중복자궁에 동반된 폐쇄 편측 질 및 동측 신장 무발생 증례 보고 6 예

주관영,배덕호,이영아,임정은,양광문,채난희,강옥림 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7

저자들은 일측 질폐쇄와 신장 무발생을 동반한 중복자궁 환자 6예를 경험하였기에 문헌적 고찰과 함께 보고 하는 바이며 사춘기 소녀에서 골반통이 있는 경우 항상 선천성 자궁기형에 대한 개념을 갖고 평가를 하는 것이 중요할 것으로 사료된다. Uterus didelphys is occasionally associated with obstructed hemivagina, and ipsilateral renal agenesis. The specific association was recognized as early as 1992. Since the report,these cases have been reported in the world literature. Medline search revealed, limited number of cases were reported. Early diagnosis is important, to preserve fertility, to prevent pelvic adhesion due to continued retrograde menstruation, hematometra, hematosalpinx and endometriosis which lead to genital organ injury. Common symptom triad with these patients is (1) dysmenorrhea that begins shortly after menarche, (2) increasing severity of dysmenorrhea with each subsequent period, and (3) a unilateral pelvic mass. Early diagnosis and prompt treatment are necessary to prevent genital tract injury, if patients complain above symptoms. The aims of treatment are relief of symptoms and reserve fertility. We report six cases of uterus didelphys associated with an obstructed hemivagina and ipsilateral renal agenesis with a brief review of concerned literatures.

난소가 적출된 임신성 융모성 질환에서 고원정체를 보인 p-hCG의 완전관해에 관한 증례

김태진,현우영,심재욱,이기헌,정환욱,강옥림,함경렬,이문섭,임경택,박종택,박인서 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.2

Although chemotherapy remains to be the mainstay of treatment of trophoblastic disease, hysterectomy has been performed as the primary management of nonmetastatic trophoblastic disease who desire sterilization and for uterine disease resistant to chemotherapy. Clinically, the documentation of disease regression is provided by serial quantitative serum β-hCG assays and the persistent disease may be indicated when the serum β-hCG values rise for 2 weeks or plateau for 3 weeks or more. Because of similarity in molecular structure, the confounding effect of an elevated LH on β-hCG assessment in castrated women after treatment for trophoblastic disease has been documented. This LH cross-reactivity may be suspected in women with bilateral oophorectomy demonstrating persistent low levels of β-hCG. It is particularly true when the assay is perfo-rmed by conventional polyclonal radioimmunoassay. We have experienced two cases of nonmetastatic trophoblastic disease whose serum β-hCG assay plateaued at a low level atotal abdominal hysterectomy with bilateral salpingo-oophorectomy and chemotherapy. Clinical and radiologic work-ups were done for metastatic lesion in dose patients, but the results were negative. The quantitative LH assays (Serono LH MAIAclone kit, Roma, Italy) were performed with the sera obtained from the patients; the results were 37 and 31 mIU/ml (1st IRP) with β-hCG of 14 and 13 mIU/ml (1st IRP), respec-tively. With the initiation of oral estrogen replacement thrapy to those patients, the quantitative β-hCG values fell below 5 mIU/ml (1st IRP) and they remained in complete chemical remission without any additional chemotherapy for one year. The persistant low titers of β-hCG in those patients were considered to be result of LH cross-reactivity on β-hCG assessment. It is concluded that whenever the assay of β-hCG shows persistent low titers in the oophorectomized patient for treatment of trophoblastic disease, LH cross-reactivity should be suspected.

자궁경부 세포진검사에서 저등급 편평상피내 병변 (low grade squamous intraepithelial lesion)을 지닌 여성의 임상적 고찰

김태진,심재욱,이영아,박종택,정환욱,박인서,임경택,이기헌,김희숙,강옥림,함경렬 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.2

The purpose of this study was for clinical evaluating those women with low grade squamous intraepithelial lesions (LSIL) who have been detected on Pap smears. We analyzed 279,270 Pap smears, from January 1994 to August 1997, of which 703 cases were identified as LSIL, and their medical records were reviewed retrospectively. Among them, 616 cases were able to follow-up by altered methods (repeated Pap smear only vs. histologic examination) and their efficacy for detecting more significant lesion (high grade squamous intraepithelial lesion: HSIL or invasive cancer) were also compared. The results were as follows; 1. The frequency of LSIL on Pap smears was approximately 0.25%. 2. The mean age was 39 years (range 18 ∼70 years). 3. Most of the gross finding of the cervix were normal or mild erosion. 4. Most of symptom was asymptomatic, or nonspecific. 5. Eighty-seven women with LSIL on initial Pap smears, have performed repeated Pap smears. 74 (85.1%) was normal, 7 (8.0%) was ASCUS, 6 (6.9%) was LSIL. Remained 52 women had subsequently histologic examination such as colposcopic directed biopsy or cone knife biopsy. These histologic results showed 192 (36.3%) with normal, 258 (48.8%) with LSIL, 77 (14.6%) with HSIL, 2 (0.4%) with microinvasive carcinoma. Based on the results in this study, we emphasize the importance of regular screening procedures for early detection of cervical lesions because there was no specific clinical characteristics in women with cytologic diagnosis of LSIL. In addition, we recommened colpo-scopic directed biopsy or cone knife biopsy as follow-up evaluation method in women with LSIL on initial Pap smear for detecting more significant cervical lesion.

자궁경부 미세침윤암의 진단 및 치료에 관한 고찰

김태진,심재욱,박인서,임경택,이기헌,박종택,노성훈,송하균,안현경,함경렬,강옥림,전종수 대한부인종양 콜포스코피학회 1997 Journal of Gynecologic Oncology Vol.8 No.2

Microinvasive carcinoma of the uterine cervix(FIGO stage IA) has been reported as highly curable disease even with conservative surgery such as conization and simple hysterectomy. Nevertheless, the surgical management for microinvasive carcinomas has been proposed varying from conservative surgery to radical hysterectomy with pelvic nodes dissection according to different diagnostic criterias for microinvasive carcinoma. We reviewed 512 patients who had been diagnosed as microinvasive carcinoma of the uterine cervix at the Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center from Jan. 1988 to Dec. 1995. Among them, 376 patients were included in this study satisfying guided criterias such as proper management and follow up more than at least one year, and they were analyzed retrospectively based on the clinicopathologic characteristics, pattern of surgical management and postoperative status. The majority of patients were diagnosed at 4th and 5th decades of their lives(271/376, 72.1%). The main presenting symptoms were abnormal vaginal bleeding including postcoital spotting and leukorrhea, but considerable numbers of patients were asymptomatic(108/376, 28.7%). The majorities of patients had findings of erosion and inflammation in the cervix, but grossly normal appearing cervices were encountered in considerable numbers(97/376, 25.8%). Satisfactory colposcopic evaluations for abnormal findings were observed in 145 cases among 164 colposcopically examined patients. Abnormal findings such as aceto-white epitherium, erosion, mosaicism, atypiacal vessels were frequently observed. Overall diagnostic accuracy of Pap smear and colposcopically directed biopsies were 59.3% and 61.6%, respectively. Significant correlations were statistically observed between the rates of diagnostic accuracy and the depth of stromal invasion. Findings of positive lymph-vascular space invasion and confluent pattern of invasion were observed in 8.2% and 16.2% of cases, respectively. Both findings were observed more frequently in advanced depth of stromal invasion with statistical significance. The findings of positive lymph-vascular space invasion and/or confluent pattern of invasion in conized specimens with negative margin were also significantly correlated with relation to residual lesion in the hysterectomy specimens. The surgical managements were performed varying from conization to radical abdominal hysterectomy with pelvic nodes dissections. The conservative surgeries were performed in 218 cases and there were tendenciesnto perform conservative surgery in cases which correspond to SGO or JSOG criterias for microinvasive carcinoma. No positive node was observed in 1,294 pelvic lymph nodes dissected. There was no case of surgery-related death in this series. Including one case of central recurrence, 8 cases required postoperative treatment due to occult lesions. Among them, 5 cases did not correspond to JSOG criteria for microinvasive carcinoma and another 2 cases had positive cone margin. Accordingly we emphasized again the significance of the regular screening procedures for early detection of cervical lesions and liberal use of diagnostic conization in suspected microinvasive carcinoma cases to evaluate the exact pathologic characteristics. In addition, we suggest the JSOG criteria as a criteria for conservative surgery in microinvasive carcinoma based on the results in this study.