Jae-Uk Shim

Fertility preservation in patients with early epithelial ovarian cancer.

OBJECTIVE To assess the role of fertility preservation in the treatment of patients with early epithelial ovarian cancer (EOC). METHODS We retrospectively analyzed the medical records of 21 patients with early EOC from January 1995 to December 2006. All eligible patients with a strong desire to preserve fertility were younger than 35 years and underwent fertility-sparing surgery with or without adjuvant chemotherapy. RESULTS Twenty-one eligible patients with a median age of 26.7 years (range, 20 to 33 years) were identified, and the mean follow-up period was 43 months (range, 5 to 86 months). Only one patient with stage IC recurred 34 months after the first operation. A total of five patients were able to become pregnant at least once after the first fertility preserving treatment, with or without adjuvant chemotherapy. All five patients succeeded in full-term vaginal delivery with healthy infants. No patients died of their disease. CONCLUSION Fertility preserving treatment in patients with early EOC can be considered as a proper treatment strategy in patients with early EOC, who have the strong desire for fertility preservation.

Ovarian Cancer during Pregnancy: Clinical and Pregnancy Outcome

The aim of this study is to evaluate the clinical feature and pregnancy outcome in patients with ovarian cancer diagnosed during pregnancy. We retrospectively analyzed the medical records of 27 patients diagnosed with ovarian cancer during pregnancy at Cheil General Hospital & Womens Healthcare Center from January 1996 to December 2006. Mean age of the patients was 29.1 yr (range 23-40), and a mean follow-up period was 57 months (range 7-112 months). Of 27 patients, 15 (55.5%) had borderline malignancies, 7 (25.9%) had epithelial malignancies and 5 (18.6%) had germ cell tumors. A total of 26 patients received a conservative surgery preserving pregnancy. The mean time for surgical intervention during pregnancy was 20 weeks of gestational age. Of the 27 patients, 26 had full term delivery of a healthy baby without any congenital malformation. Only one patient with epithelial ovarian cancer had a relapse at 19 months after the first conservative operation with adjuvant chemotherapy. There were few data for managing patients with ovarian cancer diagnosed during pregnancy. This study results could help establish a guideline for management of ovarian malignancy complicating pregnancy.

Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia

OBJECTIVE To evaluate the prevalence of concurrent endometrial carcinoma in women diagnosed with atypical endometrial hyperplasia (AEH) by endometrial biopsy. STUDY DESIGN We retrospectively analyzed the medical records of 126 patients who underwent hysterectomies for AEH diagnosed by endometrial biopsy from 1999 to 2008. AEH was initially diagnosed by dilatation and curettage (98 cases) or endometrial biopsy with a Z-sampler (24 cases). The remaining four cases were diagnosed by hysteroscopic polypectomy. The results of the endometrial biopsies were graded on an ordinal scale and were compared with pathologic features obtained at the hysterectomy. RESULTS In patients preoperatively diagnosed with AEH by biopsy, hysterectomy specimens revealed a rate of simple or complex endometrial hyperplasia without atypia of 27% with AEH and normal proliferative phases found in 54.7 and 7.9% of specimens, respectively. The incidence of endometrial carcinoma was considerably high (13/126, 10.3%). Eleven of 13 cases were confined to the endometrium and the remaining two were located at the adenomyosis without myometrial invasion. All patients with endometrial carcinoma displayed coexisting atypical complex hyperplasia following hysterectomy. CONCLUSIONS Biopsy specimens showing AEH, particularly atypical complex hyperplasia, are associated with a risk of coexisting endometrial carcinoma. When considering management strategies for women with a biopsy diagnosis of AEH, clinicians should take into account the considerable rate of concurrent endometrial cancer and the discrepancy with pathologic diagnosis. Treatment modalities may differ depending on population as the rates of concurrent endometrial cancer with AEH and myometrial invasion vary by geographical location.

A 10-year experience of laparoscopic surgery for adnexal masses during pregnancy

To assess the clinicopathologic outcomes of laparoscopic surgery for adnexal masses during pregnancy.

Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy

Background:  Laparoscopy has been highlighted as an effective surgical modality for diverse pelvic organ diseases. However, its surgical and obstetric efficacy has not been fully confirmed in pregnant women because of the absence of a large comparative study. The objective of this study was to compare outcomes between laparotomy and laparoscopic surgery for adnexal masses during pregnancy.

Lymphovascular space invasion is highly associated with lymph node metastasis and recurrence in endometrial cancer.

Lymphovascular space invasion (LVSI) has been evaluated as a predictor for nodal metastasis or poor survival in endometrial adenocarcinoma.

Risk of torsion and malignancy by adnexal mass size in pregnant women

Objective. To investigate risks of torsion and malignancy by adnexal mass size during pregnancy. Design. Retrospective review of medical records. Setting. General university hospital and healthcare center. Population. Four hundred and seventy women who underwent surgery for adnexal masses during pregnancy between 2002 and 2009. Main Outcome Measures. Rate of torsion and malignancy according to mass size classified into four groups: <6, 6–10, 10–15 and ≥15 cm. Results. Torsion was encountered in 55 patients (11.7%) and malignancy was confirmed in 20 (4.3%). A mass size of 6–10 cm had a significantly higher risk of torsion than a mass <6 cm (odds ratio 2.68, 95% confidence interval 1.33–5.40, p=0.006). Masses ≥15 cm had an approximately 12‐fold higher risk of malignancy compared with masses <6 cm (odds ratio 12.36, 95% confidence interval 2.90–52.67, p=0.001). However, for masses of 10–15 cm, the risks of both torsion and malignancy were not higher than those of masses <6 cm. Conclusions. Risks of torsion and malignancy are not directly proportional to increasing mass size in pregnant women. Physicians should be aware of a high risk of malignancy in women with an adnexal mass of over 15 cm. However, if a mass is smaller, the size should not be considered as a single independent factor in a decision for surgery.

Predictors associated with severity of pelvic actinomycosis

Aim:  To evaluate the clinical features of pelvic actinomycosis and to identify predictive factors associated with severity of pelvic actinomycosis.

Distribution and perinatal transmission of bacterial vaginal infections in pregnant women without vaginal symptoms.

Abstract Background: We evaluated the distribution and vertical transmission of bacterial vaginal infections in asymptomatic pregnant women. Methods: We performed multiplex PCR on secretions collected on cervical swabs from pregnant women at over 36 weeks of gestation and on oral secretions collected from their neonates immediately after delivery. We detected sexually transmitted infections (STIs) with the following 6 species: Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, and Ureaplasma urealyticum. Results: Infectious agents were detected in 64 of 455 pregnant women (14.1%) and in 11 neonates (2.4%). The rate of vertical transmission was 17.2% and all the infectious agents detected in neonates were concordant with those found in their mothers. U. urealyticum was the most frequently detected in the maternal genitalia, followed by M. hominis. Women who were in labor for a longer period of time had a higher risk of vertically transmitting STI agents to their neonates. Conclusions: Vertical transmission of bacterial STIs from mothers to their infants is possible at delivery and influenced by the duration of labor. STIs should be diagnosed in pregnant women to prevent vertical transmission from the mother to the infant at the time of delivery.

M351 QUANTIFICATION AND GENOTYPING OF HUMAN PAPILLOMAVIRUS BY REAL-TIME PCR AND HPV DNA CHIP IN CERVICAL SAMPLES

Quantification and genotyping of human papillomavirus by real-time pcr and hpv dna chip in cervical samples Hyoung Sun Jang, Jun Soo Kim, Young Soon Kang, Hyun Hee Seo, MiSeon Jeong Heung Seop Song, Sung Ran Hong, Hy Sook Kim, Jae Ho Lee, A Reum Cho, Kyung Taek Lim, In Ho Lee, Ki Heon Lee Jae Uk Shim, Jae Wook Kim, Tae Jin Kim Laboratory of Research & Development for Genomics, Department of Obstetrics and Gynecology, Department of Pathology, Laboratory of Molecular oncology, Cheil General Hospital and Womens Healthcare Center, University of Kwandong, Seoul, Korea