Un Suk Jung

Prognostic value of total lesion glycolysis measured by 18F-FDG PET/CT in patients with locally advanced cervical cancer

AimThe aim of this study was to determine the most relevant parameters of fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) for predicting recurrence in patients with locally advanced cervical cancer. Materials and methodsFifty-six patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IVA cervical cancer who underwent 18F-FDG PET/CT before definitive chemoradiotherapy were retrospectively enrolled. Various PET parameters, namely, maximum standardized uptake value, mean standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor, were analyzed to evaluate the relationship between these PET parameters and recurrence-free survival (RFS). The cut-off values of PET parameters that showed the best trade-off between sensitivity and specificity for RFS were determined by receiver operating characteristic curve analysis. ResultsThe median follow-up was 20 months (range, 6–63 months). Univariate analysis indicated that higher FIGO stage [hazard ratio (HR) 5.606, 95% confidence interval (CI) 1.682–18.68, P=0.005], metabolic tumor volume more than 47.81 cm3 (HR 6.203, 95% CI 1.351–28.481, P=0.019), and TLG more than 215.02 (HR 11.817, 95% CI 1.518–91.963, P=0.018) were associated with RFS. In multivariate analysis, FIGO stage (HR 4.618, 95% CI 1.295–16.463, P=0.018) and TLG more than 215.02 (HR 10.171, 95% CI 1.246–83.044, P=0.030) were independent predictive factors for RFS. Kaplan–Meier curves for RFS indicated that patients with TLG less than or equal to 215.02 showed better RFS (P=0.003). ConclusionPretreatment TLG proved to be an independent prognostic factor for RFS in patients with locally advanced cervical cancer treated by definitive chemoradiotherapy.

Dedifferentiated Endometrioid Adenocarcinoma of the Uterus: Highly Aggressive and Poor Prognostic Tumor

Dedifferentiated endometrioid adenocarcinoma (DEAC) is a recently described, rare uterine neoplasm containing both low-grade endometrioid adenocarcinoma and undifferentiated carcinoma.1 Undifferentiated carcinoma in DEAC may originate secondary to transformation or dedifferentiation of low-grade endometrioid adenocarcinoma and appears to be more aggressive than endometrial endometrioid adenocarcinoma.2 The undifferentiated component in DEAC can be misdiagnosed as the solid component of grade 3 endometrioid adenocarcinoma.3 Therefore, accurate diagnosis of this neoplasm is important in treatment and prognosis. Here we report a case of DEAC of the uterus.

CXCL11 mediates TWIST1-Induced angiogenesis in epithelial ovarian cancer

To investigate the role of TWIST1 in tumor angiogenesis in epithelial ovarian cancer and to identify key molecules involved in angiogenesis. TWIST1 small interfering RNA was transfected into A2780 cells, while a complementary DNA vector was transfected into non-malignant human ovarian surface epithelial cells to generate a TWIST1-overexpressing cell line. To evaluate how this affects angiogenesis, human umbilical vein endothelial cell tube formation assays were performed using the control and transfected cell lines. An antibody-based cytokine array was used to identify the molecules involved in TWIST1-mediated angiogenesis. After knockdown of TWIST1 via transfection of TWIST1 small interfering RNA into A2780 cells, the number of tubes formed by human umbilical vein endothelial cells significantly decreased in a tube formation assay. In a cytokine array, TWIST1 downregulation did not significantly decrease the secretion of the common pro-angiogenic factor, vascular endothelial growth factor, but instead inhibited the expression of the CXC chemokine ligand 11, which was confirmed by both an enzyme-linked immunosorbent assay and western blotting. In contrast, TWIST1 overexpression resulted in increased secretion of CXC chemokine ligand 11. Conversely, CXC chemokine ligand 11 downregulation did not inhibit the expression of TWIST1. Furthermore, the ability of TWIST1-expressing A2780 cells to induce angiogenesis was found to be inhibited after CXC chemokine ligand 11 knockdown in a tube formation assay. TWIST1 plays an important role in angiogenesis in epithelial ovarian cancer and is mediated by a novel pro-angiogenic factor, CXC chemokine ligand 11. Downregulation of CXC chemokine ligand 11 can inhibit tumor angiogenesis, suggesting that anti–CXC chemokine ligand 11 therapy may offer an alternative treatment strategy for TWIST1-positive ovarian cancer.

Feasibility and efficacy of laparoscopic restaging surgery for women with unexpected ovarian malignancy.

OBJECTIVE To evaluate the feasibility, surgical outcomes and complications of laparoscopic restaging surgery for women with unexpected ovarian malignancy. STUDY DESIGN We conducted a retrospective chart review of 14 women with unexpected ovarian malignancy who underwent laparoscopic restaging surgery including peritoneal washing cytology, laparoscopic pelvic and paraaortic lymphadenectomy up to the left renal vein level, omentectomy, and multiple peritoneal biopsies, and hysterectomy except three fertility saving surgery. RESULTS The median age and median body mass index women were 49 years (range, 22-63) and 24.2m/kg(2) (range, 18.9-25.3), respectively. The median operating time was 230min (range, 155-370). The median numbers of harvested pelvic and paraaortic lymph nodes were 26 (range, 6-41) and 18 (range, 2-40), respectively. The median return of bowel activity was 28h (range, 21-79). Four of the women were upstaged from the initial presumed stage. There were two intraoperative complications, laceration of the inferior vena cava and cisterna chyli rupture. There was one postoperative complication, port-site metastasis. There was no conversion to laparotomic surgery. The median follow-up period was 33 months. Thirteen of the patients have no evidence of recurrences, however one patient died after 22 months after the surgery. CONCLUSION Laparoscopic restaging surgery, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in the management of unexpected ovarian malignancies.

Analysis of Pregnancy Outcomes among Interracial Couples in Korea

Although the prevalence of interracial marriages in Korea is increasing, little is known regarding the pregnancy outcomes of interracial couples. The aim of this study was to investigate the differences in pregnancy outcomes between Korean and interracial Korean-foreign couples. Data for infants born in 2011 and 2012 were obtained from the national birth registry of the Korean Statistical Office. The couples were subdivided into Korean father-Korean mother, Korean father-foreign mother, and foreign father-Korean mother groups. Pregnancy outcomes included neonates with low birth weight (< 2,500 g) and those with high birth weight (> 4,000 g). In 2010 and 2011, 888,447 Korean father-Korean mother, 36,024 Korean father-foreign mother, and 4,955 foreign father-Korean mother neonates were delivered in Korea. After adjustment for parental age, educational level, parity, gestational age at delivery, and neonatal sex, the birth weights were found to be different between groups, with the highest number of foreign father-Korean mother and lowest number of Korean father-foreign mother pregnancies. Based on multivariate logistic regression analysis, the risk of low and large birth weights was higher in the Korean father-foreign mother and foreign father-Korean mother groups, respectively, compared with that in the Korean father-Korean mother group. There are significant differences in pregnancy outcomes including birth weights between Korean and interracial Korean-foreign couples.

Laparoscopic treatment of Castleman's disease in a patient with a history of malignant Brenner tumor.

Castlemans disease (CD) is a rare, atypical, lymphoproliferative disease of unknown etiology. The most common location for CD is the mediastinum (63%) [1]. A retroperitoneal location has been reported in 7% of patients, with only 2% of cases involving the pararenal region [2]. For this reason, CD located in the retroperitoneum is difficult to differentiate from other benign or malignant lesions. Here, we report a patient with CD located in the anterior lower pole of the right kidney who had been diagnosed with a malignant Brenner tumor after hysterectomy. A 56-year-oldwoman visited our hospital with a chief complaint of a growing abnormal retroperitoneal mass. She had undergone a total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) due to a malignant Brenner tumor at another university hospital 3 months previously. Baseline serum levels of CA-125 and CA 19-9 were normal (5.59 U/mL and 8.11 U/ mL, respectively). An abdominal computed tomography (ACT) scan revealed a 3.0-cm nodule in the anterior lower pole of the right kidney that had been visualized by ACT prior to the TAH and BSO. The mass had increased in size over the course of 3 months (Figure 1). No distant metastases or other abnormal findings were noted on ACT. We suspected that the mass was a metastatic lymph node and performed laparoscopic retroperitoneal removal. The patient was placed in the dorsolithotomy position, and four ports were used for the procedure (Figure 2). The first assistant gradually rotated the telescope 180 clockwise from the pelvic