자궁경부 상피내종양 및 침윤성 자궁경부암과 Human Papilomavirus type 16 type 18 DNA 의 상호 연관성에 관한 연구

최동희(DH Choi),박찬규(CK Park),김경섭(KS Kim),김건홍(KH Kim),김윤수(YS Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.9

본 연구에서 우리나라 부인암중 그 빈도가 가장 높은 자궁경부암의 발암인자로소 최근 중요 하게 연구되고 있는 HPV type 16, type 18 DNA와 자궁경부상피내 종양 및 침윤성 자궁경부 암의 연관성에 대해 알아보고자 하였다. 자궁경부 상피내종양 12예, 침윤성 자궁경부암 34예, 자궁경부의 전이성 선암 1예 및 대조군 24예등 총 71예에서 자궁경부조직을 생검하여 각각 세포내 DNA를 추출한 다음 32Plabelled HPV type 16, type 18 DNA를 probe로 사용하여 dot blotting hybridization 및 autoradiography 를 시행하여 자궁경부 조직에서 HPV type 16 과 type 18 DNA의 출현빈도를 조사한 결과 1) 침윤성 자궁경부암과 자궁경부 상피내종양군에서 type 16/ type 18 DNA의 출현빈도는 각 각 58.8%, 58.3%로서 대조군의 8.4%에 비해 의의있게 높았다. 2) 자궁경부암 환자에서 병기와 자궁경부 조직의 HPV DNA 출현빈도에는 의의있는 상관관 계가 없었다. 3) 조직학적 세포형태별로 볼 때, 편평상피암에서 HPV type 16/ type 18의 출현빈도는 56.7% 였고, 선암 2예중 1예, 및 선편평상피암 1예에서는 type 16과 18, type 18이 각각 검출되었 다. 이상의 연구결과를 볼 때 한국여성에서 자궁경부조직의 HPV type 16/ type 18의 감염은 자 궁경부의 편평상피암뿐 아니라 선암, 선편평상피암의 발생에도 관여할것으로 사료되며, type 16의 경우 자궁경부 조직 세포내에서 바이러스 genome중 1.7 kb의 B조각의 존재유무가 암 의 발생, 진행 등에 중요할 것으로 사료된다. 따라서 HPV type 16/ type 18 DNA가 자궁경부 암의 확실한 발암 인자임을 밝히기 위하여 앞으로 이들 바이러스 genome내에서 발암 능력 을 갖는 부위를 규명하기 위한 연구가 필요할 것으로 사료된다. The purpose of this study is to identify the relationship of HPV types 16 and 18 DNA and CIN and invasive cervical cancer by analyzing the occurrence of their DNA sequences in the cervical tissues and their physical states in the cancerous cervical tissues. A total of 71 cases of cervical tissues ; 21 cases of cervical intaepithelial neoplasia (CIN) 34 cases of invasive cervical cancer, 1 case of metastatic adenocarcinoma of the cervix and 24 cases of control group of chronic cervicitis were analyzed by extracting celluar DNA. Using 32P-labelled HPV type 16 or type 18 DNA as a probe, HPV DNA typing was performed by dot blotting hybridization and autoradiography and the following results were obtained . THe positive rates for HPV type 16 and/or 18 for the invasive cervical cancer and CIN were 58.8% and 58.3% respectively, and it was significantly higher than that of control group (8.4%) in invasive cervical cancer there was no significantly difference in positive rate for HPV DNA according to the stage of the disease . According to the histological cell type HPV type 16 and type 18 DNA were detected in 43.3% and 23.3%respectively in squamous cell carcinoma . HPV type 16 and type 18 DNA were detected in 1 of 2 cases of adenocarcinoma and only HPV type 18 was detected in 1 case of adenosquamous carcinoma.

임신중기에 자궁파열을 동반한 Placenta Percreta 1 예

최동희(DH Choi),홍승천(SC Hong),이병석(BS Lee),박용원(YW Park) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.4

Placenta percreta는 빈도가 적고 합병증이 생기기전에는 진단이 어려우나 태아사망율, 산모의 이환율 및 사망률이 높은 응급을 요하는 산과적 질환이다 저자들은 과거 임신중절술을 시행받은 경산부에서 제 5회 임신 18주에 자궁파열에 의한 복강내 출혈로 응급 개복수술을 하여 전자궁적출술로 치료한 placenta percreta 1예를 체험하였기에 간단한 문헌고찰과 함께 보고하는 바이다 Spontaneous rupture of the uterus due to placenta percreta is one of the most urgent catastrophies resulting in rapid exsanguination and high mortality We present a case of spontaneous rupture of the uterus in midtrimester of pregnancy due to placenta percreta with brief review of the literature

자궁경부암 환자에서 국소 임파절형태에 따른 예후 평가

최동희 ( DH Choi ),박찬규 ( CK Park ),박찬일 ( CI Park ),이병석 ( BS Lee ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.11

Histologic materials from 91 cases of primary invasive cervical cancer in patients who underwent pretreatment laparotomy followed by radical abdominal hysterectomy and bilateral pelvic lymph node dissection were studied, with particular emphasis on the morphology of regional lymph nodes. Lymph nodes were classified morphologically according to the criteria proposed by Cottier (1972). The relationship between regional lymph node morphology and other clinicopathologic prognostic factors, and the cumulative survival rate in various types of regional lymph node morphology were evaluated. Among the 91 cases, lymphocyte predominance pattern(LP) was most common, occurring in 58 cases (63.7%), germinal center predominance pattern(GCP) in 22 cases (24.2%), and unstimulated node (U) in 11 cases in order of frequency. Lymphocyte depletion pattern (LP) was not present in this study. The mean age of the patients with US was 46 years, significantly older than those patients with GCP whose mean age was 41 years (P<0.05). The frequency of surgical stage IB in patients with LP was 94.8%, significantly higher than 68.1%, 72.7% of those with GCP, and US each. There was no direct relationship between lymph node morphology and cervical lesion size, cell type, depth of tumor invasion of cervix, or major type of lymphoplasmacytic cell infiltration into cervical lesion. LP was associated with a statistically significant decrease (3%) in lymph node metastases (P<0.01). In contrast, patients with lymph nodes showing US or GCP had a high incidence of metastatic lymph node (27.3% each). The Three-year cumulative survival rate according to lymph node morphology was the highest in LP (92.8%), followed by GCP (87.5%) and US (76.7%). These findings suggest that regional lymph node morphology may be of prognostic significance and lymphocyte predominance pattern seemed to be connected with favorable prognosis in patients with invasive carcinoma of the uterine cervix

원발성난관암 7 예에 대한 고찰

김도형(DH Kim),박찬규(CK Park),란세관(SK Lan),김재욱(JU Kim),최동희(DH Choi) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.6

Primary carcinoma of the fallopian tube is extremely rare malignant tumor of the female genital tract. Clinical aspect of 7 cases of primary adenocarcinoma of the fallopian tube are presented with the review of literature.

치료 실패율이 높은 예후인자를 가진 자궁경부암 환자에서 항암화학방사선요법의 역할

박찬규(CK Park),최동희(DH Choi),김영태(YT Kim),김수녕(SN Kim),김귀언(GE Kim),서창옥(CO Seo),노준규(JK Rho) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.4

This study evaluated the potential value of chemoradiotherapy (CRT) in preventing treatment failures (TF) and improving survivals in cervical cancer (CC) associated with high risk prognostic factors (HRPFs) after primary treatment (PT) of radiotherapy (RT). Cervical cancer patients treated with radiotherapy or chemoradiotherapy and followed at YUMC from 1976 to 1989 were evaluated for the treatment outcomes and also the toxicities of chemotherapy (CT) done prior to RT in CRT group. and also the toxicities of chemotrherapy (CT) done prior to RT in CRT group. HRPFs such as stages Ⅲ and Ⅳ, small cell, adeno-and adenosquamous carcinoma, lesion size 4.0cm, stage I or with respective lesion size 4.0cm, or evidence of lymph node metastasis on lymphography were selected by statistically analyzing the 386 CC cases primarily treated with RT alone at YUMC from 1976 to 1984. CRT where induction CT (ICT) is instituted prior to conventional RT was subsequently given to the 113 CC patients with at least one of these HRPFs. Two to 3 courses of ICT were administered, each at intervals of about 3 weeks, and a total of 312 cycles was administered. For squamous cell carcinomas, cisplatin (DDP), 100mg/㎡ Ⅳ infusion was followed immediately by 5-fluorouracil (5FU), 100mg/㎡/day as a 24-hour Ⅳ infusion for 5 days. For adenocarcinomas, DDP 70mg/㎡ Ⅳ infusion on day 1 was followed by cytoxan (C) 250mg/㎡ on day 2, and adriamycin (A) 45mg/㎡ on day 3. In 113 cases treated with CRT the overall response rate (RR) to ICT prior to RT was 86.7% (98 cases), complete response (CR) and partial response 26.5% (30 cases) and 60.2% (68 cases) respectively, and the CR rate after subsequent RT was 92.9% (105 cases). The 5 year cumulative survival rate (CSR) was lower in cases with lesion size 4cm or more than those with lesion size less than 4cm (P

난소암 ( 1966∼1983 ; 연세의료원 ) -Ⅰ. 난소암의 임상 및 조직병리학적 분석 -

이병석(BS Lee),최동희(DH Choi),박찬규(CK Park) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.8

1966년 1월 1일부터 1983년 12월까지 18년간 본 연세의료원 산부인과에 입원 치료받은 142예의 악성 난소종양에 대한 임상 및 조직병리학적 고찰을 통하여 다음과 같은 결론을 얻었다. 1. FIGO classification에 의한 암파급정도는 암 제 1기 38.7%, 암 제2기 5.6%, 암 제3기 15.5%, 암 제4기 40.2%였다. 2. 난소암의 WHO에 의한 조직병리학적 분류는 상피성 악성 난소종양이 2.8%, 배세포 악성난소종양 이 20.4%, 전이성 악성 난소종양이 18.3%, sex cordstromal tumor가 8.5%였다. 3. 난소암 환자의 연령별 분포는 상피성악성 난소종양이 45∼55세, 배세포 악성난소종양이 20∼30세 에 가장 호발하였다. 4. 난소암 환자에게 실시한 다양한 치료방법은 외과적 처치만 받은 환자가 34예였고 생검을 포함한 외과적 처치후 추가 약물요법을 받은 환자가 72예, 의과적 처치후 추가 방다선 요법을 받은 환자가 25예였다. 5. 핵 분열수에 따라 분류한 grade와 조직학적 인자인 증식상, 유두상 증식, 세포의 이형도, 기질 침 윤에 있어서 grade가 증가할수록 이러한 조직학적 인자들이 더 심한 양성을 보였다. 6. Grade에 의한 상피성 악성 난소종양의 3년 누적 생존율은 grade Ⅰ에서 78%, grade Ⅱ에서 55%, grade Ⅲ에서 32%, grade Ⅳ에서 17%로 grade가 증가할수록 그 생존율이 감소하였다. 7. 암파급정도에 따른 3년 누적 생존율은 암 제1기에서 68%, 암 제2기에서 38%, 암 제3기에서 23%, 암 제4기에서 0%였다. 이상의 결과로 난소암의 정확한 파급정도 결정시 가능한 종괴제거에 따른 적출물의 병리조직학적 인 자인 세포형태, grade 등의 난소암의 예후인자와 더불어 biologic behavior를 고려한 추가항암 화학요 법 또는 방사선 요법 등의 다양한 치료방법이 난소암 치료시 매우 중요한 것이다. A clinico-histopathologic study was made on a series of 142 cases of malignant ovarian cancers, which were admitted to the department of obstetrics and Gycecology, Yonsei University Medical Center during the period Jan 1, 1966 to Dec 31, 1983 The results obtained were as follows: 1. According to FIGO classifcation, the patient were classifed as; stage Ⅰ 38.7% stage Ⅱ 5.6%, stage Ⅲ 15.55 and stage IV 40.25 2. According to WHO histopathological classifcation epithelial ovarian tumor was found in 52.85, germ cell tumor in 20.4% metastatic tumor in 18.3% sex cord-stromal tumor in 8.5% 3. Age distribution of ovarian cancer showed the highest frequency in 45-55 years of epithelial ovarian tumor, 20-30 years of germ cell tumor 4. As for the modalities of treatment surgeries only were performed in 34cases surgeries(including biopsies) with adjuvant chemotherapy in 72cases, and surgeries with adjuvant radiotherapy in 25cases 5. Corrdlation between hisological grading and histologic features such as stratif cation nuclear pleomorphism, papillary projection and stromal invasion showed that these histologic features tend to become more severe as the grade developed 6. A three year cumulative survival rate of epithelial ovarian cancer according to histologic grading was 78% in grade Ⅰ, 55% in grade Ⅱ, 32% in grade Ⅲ, 17% in grade Ⅳ, The survival rate of patients was directly related to histologic grading 7. A three year cumulative survival rate of epithelial ovarian cancer 68% in stage Ⅰ, 38% in stage Ⅱ, 23% in stage Ⅲ, 0% in stage IV. Therefore in the treatment of ovarian cancer it is very important to perform adjuvant radiotherapy of chemotherapy according to the prognostic factors and biologic of the cancer

전이된 고위험임신성 융모상피종양에서 항암화학요법에 따른 합병증 및 치료성적

이혜승(HS Lee),박찬규(CK Park),최동희(DH Choi),김재욱(JU Kim),이창훈(CH Lee) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.3

The choice of initaial treatment modality in the high risk group of metastatic gestational trophoblastic neoplasia in which resistance to single agent chemotherapy is predicted, is very important. To investigate the significance of initial treatment modality, results of chemotherapy and subsequent toxicities were compared between primary and secondary combination chemotherapy after failure of initial single agent chemotherapy. 48 subjects with high risk metastatic gestational trophoblastic neoplasia were admitted to Severance Hospital and received anticancer chemotherapy from January, 1970 to December, 1988. The results of chemotherapy according to modality and subsequest toxicities were retrospectively analyzed. The results were as follows : 1. In the primary combination chemtoherapy group, the remission rate was 69.6%, mean remissiin duration was 18.3 months, 5 year cumulative survival rate was 66.1%, all of which were significantly better than either the single agent chemotherapy group or the secondary combination chemotherapy group. 2. The incidence of hepatotoxicity and granulocytopenia, 80% and 83.3% respectively, were more frequent in the secondary combination chemotherapy group than the other groups. 3. After the use of primary combination chemotherapy became popular since 1983, remission rate was improved up to 81.8%, from 48.7%. The mean remission duration and the 5 year cumulative survival rate were also significantly increased when compared to the period from 1970 to 1982. In conclusion, primary combination chemotherapy in high risk group of metastatic gestational trophoblastic neoplasia is recommended not only to improve remission rate and survival, but also to reduce toxicities of chemotherapy.

난소의 악성 배세포종양

이성기(SK Lee),박찬규(CK Park),최동희(DH Choi),김재욱(JU Kim),김수녕(SN Kim),박찬일(CI Park) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.10

Seventy-one patients with malignant germ cell tumors of the ovary treated at Yonsei University College of Medicine from January 1967 throught Decembdr 1988 were retrospectively reviewed. Mean age of the patients was 23 years. Distribution of patients by histlolgic type revealed that dysgerminoma was most frequent (55%), followed by endodermal sinus tumor(13%), immature teratoma (13%), embryonal carcinoma(10%), mixed germ cell tumor(8%), and choriocarcinoma (1%). The overall 5-year cumulative suvival rate was 60%. Stage, residual tumor size, and ascites were found to be significant prognostic factors. Tumor size was a prognostic factor of marginal importance.

항갑상선 항체를 동반한 습관성 유산 1 예

윤태기(TK Yoon),차광열(KY Cha),최동희(DH Choi),한세열(SY Han),남윤성(YS Nam) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

An autoimmune etiology has been proposed as the cause of recurrent abortions in couples with no other obvious explanation for their reproductive failure. It has been known for quite sometime that women with systemic lupus erythematosus(SLE) have an increased risk of pregnancy loss. Pregnancy loss in these women has been associated with the presence of non-organ-specific antibodies not only in the presence of active SLE but also in subclinical autoimmune disease. The most common autoantibodies associated with pregnancy loss are antiphospholipid antibodies(in particular anticardiolipin and the lupus anticoagulant)and antinuclear antibodies. These autoantibodies along with other non-organ-specific antibodies are implicated not only in pregnancy loss but other aspect of infertility. Among organ-specific autoantibodies, antithyroid antibodies specifically have been linked to repeated pregnancy loss. We have experienced a case of recurrent pregnancy loss associated with antithyroid antibodies. So we report this case with a brief review of literatures.

자궁경부암 병기결정에 있어서 전산화단층조영술의 효용성

박찬(C Park),박찬규(CK Park),최동희(DH Choi),김재욱(JU Kim),성혜리(HR Sung),이규영(KY Lee),김수녕(SN Kim),유형식(HS Yoo),이종태(JT Lee),정태섭(TS Jung) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.4

Computed tomography is noninvasive and provides relatively accurate information on the cancer involvement of the kidneys, rectum and bladder. Recently computed tomography (CT) is selectively used along with the other diagnostic methods in the staging of the cervical cancer. The authors have aimed to compare the efficacy of the CT with other study methods, and to investigate if replacement by CT is possible. From January 1985 to March 1989, 472 cervical cancer patients underwent pre-staging studies including computed tomography. The concordance rate, positive predictive values, negative predictive values, sensitivity, specificity of each method of study were compared. When the results of the CT and IVP were the same, hydronephrosis occurred in 19 cases and was not present in 472 cases, resulting in 98.9% concordance rate. The positive predictive value of CT for hydronephrosis was 95% and the negative predictive value was 99%. The concordance between CT and cystoscopy with regard to bladder invasion showed that 11 cases were positively concordant, 157 cases were negatively concordant, the positive predictive value of CT for bladder invasion was 33.3% and the negative predictive value was 100%. The concordance between CT and sigmoidoscopy with regard to rectal invasion showed that 1 case was positively concordant, 415 cases were negatively concordant and the positive predictive value of CT for rectal invasion was 6.3% and the negative predictive value was 100%.