난소임신 2예

방장훈(JH Bang),이건용(KY Lee),박광수(KS Park),남주현(CH Nam) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.5

본 증례는 Spiegelberg`s criteria에 충족한 난소임신의 2례였으며 이에 문헌적 고찰과 함께 보고하는 바이다. Two cases of ovarian pregnancy which have spiegelberg`s criteria for a primary ovarian pregnancy, are presented with a brief review of literatures.

Preliminary Results of Concurrent Radiation Therapy and Chemotherapy in Locally Advanced cervical Carcinoma

양광모(KM Yang),안승도(SD Ahn),최은경(EK Choi),장혜숙(HS Chang),김영탁(YT Kim),남주현(JH Nam),목정은(JE Mok) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.2

본 연구는 1991년 5월부터 국소적으로 진행된 자궁경부암 (FIGO stage IIB~IVA) 환자를 대상으로 5-FU와 Cis-platinum을 방사선 치료와 동시에 투여하여 치료 독성, 치료의 적합성과 국소관해율을 평가하기 위해 시행되었다. 방사선 치료는 외부방사선 조사로 전골반부에 23회에 걸쳐 4140 cGy 시행후, 고선량 근접치료기로 강내조사를 6회 내지 7회 (A점에 3000~3500 cGy) 시행하였으며, B점에 추가조사를 시행하여 IIB병기 환자는 6000 cGy까지 IIIB병기 환자는 6500 cGy가지 B점에 조사되도록 하였다. 첫 번째 항암화학요법은 외부방사선 치료 시행의 두번째 주에 5-FU는 1000 mg/㎡/24hr를 96시간 동안에 걸쳐 토여하고 Cis-platinum은 20mg/㎡/day를 3일 투여하였다. 두번째 항암화학요법은 처음과 동일한 방법으로 첫번째 고선량 근접 강내 치료가 시행될 때 투여 되었다. 1993년 8월까지 총 16명의 환자(10 IIB 병기, 4 IIIB병기, 2 IVA 병기)가 등록되었으며, 이중 2명은 외부방사선 2회 조사후 치료를 중단하였으며, 1명은 강내치료중 3등급의 비뇨기계독성으로 치료를 중단하였다. 2회의 항암화학 요법이 종료된 후 독성의 평가가 가능했던 14명의 환자중 5명이 3등급의 위장관독성이 발생하였으나, 4명은 치료종료후 평가에서 회복되었다. 1명은 병기 IIIB환자로 초기에 서혜부 임파절 전이가 있어 다량의 방사선이 조사되었는데, 치료종료 후에 위장관독성이 악화되었고, 1개월후 원격전이로 사망하였다. 치료후 치료전 체중의 10% 이상 감소된 환자는 2명이었고, 1명이 3등급의 백혈구 감소를 보였다. 환자의 평균 치료 기간은 75일(포준 치료 기간은 70±7일)이었고, 80일 이상인 환자는 3명 (84, 84, 89일)이었다. 추적관찰 가능했던 13명 환자중 8명이 완전관해를 보였고, 특히 IIB병기 환자의 경우 9명중 8명이 완전관해를 보였다. 본 연구결과 진전된 자궁 경부암에서 방사선과 항암화학요법 병행치료는 효과나 독성면에서 수용가능 하였으나 향후 근치적 방사선치료 단독으로 시행된 경우와의 전향적 비교연구가 필요할 것으로 생각된다. Since May 1991, authors have conducted a pilot study to determine the feasibility and evaluate the effect of concurrent radiation therapy and chemotherapy with 5-FU and Cis-platinum for locally advanced cervical cancer (stage IIB-IVA). Radiation therapy consisted of external irradiation to whole pelvis (4140 cGy/23 fx) in 4.5 weeks followed by high dose rate intracavitary radiation therapy (HDR ICRT) to deliver a dose of 30 to 35 Gy to A point in 6 to 7 fractions. After the intracavitary radiation therapy, parametrial boost was delivered for B point dose of 60 Gy in Stage IIB and 65 Gy in stage IIIB. 5-FU (1000 mg/㎡/24hr for 96 hour iv infusion) and Cis-platinum (20 mg/㎡/day IV bolus for 3 days) were given during the second week of external RT and the second course chemotherapy administered at the first HDR ICRT with the same method as the first chemotherapy. Sixteen patients (10 stage IIB,4 stage IIIB,2 stage IVA) were registered to this protocol. Among these 16 patients, two refused treatment after 2 fractions of external irradiation, and one could not continue intracavitary irradiation because of treatment related genitourinary toxicity. So 14 patients were evaluated for toxicity and 13 patients were evaluated for response analysis. Five of 14 patients developed grade 3 gastrointestinal toxicity but 4 of them recovered at the completion of treatment. One stage IIIB patient with inguinal lymph node metastasis who received higher dose of radiation in spite of initial poor performance status did not recover from gastrointestinal toxicity at the completion of treatment. And she died of distant metastasis at one month after the completion of treatment. Two of 14 evaluable patients showed weight loss, more than 10% of initial weight. One patient developed grade 3 leukopenia. In this study, the average total treatment period of completely treated patients was 75 days and three of them took more than 80 days (84, 84, 89 days). Toxicities were generally acceptable and there were no treatment related death. At the last follow-up, complete response was achieved in 62%(8/13) and especially of nine patients with stage IIB, eight patients showed complete response. This study suggests that concurrent radiation therapy and chemotherapy (5-FU and Cis-platinum) is tolerable and effective. Further follow-up is needed to determine whether this protocol will have a favorable impact on survival and to evaluate the late effect on normal tissues. In future, prospective randomized trials are needed to compare the standard radiation therapy alone with concurrent chemotherapy and radiation therapy for locally advanced cervical carcinoma.

골반내 종괴의 악성 감별 진단에 있어서 종양표지물질 CA 125, CA 15-3 및 UGF의 유용성

남주현,목정은,김용만 대한부인종양 콜포스코피학회 1994 Journal of Gynecologic Oncology Vol.5 No.2

Objective : The purpose of our study was to evaluate wheather the combined use of various tumor markers, CA 125, CA 15-3 and UGF(urinary gonadotropin fragment) could improve the efficacy for differentiating malignant from benign pelvic tumors. Study design : Preoperative samples were collected from 109 patients with pelvic masses. Using immunoradiometric assays, CA 125, CA 15-3 and using enzyme immunoassay UGF were measured. Results : Serum CA l25 level, were elevated above 35 U/m1 in 78.l% and above 65 U/ml in 62.5% of 32 patients with malignant pelvic masses, and in 20.3%, and 8.7% of 69 patients with benign pelvic masses, respectively. Sensitivity of CA 15 3($gt;30 U/ml) and UGF($gt;3 fmol/mgCr) levels occured in 29% and 50% of patients with malignancies, and in l.7%, and 6.6% of patients with benign masses, respectively. Sensitivity of CA 125 were higher than those of CA l5-3 and UGF. However specificity of CA 125 was lower than those of other two markers. Sensitivity and Specificity of UGF were located between those of CA 125 and CA 15-3. For differentiating malignant from benign, among patients below 50 years of age, coordinate elevation of CA 125($gt;35 U/ml) and, CA 15-3($gt;30 U/ml) ar UGF($gt;3 fmol/mgCr) reveal with a sensitivity of 550% and a specificity of 100% in malignant pelvic masses, and with 57% of sensitivity and 100% of specificity in malignant epithelial ovarian cancer, respectively. Conclusion'.Combined use of CA 125 of CA l5-3 and UGF could obtain an acceptable sensi-tivity and an excellent specificity in differentiating malignant from benign pelvic masses, especially among patients below 50 years of age.

난소암 조기진단을 위한 정상여성에서의 혈중 CA 125와 CA 15-3의 유용성

남주현,목정은,한지수,김용만,김영탁 대한부인종양 콜포스코피학회 1994 Journal of Gynecologic Oncology Vol.5 No.2

Objective : The objective was to determine the efficacy of CA 15 3 as a complimentary marker to CA 125 for ovarian cancer screening. Study design : Serum CA 125 and CA 15-3 levels were measured by immunoradiometric assay in 550 apparently healthy women and 46 ovarian cancer. Results : The cut-off level of serum CA 125 in the apparently healthy women were 65.0 U/ml in the under 50 age group and 34.8 U/ml in the over 50 age group, And the cut-off level of serum CA 15---3 were 37.0 U/ml and 34.7 U/ml, respectively. The sensitivity of serum CA 125 were 95.7% at the cut-off level of 35 U/mi and 93.5% at the cut-off level of 65 U /ml. And that of serum CA15-3 were 52.2% at the cut off level of 30 U/ml and 45.7% at the cut, off level of 40 U/ml. The specificity of serum CA 125 were 95.6%(35 U/ml) and 99.3 %(65 U/ml). And that of serum CA 15 3 were 98.3(30 U/ml) and 99.6%(40 U/rnl). Conclusion : The serum CA 15-3 w~my combination with CA 125 would not contribute to increase the efficacy of screening strategy for ovarian cancer. The serum CA 125 is very use-full tumor marker in ovrian cancer screening ,especially m the over 50 age group and at 35 U/ml cut-off level.

난소의 악성 혼합성 뮬러리안 종양 2예

남주현,목정은,김용만,김영탁,고준성,김경진,허주령,이인철 대한부인종양 콜포스코피학회 1995 Journal of Gynecologic Oncology Vol.6 No.2

Malignant mixed Mullerian tumor of is a rare tumor containing epithelial and mesenchymal components. Almost all mixed Mullerian tumors are found in postmenopausal women, often with low parity and usually in an advanced stage, Malignant mixed Mullerian tumor is highly malignant and the prognosis is poor due to frequent metastasis and recurrence. We experienced two cases of malignant mixed Mullerian tumor of ovary and report with a brief review of the literature.

골반내 종괴의 수술 전 감별 진단에 있어서 종양표지물질의 유용성

남주현,박만철,정좌구,박상윤,이제호,목정은 대한부인종양 콜포스코피학회 1992 Journal of Gynecologic Oncology Vol.2 No.1

$quot;Preoperative serum samples were collected from 78 patients with pelvic masses. Using immunoradiometric assays, tumor-associated antigens CA 125, CA 15-3, and TAG 72 were measured to evaluate the usefulness af these markers in differentiating benign from malignant pelvic masses. Serum CA 125 levels were elevated above 65 U/ml in 85% of 33 patients with malignant pelvic masses, and in 24% of 45 patients with benign pelvic masses. Elevation of CA .1.5-3($gt;30 U/ml) and TAG 72($gt;10 U/ml) levels occurred in 45% and 30% of patients with malignancies, And 9% and 4o of patients with benign masses, respectively. Serum CA 125 levels distinguished. most effectively between patients with malignant pelvic masses and those with benign pelvic masses, having a sensitivity of 85% and a specificity of 76% at the cut-off level of 65 U/ml. When differentiating 21 patients with epithelial ovarian cancer from 45 patients with benign masses, the CA 125 levels($gt; 65 U/ml) alone had a sensitivity of 95% and a specificity of 76%. Comparing to CA 125, sensitivities of CA 15-3 and TAG 72 were much lower, 57% and 48%, respectively. However, specificities of these two markers were much higher than CA 125, 91% and 96%, respectively, Coordinate elevations of CA l25($gt; 65 U/ml) and CA 15-3($gt; 30 U/ml) or TAG 72($gt; 10 U/ml) discriminated epithelial ovarian cancers from benign m es with a sensitivity of 62% and specificity of 90%. Among patients over 50 years of age, a sensitivity and a specificity increased to 79% and 100%, respectively. Consequently, combined use of CA 15-3 and TAG 72 with CA 125 can obtain an acceptable sensitivity and an excellent specificity in differentiating malignant from benign pelvic masses, particularly among patients over 50 years of age. Prospective studies will be required to examine the efficacy of combined use of additional markers with CA 125 in the screening of ovarian cancer.

임신초기 이상임신의 진단에서 혈중 hCG와 CA-125치의 의의

남주현,김영민,조해영,송재천,김준형,김현경,하성헌 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.2

임신초기 이상임신의 진단을 위하여 초음파, 혈중 hCG와 CA 125치를 측정하여 다음과 같은 결론을 얻었다. 1. 정상임신에서 혈중 hCG치의 분포는 1,138 mIU/ml에서 399,000 mIU/ml사이였으며 95% 신뢰구간은 32,000~398,000 mIU/ml이었다. 2. 이상임신의 혈중 hCG치를 보면 자궁외임신에서는 93.8%, 무태아란에서는 60%, fetal demise, 계류유산은 전 예에서 이 구간보다 낮았으며 융모성 질환에서는 67.5%가 이 구간보다 높았다. 3. 혈중 CA 125치는 정상임신에서는 68%가 35U/ml이상 증가되어 있었으며 95% 신뢰구간의 상한치는 150 U/ml이었다. 4. 이상임신에서 CA 125치가 35U/ml이상 증가한 빈도는 정상임신과 비교하여 유의한 차이가 없었으나 상한치를 150U/ml로 정하였을 경우 fetal demise군에서 정상임신보다 유의하게 증가 하였다(p$lt;0.05). 따라서 임신초기 임신 예후판정을 위하여 초음파와 혈중 hCG 및 CA 125치를 측정하여 태아 심박이 없으며 hCG가 정상 범위보다 낮으며 CA 125치가 150 U/ml이상 증가하였을 경우 유산의 가능성이 높을 것으로 생각된다. To evaluate the efficacy of ultrasound, serum hCG and CA-125 levels for early detection of abnormal pregnancy in the first trimester of pregnancy, we collected samples from 90 pregnant women who had vaginal spotting. Among them, 27 women continued their pregnancy normally and 63 women were confirmed as abnormal pregnancies pathologically-ectopic pregnancy (30), blight ovum (10), missed abortion (5), fetal demise (10) and molar pregnancy (8). The 95% confidence interval of serum hCG level in normal pregnant women was 32,000mUI/ml to 398,000mIU/ml. Deversed rates of serum hCG level below 95% confidence interval were 93.8% in women with ectopic pregnancy, 100% in women with missed abortion and fetal demise and 60% in women with blighted ovum. Increased rate of serum hCG level above 95% confidence interval was 67.5% in women with molar pregnancy. The incidence of elevated serum CA-125 level above 35u/ml was 68% in normal pregnant women. The upper limit of 95% confidence interval of serum CA-125 level in normal pregnant women was 150u/ml. We noticed no significant difference of incidence of elevated CA-125 level above 35 u/ml between normal and abnormal pregnant women. Compared to normal pregnant women, however, significant increase of CA-125 level above 150u/ml in women with fetal demise was obtained.

임신 중기에 발견된 전이성 융모상피암 1예

남주현,목정은,이주학,김영신,전대준,장현정 대한부인종양 콜포스코피학회 1994 Journal of Gynecologic Oncology Vol.5 No.1

This is the third reported case of choriomrcinoma during pregnancy in Korea. A 28-years-old gravida 2 patient with an intrauterine pregnancy of 29 weeks had a coexisting vaginal metastatic choricareinorna. After termination of pregnancy, treatment with triple combination chemotherapy (methotrexate, actinomycin-D,cytaxen) was successfully done.

골반내 종괴로 진단된 환자에서 CA125 와 CA 130의 비교

남주현,목정은,한지수,원혜성,이상범,박용범 대한부인종양 콜포스코피학회 1993 Journal of Gynecologic Oncology Vol.4 No.3

Objective : Our objective was to compare the usefulness of tumor markers, serum CA125 and CA130 in differentiating malignant, from benign pelvic masses. Study design : Serum CA125 and CA130 levels were measured by immunoradiometric assay in total 135 samples which were collected from 91 patients with benign pelvic masses, 21 patients with ovarian cancer, 3 patients with no evidence of disease after treatment for ovarian cancer and 20 apparently healthy women Results : In epithelial ovarian cancer, mean value of serum CA125 and CA130 were 1224.0 U/ ml and 891.0 U/ml, respectively, Serum. CA125 and CA130 levels were above 35 U/ml in 90,5% and 81.0/ of patients with malignant pelvic masses, respectively, Serum CA130 levels showed lower false positive rate in patients with benign pelvic masses, 34.1%($gt;35U/ml) than that of serum CA125 levels 51.6%($gt;35U/ml). In control group, serum CA125 and CA130 levels were above 65 U/ml in 13.0% and 0% respectively. Values of both markers correlated each others very well. Regression equation between CA125 and CA130 is following; CA130 = 10.0+0.673 CA125 and correlation coefficient is 0.992, Combining of CA125 and CA130, a sensitivity was 81.0% ($gt;35U/ml) and 81.0% ($gt;65U/ml) similar to CA125 levels alone, 90.5% ($gt;35U/ml) and 85.7% ($gt;65U/ml). In specificity, combining of serum CA125 and CA130, 68.1/. ($gt;36U/ml), 76.9 /a ( $gt; 65U/ml) were much higher than CA125 alone, 48.4% ($gt;36U/ml), 71.4% ($gt;66U/ml). And diagnostic accuracy was higher in the combined use of CA125 and CA130, 69.6% ($gt;35U/ml), 77,7% ($gt;65U/ml) than CA125 alone, 56.3% 35U/ml), 74.1% ($gt;65U/ml). Conclusion : Values of serum CA130 well correlated with those of CA125 and combined use of both markers can obtain an acceptable sensitivity and a better specificity than thous of serum CA125 alone in differentiating malignant from benign pelvic masses.

Brenner 종양 3예

남주현,목정은,장현정,김용만,김영탁,이인철,황성욱,허주령 대한부인종양 콜포스코피학회 1995 Journal of Gynecologic Oncology Vol.6 No.2

Brenner tumor is an uncommon type of ovarian neoplasm which is typically small, solid and well circumscribed. It is composed of hyperlastic fibromatous matrix interspersed with nest of epithelioid cell which show characteristic coffee bean appearance. We experienced three cases of Brenner tumor, two benign and one malignant. One case of benign and malignant case were, associated with mucinous tumor. So we report these cases with a brief review of literature.