Primary Malignant Melanoma of the Vagina

장지영(Ji-Young Jang),김도강(Do-Kang Kim),이은희(Eun-Hee Lee),김준상(Jun-Sang Kim) 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.3

여성의 질에 발생하는 원발성 악성흑색종은 매우 드문 질환으로 알려져 있다. 질의 원발성 흑색종은 피부나 외음부에 발생하는 원발성 흑색종에 비해 매우 빠른 임상경과를 나타낸다. 본 증례는 58세의 폐경기 여자환자로 종양 크기가 비교적 큰 흑색종이 하부질에 있었으며,작은 색소침착된 병변이 자궁경부에 보였다.환자는 수술 적인 처치 없이 통상 분할 외부방사선 조사와 근접방사선 치료 만을 시행하였다. 치료 후 원발병소는 부분관해를 보였으나, 진단 후 4.5개월 만에 다발성 원격전이로 사망하였다. 종양크기가 큰 흑색종이 질에 발생한 경우 방사선치료 단독으로도 만족할만한 국소제어를 보였지만, 본 증례와 같이 종 양 의 크 기가 큰 예에서는 소분할방사선 조사와 수술적인 종양제거로 국소 치료기간을 단축하고, 전신적인 치료를 고려하여 조기에 발생하는 원격전이를 막기 위한 치료가 고려되어야 할 것으로 사료된다. A primary malignant melanoma of the vagina is a very rare gynecological malignant tumor. Its clinical behavior is more aggressive than that of cutaneous and vulvar melanomas. We present a case of a large sized primary melanoma of the lower third of the vagina, with a cervical lesion, in a 58-year-old postmenopausal woman. The patient was treated with conventional external radiation therapy and intracavitary radiotherapy (ICR), without surgical treatment. Although the primary lesion showed a partial response, the patient died of extensive metastases, which were found 4.5 month safter the initial diagnosis. We suggest that shortening the treatment period, such as hypofractionated radiation therapy and surgical removal, and various systemic therapies for preventing early distant metastasis, are appropriate treatments for a primary malignant melanoma of the vagina, with alarge tumor size.

정상 임신과 비정상 임신의 초기 혈중 CA - 125 수치에 관한 연구

노덕영(Duck Yeong Ro),김도강(Do Kang Kim),김수평(Soo Pyung Kim),문희봉(Hee Bong Moon),강규섭(Gyu Sub Kang),황지영(Jee Young Hwang),신봉영(Bong Young Shin),장병우(Byeung Woo Jang) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

N/A A prospective study was initiated to compare maternal serum concentration of CA-125 during the first trimester of normal and abnormal pregnancies. Serum specimens were obtained from 87 women with a normal intrauterine pregnancy and 47 women with abnormal pregnancies which were ended in spontaneo abortion or pathologically confirmed to be missed abortion. In normal pregnancies, the mean serum CA-125 concentrations were increased significantly from amenorhea 6 weeks (139.838.7 IU/ml), and were higher statistically than the values tested in the same weeks of abnormal pregnancies. In abnormal pregnancies serum CA-125 concentations were relatively lower than those of normal pregnancies. But these differences were not statistically significant except the values tested in amenorhea 6weeks. So serum levels of CA-125 may not be proved useful in monitoring of early pregnancies outcome.

자연 유산의 영양배엽에서 LH / CG 수용체 , α 및 β - hCG 의 발현

강대호(Dae Ho Kang),변태섭(Tae Sup Byeun),이수선(Su Sun Lee),이방현(Bang Hyeon Lee),최성권(Song Kwon Choi),류기성(Gi Sung Ryu),오준환(Joon Hwan Oh),신진웅(Jin Woong Shin),김도강(Do Kang Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.10

N/A Objective : To investigate the mechanisms involved in the mRNA expressions of hCG, LH/CG receptor and in hormone secretion in the trophoblast of normal and abnormal early pregnancy. Methods : hCG, free β-hCG, and progesterone concentrations were measured in serum and the mRNA expressions of α,β-hCG and LH/CG receptor were measured in the placental trophoblast of 22 spontaneous abortion patients (spontaneous abortion group), 20 normal pregnancy women (normal pregnancy group) and 6 hydatidiform mole patients (hydatidiform mole group). Results : 1. Mean values of serum hCG and free β-hCG concentrations were the lowest in spontaneous abortion group (46343.63±40404.18 mIU/ml, p<0.001; 31.34±61.57 mIU/ml, p<0.01 respectively) among the three groups. Mean progesterone concentration was the lowest in spontaneous abortion group (11.84±7.60 ng/ml, p<0.01), too. 2. The expression levels of α,β-hCG were the highest in spontaneous abortion group (4.64±5.47, p=0.015; 4.57±4.42 p=0.002 respectively). The expression levels of LH/CG receptor were not different statistically among the three groups and they were high at the 5th week of gestation, reaching nadir at the 10th week of gestation when the concentrations of serum hCG showed peak values in normal pregnancy group. 3. The correlations between serum hCG and progesterone concentrations were positive in both spontaneous abortion (r=0.827, p<0.001) and normal pregnancy (r=0.438, p=0.054) group. Though they were not significant statistically, the correlations between progesterone concentrations and the levels of α,β-hCG expressions were negative in both spontaneous abortion (r=-0.237, p=0.289; r=-0.211, p=0.347) and normal pregnancy (r=-0.270, p=0.250; r=-0.235, p=0.318) group. In hydatidiform mole group, the correlation between progesterone concentrations and the levels of β-hCG expression was positive (r=0.968, p=0.002). Conclusion : Our results suggest that the mechanisms involved in the secretion of hCG, progesterone and the expression of α,β-hCG, LH/CG receptor be normal in spontaneous abortion as in normal pregnancy and in the both groups, hCG stimulate the secretion of progesterone by autocrine function and control the secretion of itself, through the suppression of the expressions of α,β-hCG and LH/CG receptors. So the cause of spontaneous abortion in early pregnancy may be not placental dysfunction but the defect of embryo itself with poor placental growth.

자궁외 근종으로 오인된 회장의 기질 종양 1 예

이수선(Soo Sun Lee),강대호(Dae Ho Kang),최성권(Song Kwon Choi),최윤경(Yoon Kyung Choi),오준환(Joon Hwan Oh),신진웅(Jin Woong Shin),김도강(Do Gang Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.1

Gastrointestinal stromal tumor (GIST) of ileum is a rare tumor of gastrointestial tract that arise from primitive mesenchymal cells. GIST occur predominantly in persons over 40 years of age with an equal sex incidence. GIST expresses a heterogenous clinical course and the most important prognostic factors are tumor size, site, degree of mitotic activity, tumor necrosis. We report a case of GIST of ileum, which was misdiagnosed as extrauterine leiomyoma preoperatively.

자궁경부의 정상 및 종양 조직에서 EGF, TGF-α와 EGFR의 발현

이방현(Bang Hyun Lee),권동진(Dong Jin Kwon),김찬주(Chan Joo Kim),권용일(Yong Ill Kwon),박태철(Tae Chul Park),김진홍(Jin Hong Kim),이진우(Jin Woo Lee),김도강(Do Kang Kim),남궁성은(Sung Eun Namkoong) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.2

본 저자들은 자궁경부 상피 세포의 악성화 과정을 관찰하기 위하여 정상 자궁경부, 자궁경부상피내 종양과 자궁경부암 조직의 각 5예, 18예와 7예에서 면역조직염색법으로 EGF, TGF-α와 EGFR의 발현을 관찰하여 다음과 같은 결과를 얻었다. EGF 발현 양상은 정상 조직 및 CIN의 경우 기저부에서 약한 발현이 관찰되었으며 자궁경부암의 경우는 국소적인 부위에서 중등도의 발현이 관찰되었다. TGF-α 발현 양상은 정상 조직 및 CIN I의 경우 발현이 약했으며 CIN II와 III의 경우는 경도 또는 중등도의 발현이 기저부와 간질부 하부에서 관찰되었고 자궁경부암의 경우는 국소적인 부위에서 경도의 발현이 관찰되었다. EGFR 발현 양상은 정상 조직의 경우는 중등도의 발현이 관찰되었으나 CIN의 경우 질병이 진행함에 따라 발현의 강도가 증가하는 양상을 보였고 자궁경부암의 경우 대부분의 암세포에서 강한 발현이 관찰되었다. 이상의 결과를 볼 때 EGF, TGF-α와 EGFR는 자궁경부 상피 세포의 증식과 악성화 과정에 있어서 일부 관여하리라 생각되나 향후 이에 관한 실험이 좀더 이루어져야 할 것으로 사료된다. Objective : This study seeks to define the expression of epidermal growth factor(EGF) and transforming growth factor(TGF)-α and epidermal growth factor receptor(EGFR), and the relationship to the tumor progression of human cervical epithelial neoplasia. Methods : To confirm the expression of EGF, TGF-α and EGFR immunohistochemically in normal cervix, cervical intraepithelial neoplasms and cervical carcinomas, we used monoclonal antibodies to EGF, TGF-α and EGFR. Results : Immunohistochemical stainings using anti-EGF, anti-TGF-α and anti-EGFR antibodies showed weak or moderate stainings in all cases. Normal and CIN cases showed predominantly basal and parabasal expression of EGF, TGF-α and EGFR, and its expression decreased as the cells became increasingly differentiated toward the surface of the epithelium. In the cervical carcinoma EGF and TGF-α expressed weakly to moderately focally, and EGFR expressed intensely in all malignant cells. Conclusion : These results suggest that EGF, TGF-α and EGFR may involved in cellular proliferation of cervical squamous epithelium and have a significant role in the progression of cervical cancer.

자궁적출술시 발견된 충수돌기 점액낭종

박은경 ( Eun Kyung Park ),서미영 ( Mi Young Seo ),팽기영 ( Ki Young Paeng ),임채춘 ( Chae Chun Rhim ),김도강 ( Do Kang Kim ),남궁성은 ( Sung Eun Namkoong ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9

Mucocele arised at the vermiform appendix is uncommon, either benign or malignancy and their clinical presentation is not specific. The preoperative diagnosis is rare,^1 their diagnosis is an incidental event. Mucocele seems to be developed due to chronic obstruction of the lumen of the appendix. Higa and Cowerkers^2 classified 73 cases of mucocele into three clinicopathologic entities; focal or diffuse mucosal hyperplasia, mucinous cystadenoma, mucinous cystadenocarcinoma. Appendiceal mucoceles are rare lesions of the appendix, characterized by a gross enlargement of the appendix from accumulation of mucoid substance within the lumen. It is encountered in only 01-04% of all appendectomies with a female predominance and an average age at the time of diagnosis over 50 years. A case of appendiceal mucocle found during total hysterectomy is presented with a brief review of the leteratures.

임신 중반기의 무통성 자궁경관 개대에 대한 응급 자궁경관 봉축술의 임상적 의의에 대한 연구

신진웅(Jin Woong Shin),이종승(Jong Seung Lee),문희봉(Hee Bong Moon),안상권(Sang Kwon Ahn),변태섭(Tae Sup Byeun),장병우(Byeung Woo Jang),노덕영(Duck Yeong Ro),김도강(Do Kang Kim),김수평(Soo Pyung Kim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

N/A A retrospective study was conducted to evaluate the clinical outcomes of midtrimester emergency cervical cerclage in patients with painless cervical dilatation with/without prolapsed amniotic sac, including cases of no previous history of cervical incompetence. 10 patients including 1 twin pregnancy were teviewed for study, All had received emergency cervical cerclage with Macdonald operation or Shirodka operation at 18 to 31 weeksgestation. The procedures were carried out without serious complication except for one patient who had received re-operation 3 days after Macdonald operation because of re-protrusion of amniotic sae. The mean procedure to delivery internal was 8.9+5.3 (range 1 to 17) weeks. The mean gestational age at delivery was 32.4+5.6 (range 22 to 39+6) weeks for the entire group, 36.1+2.6 (range 32+4 to 39+6) weeks for the 6 who achived viability, and 27.6+5.0 (range 22 to 29+4) weeks for the 3 who died during the neonatal period. 1 died during gestation and was delivered at 33+6 weeksgestation. The mean birthweight was 2181.6+971.6 (range 498 to 3500)g for the entire group, and 2712.9+ 571.5 (range 1860 to 3500)g for the 7 infants who lived until after neonatal period. The total survival rate for 11 babies was 64%. This study demonstrates that midtrimester emergency cervical cerclage for the patients who have dilated cervix with/without prolapsed amniotic sac is valuable method to try in the cases predicted they would lost the baby with conservative treatment only.