Bilateral salpingectomy to reduce the risk of ovarian/ fallopian/peritoneal cancer in women at average risk: a position statement of the Korean Society of Obstetrics and Gynecology (KSOG)

( Miseon Kim ),( Young-han Kim ),( Yong Beom Kim ),( Jayeon Kim ),( Jae-weon Kim ),( Mi Hye Park ),( Joo Hyun Park ),( Jeong Ho Rhee ),( Myong Cheol Lim ),( Joon-seok Hong ) 대한산부인과학회 2018 Obstetrics & Gynecology Science Vol.61 No.5

Based on the current understanding of a preventive effect of bilateral salpingectomy on ovarian/fallopian/peritoneal cancers, the Korean Society of Obstetrics and Gynecology, Korean Society of Gynecologic Endocrinology, Korean Society of Gynecologic Oncology, Korean Society of Maternal Fetal Medicine, and Korean Society for Reproductive Medicine support the following recommendations: · Women scheduled for hysterectomy for benign gynecologic disease should be informed that bilateral salpingectomy reduces the risk of ovarian/fallopian/peritoneal cancer, and they should be counseled regarding this procedure at the time of hysterectomy. · Although salpingectomy is generally considered as a safe procedure in terms of preserving ovarian reserve, there is a lack of evidences representing its long-term outcomes. Therefore, patients should be informed about the minimal potential of this procedure for decreasing ovarian reserve. · Prophylactic salpingectomy during vaginal hysterectomy is favorable in terms of prevention of ovarian/fallopian/ peritoneal cancer, although operation-related complications minimally increase with this procedure, compared to the complications associated with vaginal hysterectomy alone. Conversion to open or laparoscopic approach from vaginal approach to perform prophylactic salpingectomy is not recommended. · Women who desire permanent sterilization at the time of cesarean delivery could be counseled for prophylactic salpingectomy before surgery on an individual basis.

난소-자궁부속기 종괴: 다중기법 MR 영상의 임상 적용과 O-RADS MRI

Eom So Young,Rha Sung Eun 대한영상의학회 2021 대한영상의학회지 Vol.82 No.5

초음파에서 우연히 접하는 자궁부속기 병변은 양성 병변이 더 흔하지만, 일부는 악성도가 애매한 병변으로 간주되어 추가적인 평가를 위해 다중매개변수 MRI가 필요하다. 고식적 MRI 를 통해 해부학적 모양을 살피고, 지방, 출혈, 섬유성 조직, 고형성 조직 등 병변의 구성성분을 파악하여 많은 양성 종괴들을 정확하게 진단할 수 있다. 또한 추가적인 확산강조영상과역동적 조영증강 기법의 관류영상으로 양성과 악성의 감별 진단 정확도를 높일 수 있다. 최근 자궁부속기 종괴의 악성 위험도를 평가하고, 각 위험도 군에 대한 적절한 조치를 권고하는데 있어 표준화된 의사소통이 가능하도록 하기 위해 난소-자궁부속기 MRI 보고 및 자료시스템(ovarian-adnexal reporting and data system MRI; 이하 O-RADS MRI)이 발표되었다. 본 종설에서는 자궁부속기 종괴의 악성도 예측 및 감별 진단을 위한 다중매개변수 MRI 의 임상 적용과 O-RADS MRI에 대하여 기술하고자 한다. Incidental adnexal masses considered indeterminate for malignancy are commonly observed on ultrasonography. Multiparametric MRI is the imaging modality of choice for the evaluation of sonographically indeterminate adnexal masses. Conventional MRI enables a confident pathologic diagnosis of various benign lesions due to accurate tissue characterization of fat, blood, fibrous tissue, and solid components. Additionally, functional imaging sequences, including perfusion- and diffusion-weighted imaging, improve the diagnostic efficacy of conventional MRI in differentiating benign from malignant adnexal masses. The ovarian-adnexal reporting and data system (O-RADS) MRI was recently designed to provide consistent interpretations in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. In this review, we describe the clinical application of multiparametric MRI for the evaluation of adnexal masses and introduce the O-RADS MRI risk stratification system.

Pedunculated mucinous cystic neoplasm of the liver: a case report

Sang-Woo Ha,Shin Hwang,Hyejin Han,Song Ie Han,Seung Mo Hong 영남대학교 의과대학 2022 Yeungnam University Journal of Medicine Vol.39 No.3

In 2010, the World Health Organization classified mucin-producing bile duct tumors of the liver into two distinct entities; mucinous cystic neoplasm of the liver (MCN-L) and intraductal papillary mucinous neoplasm of the bile duct. We present the case of a patient with MCN-L having a uniquely pedunculated shape. A 32‐year‐old woman was referred to our institution with a diagnosis of biliary cystic neoplasm. She had undergone left salpingo-oophorectomy for ovarian cancer 15 years ago. Imaging studies showed an 8 cm-sized well defined, multiloculated cystic lesion suggesting a mucinous cystic neoplasm. The cystic mass was pedunculated at the liver capsule and pathologically diagnosed as MCN-L. The mass was resected with partial hepatectomy. The patient recovered uneventfully. She was discharged 7 days postoperatively. The patient has been doing well for 6 months after the operation. The patient will be followed up annually because of the favorable postresection prognosis of MCN-L.

상피성 난소종양에서 MTA1 발현에 관한 연구

윤만수 ( Man Soo Yoon ),장성규 ( Sung Kyu Jang ),이동형 ( Dong Hyung Lee ),김기형 ( Ki Hyung Kim ),나용진 ( Yong Jin Na ),김활웅 ( Hwal Woong Kim ),김지연 ( Jee Yeon Kim ),최경운 ( Kyung Un Choi ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.7

목적: 상피성 난소종양을 대상으로 조직배열법을 이용한 면역조직화학염색을 실시하여 여러 임상병리학적 인자에 따른 MTA1발현의 상관관계를 알아보고자 하였다. 연구 방법: 양성 종양 53예, 경계성 종양 27예, 악성 종양 68예를 대상으로 면역조직화학염색을 시행하여 MTA1의 발현을 판정하였고, 악성 종양의 여러 임상병리학적 인자에 따른 MTA1의 발현의 차이를 분석하였다. 결과: 종양의 악성도 등급별 MTA1 염색의 성적은 악성도가 높을 수록 MTA1의 고발현 예가 많고 양성 종양에서는 저발현 예가 많아 유의한 차이를 보였고, 종양의 병기가 높을 수록 MTA1의 발현이 증가하였으며, 특히 원격전이를 보이는 4기의 경우 모두가 고발현군이었다. 그 외 환자의 나이, 조직학적 분류, 종양의 크기에 따른 MTA1 발현 정도에는 유의한 차이는 없었다. 결론: 이러한 결과들을 토대로 난소종양에서 MTA1은 종양의 침습과 공격성을 결정하는 주요한 인자일 것으로 추측할 수 있었으며 난소암의 치료나 예후에 중요한 정보를 제공할 수 있을 것으로 사료된다. Objective: MTA1 has been identified as a metastasis-promiting gene, and its gene expression is correlated with invasion and metastasis in several cancers. We examined MTA1 expression levels in epithelial ovarian neoplasm. Methods: Expression of MTA1 was evaluated by immunohistochemistry and tissue array in 53 benign tumors, 27 borderline tumors and 68 malignant tumors. The data was analyzed in reference to various clinicopathological parameters. Results: Increased expression of MTA1 was significantly correlated with histologic grade and FIGO stage. There was no relationship between MTA1 expression and age, histologic type, tumor size. Conclusion: These results suggest that MTA1 is closely related to invasiveness and progression in epithelial ovarian neoplasm. The MTA1 could thus potentially provide information on the mechanism of cancer invasion and metastasis.

Urothelial (Transitional Cell) Carcinoma Arising in Mature Cystic Teratoma - A Case Report -

이호창,이옥준 대한병리학회 2010 Journal of Pathology and Translational Medicine Vol.44 No.6

Mature cystic teratoma (MCT) is one of the most common benign ovarian tumors, but 1-2% of MCTs are transformed to a malignant neoplasm. Urothelial carcinoma (UC) or transitional cell carcinoma is the most common cancer in the urinary tract. However, UC is a very rare component of transformed malignancy of MCT. Here we report a case of UC arising in an MCT in a 52-year-old woman. Grossly, the ovary was partly cystic and partly solid. Microscopically, the cyst revealed the classic features of MCT and the solid area was papillary UC. By immunohistochemistry using cytokeratins and thrombomodulin, the UC showed a similar expression to that of UC arising in the urinary tract, rather than resembling a primary transitional cell carcinoma of the ovary. When UC is found in a component of MCT, the origin of the carcinoma should be evaluated and urinary tract examinations are required to rule out metastasis.

AGR2, a mucinous ovarian cancer marker, promotes cell proliferation and migration

이제호,Kyoungsook Park,Yong Jin Chung,Hyekyung So,김광수,박준수,Mijoung Oh,Minwha Jo,Kyusam Choi,이은주,Yoon-La Choi,Sang Yong Song,배덕수,김병기 생화학분자생물학회 2011 Experimental and molecular medicine Vol.43 No.2

Ovarian cancer is a leading cause of death in women. Early detection of ovarian cancer is essential to decrease mortality. However, the early diagnosis of ovarian cancer is difficult due to a lack of clinical symptoms and suitable molecular diagnostic markers. Thus,identification of meaningful tumor biomarkers with potential clinical application is clearly needed. To search for a biomarker for the early detection of ovarian cancer,we identified human anterior gradient 2 (AGR2)from our systematic analysis of paired normal and ovarian tumor tissue cDNA microarray. We noted a marked overexpression of AGR2 mRNA and protein in early stage mucinous ovarian tumors compared to normal ovarian tissues and serous type ovarian tumors by Western blot analysis and immunohistochemistry. To further elucidate the role of AGR2 in ovarian tumorigenesis,stable 2774 human ovarian cancer cell lines overexpressing AGR2 were established. Forced expression of AGR2 in 2774 cells enhanced the growth and migration of ovarian cancer cells. AGR2 protein was detected in the serum of mucinous ovarian cancer patients by Western blot and ELISA analysis. Thus,AGR2 is a potential biomarker for the diagnosis of mucinous ovarian cancer and an ELISA assay may facilitate the early detection of mucinous ovarian cancer using patient serum.

AGR2, a mucinous ovarian cancer marker, promotes cell proliferation and migration

Park, Kyoung-Sook,Chung, Yong-Jin,So, Hye-Kyung,Kim, Kwang-Soo,Park, Jun-Soo,Oh, Mi-Joung,Jo, Min-Wha,Choi, Kyu-Sam,Lee, Eun-Ju,Choi, Yoon-La,Song, Sang-Yong,Bae, Duk-Soo,Kim, Byoung-Gie,Lee, Je-Ho Korean Society for Biochemistry and Molecular Bion 2011 Experimental and molecular medicine Vol.43 No.2

Ovarian cancer is a leading cause of death in women. Early detection of ovarian cancer is essential to decrease mortality. However, the early diagnosis of ovarian cancer is difficult due to a lack of clinical symptoms and suitable molecular diagnostic markers. Thus, identification of meaningful tumor biomarkers with potential clinical application is clearly needed. To search for a biomarker for the early detection of ovarian cancer, we identified human anterior gradient 2 (AGR2) from our systematic analysis of paired normal and ovarian tumor tissue cDNA microarray. We noted a marked overexpression of AGR2 mRNA and protein in early stage mucinous ovarian tumors compared to normal ovarian tissues and serous type ovarian tumors by Western blot analysis and immunohistochemistry. To further elucidate the role of AGR2 in ovarian tumorigenesis, stable 2774 human ovarian cancer cell lines overexpressing AGR2 were established. Forced expression of AGR2 in 2774 cells enhanced the growth and migration of ovarian cancer cells. AGR2 protein was detected in the serum of mucinous ovarian cancer patients by Western blot and ELISA analysis. Thus, AGR2 is a potential biomarker for the diagnosis of mucinous ovarian cancer and an ELISA assay may facilitate the early detection of mucinous ovarian cancer using patient serum.

Ovarian cancer screening in menopausal females with a family history of breast or ovarian cancer

Tiffany Lai,Bruce Kessel,Hyeong Jun Ahn,Keith Y. Terada 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.4

Objective: To determine whether annual screening reduces ovarian cancer mortality in women with a family history of breast or ovarian cancer. Methods: Data was obtained from the Prostate, Lung, Colorectal, and Ovarian cancer trial, a randomized multi-center trial conducted to determine if screening could reduce mortality in these cancers. The trial enrolled 78,216 women, randomized into either a screening arm with annual serum cancer antigen 125 and pelvic ultrasounds, or usual care arm. This study identified a subgroup that reported a first degree relative with breast or ovarian cancer. Analysis was performed to compare overall mortality and disease specific mortality in the screening versus usual care arm. In patients diagnosed with ovarian cancer, stage distribution, and survival were analyzed as a secondary endpoint. Results: There was no significant difference in overall mortality or disease specific mortality between the two arms. Ovarian cancer was diagnosed in 48 patients in the screening arm and 44 patients in the usual care arm. Screened patients were more likely to be diagnosed at an earlier stage than usual care patients. Patients in the screening arm diagnosed with ovarian cancer experienced a significantly improved survival compared to patients in the usual care arm; relative risk 0.66 (95% CI, 0.47 to 0.93). Conclusion: Screening did not appear to decrease ovarian cancer mortality in participants with a family history of breast or ovarian cancer. Secondary endpoints, however, showed notable differences. Significantly fewer patients were diagnosed with advanced stage disease in the screening arm; and survival was significantly improved. Further investigation is warranted to assess screening efficacy in women at increased risk.

소아기 및 청소년기의 난소 종양에 대한 임상적 연구

황희정,정희정,정은하,고지경,조용균,김복린,최훈 인제대학교 2007 仁濟醫學 Vol.28 No.-

Objective : The purpose of this study was to review the clinical presentation, size, prevalence, tumor marker, treatment, outcomes and histopathologic findings of ovarian neoplasmas in childhood and adolescence. Methods and Materials : Medical recordings of 155 patients aged 20 years or less with adnexal mass diagnosed at the Sanggye Paik Hospital from Jan. 1997 through Dec. 2006 were reviewed retrospectively Results : The mean age of patients was 16.9±2.8 years. Abdominal pain is the most frequent symptom. The mean diameter of ovarian tumor was 12.9±8.5㎝. The number of benign ovarian tumors were 141 cases(88.7%) and the number of malignant or borderline ovarian tumors were 18 cases(11.3%). According to histopathological classification of malignant or borderline ovarian tumors, germ cell tumors were 11 cases(61.1%) and epithelial cell tumors were 7 cases(38.9%). The mean value of preoperative serum CA125 levels was 39.6±26.6 U/mL in the benign group, and 136.3±117.2 U/mL in the malignant group. According to FIGO classification of malignant or borderline ovarian tumors, most patients (17 cases) were stage Ⅰ and only one patient was stage Ⅲ. Most patients underwent unilateral salpingo-oophorectomy in an attempt for reproductive organ conservation, one case of stage Ⅲ disease was treated with hysterectomy, bilateral salpingo-oophorectomy and omentectomy. On follow up, all 18 patients survived between 5 months and 9 years 11 months after treatment. Conclusion : The proportion of malignant or borderline neoplasms in childhood and adolescence group was 11.3%. Because of the potential for malignant ovarian neoplasm in this age group, the presence of ovarian neoplasms requires prompt evaluation and treatment.

Cut-off value of D-dimer for prediction of deep venous thrombosis before treatment in ovarian cancer

Ryuji Kawaguchi,Naoto Furukawa,Hiroshi Kobayashi 대한부인종양학회 2012 Journal of Gynecologic Oncology Vol.23 No.2

Objective: The purpose of the present study was to elucidate the incidence of deep venous thrombosis (DVT) before treatment in ovarian cancer and the appropriate cut-off value of D-dimer (DD) for the diagnosis of DVT. Methods: Between July 2007 and October 2008, eighty seven patients with presumed ovarian cancer (final diagnosis: ovarian cancer, n=59; borderline malignancy, n=28) were enrolled. Measurement of DD levels and subsequent venous ultrasonography were performed before treatment. Results: The mean DD level was 4.1 μg/mL. Subsequent venous ultrasonography revealed DVT in 14 of 87 (16.1%) patients (ovarian cancer, 12 cases; borderline malignancy, 2 cases). None were found to have developed DVT if they had a DD level of <1.5 μg/mL. If 1.5 μg/mL was used as a cut-off value for DD levels to diagnose DVT, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 61.6%, 33.3%, and 100%. There was noclinical onset of postoperative pulmonary thromboembolism. Conclusion: Our data suggest that presumed ovarian cancer patients with at least more than 1.5 μg/mL should be examined using venous ultrasonogaphy to detect DVT. Objective: The purpose of the present study was to elucidate the incidence of deep venous thrombosis (DVT) before treatment in ovarian cancer and the appropriate cut-off value of D-dimer (DD) for the diagnosis of DVT. Methods: Between July 2007 and October 2008, eighty seven patients with presumed ovarian cancer (final diagnosis: ovarian cancer, n=59; borderline malignancy, n=28) were enrolled. Measurement of DD levels and subsequent venous ultrasonography were performed before treatment. Results: The mean DD level was 4.1 μg/mL. Subsequent venous ultrasonography revealed DVT in 14 of 87 (16.1%) patients (ovarian cancer, 12 cases; borderline malignancy, 2 cases). None were found to have developed DVT if they had a DD level of <1.5 μg/mL. If 1.5 μg/mL was used as a cut-off value for DD levels to diagnose DVT, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 61.6%, 33.3%, and 100%. There was noclinical onset of postoperative pulmonary thromboembolism. Conclusion: Our data suggest that presumed ovarian cancer patients with at least more than 1.5 μg/mL should be examined using venous ultrasonogaphy to detect DVT.