Kyung-Taek Lim

Clearance of persistent HPV infection and cervical lesion by therapeutic DNA vaccine in CIN3 patients.

Here, we demonstrate that electroporation-enhanced immunization with a rationally designed HPV DNA vaccine (GX-188E), preferentially targeting HPV antigens to dendritic cells, elicits a significant E6/E7-specific IFN-γ-producing T-cell response in all nine cervical intraepithelial neoplasia 3 (CIN3) patients. Importantly, eight out of nine patients exhibit an enhanced polyfunctional HPV-specific CD8 T-cell response as shown by an increase in cytolytic activity, proliferative capacity and secretion of effector molecules. Notably, seven out of nine patients display complete regression of their lesions and viral clearance within 36 weeks of follow up. GX-188E administration does not elicit serious vaccine-associated adverse events at all administered doses. These findings indicate that the magnitude of systemic polyfunctional CD8 T-cell response is the main contributing factor for histological, cytological and virological responses, providing valuable insights into the design of therapeutic vaccines for effectively treating persistent infections and cancers in humans.

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.

Laparoendoscopic single-site surgery (LESS) for adnexal tumors: one surgeon's initial experience over a one-year period

OBJECTIVE In this article, we present our initial experience with laparoendoscopic single-site surgery (LESS) for adnexal tumors and report on the safety and feasibility of this technique. STUDY DESIGN We retrospectively reviewed the medical records of the first 94 consecutive patients who underwent LESS for adnexal tumors at Cheil General Hospital and Womens Healthcare Center, Seoul, Korea between March 2009 and July 2010. Our retrospective chart review was approved by our local Institutional Review Board (IRB). We used a homemade wound retractor and surgical glove as the single-port device. All LESS procedures were performed by a single surgeon. RESULTS Of 94 patients, 90 (95.7%) successfully underwent LESS for the treatment of an adnexal tumor. The mean age of the patients was 38.51 ± 11.65 years, and the mean body mass index was 21.22 ± 2.79 kg/m(2). The mean operative time was 50.33 ± 13.26 min, and the mean diameter of the adnexal tumors was 6.26 ± 3.19 cm. The procedures included enucleation of an ovarian cyst (n=56), salpingo-oophorectomy (n=32), and salpingectomy (n=4). Two cases with suspicion for malignancy underwent conversion to laparotomy (2.1%), and frozen sections revealed serous ovarian adenocarcinoma (n=1) and chronic inflammation (n=1). Except for those two cases, the pathologic diagnoses were confirmed as mature cystic teratoma (n=30), endometriosis (n=24), mucinous cystadenoma (n=14), serous cystadenoma (n=14), borderline ovarian tumor (n=4), hydrosalpinx (n=4), serous adenocarcinoma of the salpinx (n=1), and ectopic pregnancy (n=1). Two cases required an additional trocar for adhesiolysis of severe pelvic adhesion. No major intraoperative or postoperative complications occurred. CONCLUSIONS Our results suggest that LESS is a safe and feasible alternative to conventional laparoscopic surgery for the treatment of adnexal tumors.

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.

The safety of conization in the management of adenocarcinoma in situ of the uterine cervix

Objective To evaluate the occurrence of residual or recurrent disease after conization for adenocarcinoma in situ (AIS) of the uterine cervix. Methods Medical records of 99 patients with a histologically diagnosis of AIS of the uterine cervix by conization between 1991 and 2008 were reviewed retrospectively. Results Seventy eight of 99 patients (78.8%) had negative and 18 (18.2%) had positive resection margins of the conization specimen, and 3 (3.0%) had unknown margin status. Of the 78 patients with negative margins, 45 underwent subsequent hysterectomy and residual AIS were present in 4.4% (2/45) of patients. Ten of the 18 patients with positive margins received subsequent hysterectomy and 3 patients (30%) had residual AIS. Twenty-eight patients had conservative treatment and during the median follow-up time of 23.5 months (range, 7 to 124 months), only one patient (3.6%) had recurrent AIS and was treated with a simple hysterectomy. Eight patients became pregnant after conization, 4 of them delivered healthy babies, one had a spontaneous abortion and 3 were ongoing pregnancies. Conclusion Patients with positive resection margins after conization for AIS of the uterine cervix are significantly more likely to have residual disease. However, negative resection margin carries a lower risk for residual AIS, therefore conservative management with careful surveillance seems to be feasible in women who wish to preserve their fertility.

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.