03 [

Prognostic significance of perineural invasion in cervical cancer

715.76]; p < .001). CONCLUSION Our data suggest that TVH is a safe and economic procedure even in women with a uterus weighing >500 g. Skilled surgeons should preferentially consider TVH for treatment of benign uterine disease, regardless of uterine size.

Differential diagnosis between uterine sarcoma and leiomyoma using preoperative clinical characteristics

Background This study was designed to investigate the clinical characteristics correlated with serum CA19-9 elevation in primary mucinous ovarian tumors and to evaluate the role of serum CA19-9 in predicting borderline or malignant tumors. Material/Methods We retrospectively identified 27 women with pathologically-confirmed primary ovarian mucinous neoplasms (16 borderline and 11 malignant), who had been preoperatively checked for serum CA19-9 and CA125 levels. The control group was established by 1:2 matching for age among all women with pathologically-confirmed benign mucinous tumors over the same time period. The associations of the serum CA19-9 elevation and clinical characteristics, including tumor pathology, were evaluated. Results Serum CA19-9 was more frequently elevated in borderline or malignant than benign tumors (57.9% vs. 16.7%, P=0.001), although the mean value of serum CA19-9 was not significantly different among histological subtypes. CA19-9 elevation was correlated with large tumor size (largest diameter ≥15 cm; p=0.028), serum CA125 elevation (p=0.006), and tumor pathology (borderline or malignant tumors; p=0.001). Other clinical characteristics, including parity, menopause, bilateral tumor involvement, and torsion were not correlated with CA19-9 elevation. Multivariate analysis revealed that tumor pathology was the only independent factor for CA19-9 elevation in primary ovarian mucinous tumors (odds ratio 3.842, 95% CI 1.277–11.558, p=0.017). Interestingly, subgroup analysis in women with normal serum CA 125 level revealed that CA19-9 was significantly correlated with borderline and malignant tumors but not with benign tumors (odds ratio 6.3, 95% CI 1.438–19.648, p=0.014). Conclusions Serum CA19-9 can be a useful complementary marker in differentiating benign from borderline or malignant mucinous tumors in the ovaries, particularly when serum CA125 level is not elevated.

Expression Patterns of Nrf2 and Keap1 in Ovarian Cancer Cells and their Prognostic Role in Disease Recurrence and Patient Survival.

Aims: To identify the risk factors determining conversion to laparotomy during total laparoscopic hysterectomy (TLH) for benign diseases. Methods: We retrospectively reviewed medical records of 288 patients that underwent TLH during the first 2 years of performing TLH at Kang-Nam Sacred Heart Hospital. Twenty-three cases were converted to laparotomy. We compared patient characteristics, indications for hysterectomy, operation time, estimated blood loss, adhesion, uterine weight and postoperative complications between failed and successful groups. Results: The rate of conversion to laparotomy was 8%. There were no differences in patient characteristics between the two groups. Independent risk factors for conversion were adhesion and uterine weight. The most common cause of the conversion to laparotomy was adhesions (p = 0.000). Uterine weight was found to be heavier in the failed group (331.5 ± 157.1 vs. 270.3 ± 132.5 g, p = 0.038). Estimated blood loss was greater in the failed group (455.6 ± 143.7 vs. 304.2 ± 45.8 ml, p = 0.047). Bladder injury occurred in the failed group more frequently than in the successful group (p = 0.024). Conclusion: An awareness of risk factors for conversion is important for better patient selection for TLH. Indirect measurement of uterine weight by sonography and detailed history taking is helpful in determining the appropriate hysterectomy route.

Laparoscopic Ovarian Surgery in Children and Adolescents

Objective:  To compare intra‐ and postoperative complications, operation time, and duration of hospital stay, and to evaluate cost‐effectiveness between total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH) groups.