난황낭종으로 변형된 난소의 미분화세포종 : 면역조직화학적 연구

고재환(Jae Whoan Koh),강윤경(Yoon Kyung Kang),김용봉(Yong Bong Kim),이응수(Eung Soo Lee),박성관(Sung Kwan Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

N/A Objective: The purpose of this article is to report mixed germ cell tumor, which revealed changes compatible with early transformation of dysgerminoma to endodermal sinus tumor(EST) through histogenetic considerations and immunohistochemical stains. Methods: Ovarian germ cell tumors were reviewed from files of Dept. Ob/Gyn. Seoul Paik Hospital fiom 1992.1 to 1996.12. Total of 5 cases include 4 pure dysgerminoma and 1 mixed germ cell tumars. All tissues were fixed in 10% neutral buffered formalin and embedded in paraffin and reviewed by two pathologists with immunohistochemical staining for cytokeratin, vimentin, AFP, PCNA, p53 & bc1-2. Results: Grossly, the areas of transformation were located at the middle of the mixed tumor. The outer layer of the tumor mass was filled with typical pure dysgerminoma. They were characterised as the presence of microcysts and small glandular structures in hematoxylin-eosin(H-E) stains with positive stain for vimentin, except the tissue of the EST. The cells in the intermediate layer were characterised as the mixed form of dysgerminomatous and EST structures in H-E stains. AFP in the dysgerminomatous cells in intermediate layer and EST were stained, but not in outer layer. Conclusion: Dysgerminoma may possess the ability to transform to EST. There might be intermediate stage between dysgerminoma and EST, and Immunohistochemical staining for AFP, cytokeratin, vimentin, PCNA also can be used for prognosis of germ cell tumor.

황체기 결함이 있는 불임환자에서 클로미펜 투여 여부에 따른 자궁내막 내의 Prolactin의 발현 양상의 비교 연구

고승희,황정혜,심의섭,고재환,김용봉,장세진,Goh, Seung-Hee,Hwang, Jung-Hye,Sim, Ey-Sub,Koh, Jae-Whoan,Kim, Yong-Bong,Jang, Se-Jin 대한생식의학회 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.1

Objective : Clomiphene citrate is one of the most commonly used drugs in the treatment of infertility, but the pregnancy rate achieved with clomiphene citrate is significantly lower than the ovulation rate due to its antiestrogenic effect on the endometrium. Endometrial prolactin is considered to be a marker and an inducer of predecidualization that is characteristic of secretory endometrium. The purpose of this study was to evaluate the association of clomiphene citrate and unsatisfactory endometrial differentiation to secretory endometrium by examining the endometrial expression of prolactin in clomiphene citratetreated infertile women with luteal phase defect. Methods : The endometrial samples from infertile women with luteal phase defect (n=27) were examined. Five cases during secretory phase and six cases during proliferative phase were obtained by biopsy. Sixteen cases were obtained by biopsy during secretory phase after clomiphene citrate treatment. By immunohistochemical staining for prolactin, all obtained endometrial tissues were examined. The differences in the endometrial expression of prolactin were evaluated between proliferative phase and secretory phase, and between clomiphene citrate treated group and no treatment group during secretory phase. Results: The staining of endometrial prolactin was significantly more intense in the glandular epithelial cells and stromal cells in the secretory endometrium than in the proliferative endometrium. The glandular expression of prolactin in the secretory endometrium was not significantly different between the clomiphene citrate-treated group and no treatment group (p=0.719), but the staining of prolactin in the stromal cells was significantly less intense in the clomiphene citrate-treated group than no treatment group (p=0.019). Conclusion: In this investigation, we demonstrated that the endometrial stromal expression of prolactin in the secretory phase was significantly lower in the clomiphene citrate-treated group campared with no treatment group in infertile women with luteal phase defect. And our finding suggests that clomiphene citrate may have an adverse effect on the endometrial predecidualization in infertile women.

쌍태임신 96례에 대한 임상통계학적 고찰

박준홍 ( June Hong Park ),송훈 ( Hoon Song ),고재환 ( Jae Whoan Koh ),김용봉 ( Yong Bong Kim ),이응수 ( Eung Soo Lee ),박성관 ( Sung Kwan Park ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

Twin pregnancies are interesting because of the greater risk to mother and babies than singleton pregnancies. Clinical evaluation with multiple aspects were made on 96 cases of twin pregnancy in Paik Hospital from Jan 1. 1990 to Dec. 31. 1996. The results were as follows: 1. Number of twin pregnancies were 96 cases among 5,321 deliveries. (l:55.4) 2. The predominant age group of gravida was 26 ~ 30 which covers 52.1% of all and mean age was 28.9 years old. According to parity, most frequent group was nullipara which covers 65.3%. 3. The predominent gestational age group of twin births was 35 ~ 36 weeks and mean gestational weeks of twin births was 35(+3). 4. In presentation, the cephalic-cephalic combination was 50% and the cephalic-breech 41.7%. 5. The maternal complications during pregnancy were anemia(55.2%), toxemia(19.8%), and in labor and postpartum state were uterine dysfunction(9.4%), postpartum hemorrhage(21.6%). 6. The most common mode of twin delivery was cesarean section and its incidence was 65.6%. Its main indications were elective, previous cesareansection, malpresentation and preeclampsia. Vaginal delivery was done in 34.4% of the cases, the first baby was 29.2% in spontaneous delivery and 3.1% in vaccum extraction, and the second baby was 18.7% in spontaneous delivery and 11.5% in breech extraction. 7. The average duration of labor was 7.5hours and second baby was delivered within 5 minutes after first baby delivery, in 85.4% of cases. 8. The birth weight of the first and second baby were 2,173 grams and 2,077 grams, respectively and the former washeaiver by 96 grams. 9. In 64.6% of cases, the type of placenta was diamniotic-monochorionic. 10. Both male was 43.8%, both female was 42.7%, and opposite sex was 13.5% in ingant sex. 11. There were 19 perinatal death, its revealing 9.7% of perinatal mortality rate of twin and the most common cause of perinatal death was prematurity with 84.2%. There was one maternal death due to atonic bleeding, and she refused to be transfused because that her religion was Jehovah`s witness.

자궁내막증에서 aromatase의 발현과 임상적 중등도와의 연관성

이일한 ( Il Han Lee ),김동호 ( Dong Ho Kim ),노지현 ( Ji Hyun Noh ),고재환 ( Jae Whoan Koh ),김용봉 ( Yong Bong Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.4

목적: 본 연구는 자궁내막증 조직, eutopic endometrium 및 정상 자궁내막조직에서의 aromatase 발현율 차이를 알아보고 aromatase 발현군과 비발현군 간의 임상적 중증도의 차이를 알아보고자 시행되었다. 연구 방법: 자궁내막증으로 진단되어 수술을 시행 받은 78명의 환자와 그 중에서 eutopic endometrium의 채취가 가능했던 14명의 환자를 실험군으로 하였고 난소 낭종이나 기능성 자궁 출혈로 소파술 및 자궁 절제술을 시행받은 30명의 환자를 대조군으로 하였다. 각각의 동결 절편한 조직들에서 aromatase를 이용한 면역조직화학염색을 시행하여 aromatase의 발현 정도를 비교하였고 발현 여부에 따라 환자군의 임상 증상, 검사실 소견, 수술 소견을 나누어 비교 분석하였다. 결과: Aromatase는 총 78명의 자궁내막증 조직에서 46명 (59.0%)이 발현 되었다. 이는 eutopic endometrium의 발현율보다 유의하게 높았으며 (P<0.05), eutopic endometrium의 발현율 역시 정상 조직군에 비해 유의하게 높았다 (P<0.05). Aromatase 양성인 환자는 음성인 환자에 비해서 중등도의 만성 골반통 비율, CA-125 수치가 유의하게 높았고 (P<0.05), 수술 소견에서도 중증병기 (P<0.001), 양측성 자궁내막종의 존재 (P<0.05), 근종이나 선근증의 동반 정도가 유의하게 높았다 (P<0.05). 혈중 백혈구수치와 적혈구 침강속도, CA 19-9는 양성군에서 다소 높게 관찰되었으나 통계적 유의성은 보이지 않았다. 결론: 자궁내막증환자에 있어서 eutopic endometrium과 자궁내막증 조직 내의 aromatase 발현은 국소적인 에스트로겐을 형성함으로써 자궁내막증의 발생과 유지에 연관이 있는 것으로 나타났고, aromatase의 발현의 증가는 자궁내막증의 중등도 및 활성도에 중요한 영향을 미치는 것으로 나타났다. Objective: Aromatase is the key enzyme for the conversion of C19 steroids into estrogen in certain human tissues. We studied to evaluate the aromatase expression in eutopic endometirum and endometriotic lesion and its relationship to clinical and laboratory parameters. Methods: The study included 78 cases of endometriotic lesion and 14 cases of eutopic endometrium and 30 cases of normal uterine endometrium obtained through laparoscopic surgery and curettage. The frozen tissue specimens were examined by immunohistochemistry using aromatase. Clinical symptoms, laboratory findings, and operative findings were analyzed and compared in according to aromatase expression. Results: We observed positive immunohistochemical expression for aromatase in endometriotic lesion from 46/78 patients (59.0%). Aromatase expression was elevated in comparison to eutopic endometrium (5/14 patients, P=0.032) and the difference was more pronounced when eutopic endometriums from patients with endometriosis were compared with those of healthy controls (2/30 patients, P<0.001). Aromatase-positive patients had more moderate-to-severe chronic pelvic pain, higher CA-125 level significantly. Also in operative findings, severe grade endometriosis, bilateral endometriomas, and associated leiomyoma and adenomyosis were more frequent in aromatase positive patients. High values of white blood cell count, erythrocyte sedimentation rate, CA 19-9 were more frequent in aromatase positive patients notwithstanding insignificant differences. Conclusion: Unopposed local biosynthesis of estrogens by increased expression of aromatase in eutopic endometrium and endometrial tissue could be involved in the development or maintenance of endometriosis and other uterine estrogen-triggered diseases. Our findings suggest increased expression of aromatase may be related with severity, activity, and chronic pelvic pain in patients with endometriosis.

경계성 난소종양의 복강경수술 후 투관침 부위로 착상된

최자인 ( Ja In Choi ),최희정 ( Hee Jeong Choi ),노지현 ( Ji Hyun Noh ),고재환 ( Jae Whoan Koh ),김용봉 ( Yong Bong Kim ),강윤경 ( Yun Kyung Kang ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.6

Borderline tumor of ovary is epithelial proliferation without stromal invasion, first reported by Taylor in 1929. Borderline ovarian tumor occurs in younger women and is detects in early stage. Laparosocopy is alternative treatment of younger women for postoperative quality of life because it reduces postoperative adhesion. But it is limited to incomplete staging, tumor cell dissemination and recurrence. We report a case of port site implantation of mucinous borderline tumor after the laparoscopic operation; usually recurrence of borderline tumors were occurred after ten or fifteen years later, this case a direct evidence of cause of metastasis after the laparoscopic operation.

갑상선 기능 저하증과 동반된 거대 난소 종양

노지현 ( Ji Hyun Noh ),고승희 ( Seung Hee Goh ),심의섭 ( Ey Sup Shim ),고재환 ( Jae Whoan Koh ),김용봉 ( Yong Bong Kim ),최석구 ( Suk Koo Choi ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.4

In adult women, hypothyroidism has significant effect on reproduction. Hypothyroidism is associated with oligomenorrhea, amenorrhea, anovulation, hypermenorrhea, menorrhagia, infertility, spontaneous abortion, stillbirth or preterm delivery. It can cause

자궁내막증과 progesterone receptor gene polymorphism (PROGINS)과의 연관성에 관한 연구

김윤진(Yun Jin Kim),노지현(Ji Hyun Noh),고재환(Jae Whoan Koh),김용봉(Yong Bong Kim) 대한의학유전학회 2007 대한의학유전학회지 Vol.4 No.2

목적 : 자궁내막증은 유전적 연관성이 명확히 규명되지 않은 에스트로겐 의존성 질환이다. 그 연관성에 대하여 명확히 밝혀진 것은 없으나 일부 유전적 연구 결과들을 살펴보면 자궁내막증이 프로게스테론 수용체 유전자의 특정 다형성 부위와 연관되어 있음을 알 수 있다. 본 연구는 프로게스테론 수용체 유전자의 다형성(PROGINS)을 분석하여 자궁내막증 환자와 대조군에 차이가 있는지를 알고자 고안되었다. 방법 : 수술 및 병리조직 소견에서 자궁내막증을 확진받은 100명의 환자와 건강검진을 시행 받은 일반 인구군 110명을 대상으로 하였다. 대상 환자들의 말초 혈액에서 DNA를 추출한 후 프로게스테론 수용체의 유전자 다형성 검사를 PCR-SSP (Sequence specific primer)방법으로 시행하였고 자궁내막증 환자군과 건강대조군에 있어서 특정 유전자 다형성의 빈도에 차이가 있는지 x² 검정을 통하여 통계 분석하였다. 결과 : 자궁내막증군과 대조군에서 각각 1명에서만 PROGINS 다형성 양상이 T1/T2 이형접합자로 확인이 되었고 나머지 개체에서는 모두 T1/T1 동형접합자임이 확인되었다. 결론 : 자궁내막증과 프로게스테론 수용체의 유전자 다형성(PROGINS)간의 연관성은 밝혀지지 않았으나 대규모의 연구 및 다른 유전자의 연구가 자궁내막증이 병인을 규명하는데 유용할 것으로 생각된다. Purpose: Endometriosis is a steroid dependent disease with a particular genetic background but the location of possible genomic aberrations are still poorly clarified. This study was designed to investigate the associations between the polymorphism of the progesterone receptor gene (PROGINS) and endometriosis. Methods : 100 women with surgically diagnosed and histologically confirmed endometriosis were enrolled as a patient population and a total of 110 female centre subjects undergoing health examination were enrolled as control population. DNA extraction and polymerase chain reaction (PCR) were used to genotype women for the presence of the PROGINS polymorphism in peripheral blood samples. The x2-test was used to compare genotype distributions between endometriosis and controls. Results: T1/T2 heterozygote was found to be one patient in each group, and the rest of the subjects were all T1/T1 homozygotes. There was no difference in the genotype distribution between the endometriosis group and the control group. Conclusion: These results suggest that the progesterone receptor gene PROGINS is not associated with the risk for endometriosis.

복강경하 질식 자궁절제술 후 난소에 발생한 자궁내막증

김호성 ( Ho Sung Kim ),조민형 ( Min Hyung Cho ),노지현 ( Ji Hyun Noh ),고재환 ( Jae Whoan Koh ),김용봉 ( Yong Bong Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.9

임신 중 발생한 소장 폐색

조민형 ( Min Hyung Cho ),김호성 ( Ho Sung Kim ),최자인 ( Ja In Choi ),노지현 ( Ji Hyun Noh ),고재환 ( Jae Whoan Koh ),김용봉 ( Yong Bong Kim ),홍성우 ( Seong Woo Hong ) 대한주산의학회 2008 Perinatology Vol.19 No.2

Small bowel obstruction is an unusual complication of pregnancy, but it is associated with high fetal and maternal mortality. Diagnosis is often delayed due to confusion over symptoms by both the patient and physicians, because symptoms such as colicky abdominal pain, vomiting and constipation are all common at various stages of pregnancy. If is small bowel obstruction of gravid patient suspected, prompt abdominal radiological evaluation and surgical intervention to reduce both maternal and fetal mortality are warranted. We report a recently report a recently experienced case of small bowel obstruction with brief review of literatures.

원발성 난관암

고희은 ( Hee Eun Ko ),노지현 ( Ji Hyun Noh ),강윤경 ( Yun Kyung Kang ),고승희 ( Seung Hee Goh ),고재환 ( Jae Whoan Koh ),김용봉 ( Yong Bong Kim ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.1

Primary carcinoma of the fallopian tube is very rare and accounts for less than 1% of all gynecologic malignancies. Nonspecific symptoms are presented, so primary carcinoma of the fallopian tube was confirmed postoperatively on the basis of the pathologic