A comparison of Laparoscopic assisted radical vaginal hysterectomy with radical abdominal hysterectomy in the treatment of stage IB1 cervical cancer

박종택 ( Chong Taik Park ),( Keum Jung Lee ),( Je Hoon Lee ),( Seok Ju Seong ),( Tae Jin Kim ),( Kyung Taek Lim ),( Hwan Wook Jung ),( Ki Heon Lee ),( In Sou Park ),( Jae Uk Shim ) 대한산부인과학회 2004 대한산부인과학회 학술대회 Vol.90 No.-

체외수정 시술 후 발생한 자궁벽내 임신 1예

차선화,박종택,김해숙,송현정,강은희,송현진,강인수,Cha, Sun-Hwa,Park, Chong-Taik,Kim, Hae-Suk,Song, Hyun-Jung,Kang, Eun-Hee,Song, Hyun-Jin,Kang, Inn-Soo 대한생식의학회 2004 Clinical and Experimental Reproductive Medicine Vol.31 No.4

Intramural pregnancy is an unusual ectopic gestation located within the uterine wall, completely surrounded by myometrium and separate from the uterine cavity, fallopian tube, or round ligament. It is known to be difficult to diagnose, and associated with a high rate of uterine rupture. We report a case of intramural pregnancy in which early diagnosis was made and successful treatment was done by dilatation and curettage. Diagnostic laparoscopy confirmed the absence of uterine rupture during the procedure. Therefore, conservation of fertility can be possible with early diagnosis of intramural pregnancy. To our knowledge, this is the first case report of intramural pregnancy following IVF-ET in Korea.

Bethesda system에 의한 "atypical squamous cells of undertermined significance"의 평가

김의정,홍성란,김희숙,박종숙,김계현,임경호,심재욱,박종택,전종수,Kim, Yee-Jeong,Hong, Sung-Ran,Kim, Hy-Sook,Park, Jong-Sook,Kim, Kye-Hyun,Lim, Kyung-Ho,Shim, Jae-Uk,Park, Chong-Taik,Chun, Chong-Soo 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.2

The recently proposed Bethesda system for cervical/vaginal cytology has made a standardization related to "atypia". In cellular changes due to inflammation or repair, the word "benign cellular change" has been suggested as a substitute for atypia. Terminology related to atypical cells may become standardized, but the cytologic criteria has not been well defined yet. We evaluated 160 cases of atypical squamous cells of undetermined significance(ASCUS) by the Bethesda Sys4em(TBS). Among 30,428 cases screened, a cytologic diagnosis of ASCUS was made in 498 cases(1.6%) and 160 cases were histologically verified ASCUS was diagnosed based on nuclear enlargement and nonclassical signs of condyloma. The results are as follows: One hundred and twenty three cases(76.9%) revealed chronic cervicitis. Thirty seven cases(23.1%) demonstrated squamous intraepithelial lesion. Among intraepithelial lesions, condyloma and mild dysplasia were 28 cases(75.7%). Moderate and severe dysplasia were 5 cases(13.5%) and 4 cases(10.8%), respectively. it is concluded that patients with ASCUS should be colposcopically examined.

자궁경부세포진에 있어서 AutoPap 300 QC System의 임상경험과 민감도 검사

홍성란,박종숙,장회숙,김의정,김희숙,박종택,박인서,Hong, Sung-Ran,Park, Jong-Sook,Jang, Hoi-Sook,Kim, Yee-Jeong,Kim, Hy-Sook,Park, Chong-Taik,Park, In-Sou 대한세포병리학회 1998 대한세포병리학회지 Vol.9 No.1

OBJECTIVE: False negatives of cervical smears due to screening errors pose a significant and persistent problem. AutoPap 300 QC System, an automated screening device, is designed to rescreen conventionally prepared Pap smears initially screened by cytotechnologists as normal. Clinical experience and sensitivity of the AutoPap 300 QC System were assessed and compared with current 10% random qualify control technique. MATERIALS AND METHODS: In clinical practice, a total of 18,592 "within normal limits" or "benign cellular changes" cases classified by The Bethesda System were rescreened by the Autopap System. In study for sensitivity of The AutoPap System to detect false negatives, a total of 1,680 "within normal limits" or "benign cellular changes" cases were rescreened both manually and by the AutoPap System. The sensitivity of the AutoPap System to these false negatives was assessed at 10% review rate to compare 10% random manual rescreen. RESULTS: In clinical practice, 38 false negatives were identified by the AutoPap System and we had achieved 0.2% reduction in the false negative rate of screening error. In study for sensitivity, 37 false negatives were identified by manual rescreening, and 23 cases(62.2%) of the abnormal squamous cytology were detected by the AutoPap System at 10% review rate. CONCLUSONS: The AutoPap 300 QC System is a sensitive automated rescreening device that can detect potential false negatives prior to reporting and can reduce false negative rates in the laboratory. The device is confirmed to be about eight times superior to the 10% random rescreen in detecting false negatives.

난소의 악성 배세포 종양의 임상병리학적 고찰

이인호 ( In Ho Lee ),이기헌 ( Ki Heon Lee ),박세진 ( Sei Jin Park ),홍원기 ( Won Ki Hong ),김태진 ( Tae Jin Kim ),임경택 ( Kyung Taek Lim ),심재욱 ( Jae Uk Shim ),박현 ( Hyun Park ),성석주 ( Seok Ju Seong ),박종택 ( Chong Taik Pa 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.4

목적: 본 연구의 목적은 난소에 발생하는 악성 배세포 종양의 임상병리학적 특징을 알아보고자 하였다. 연구방법: 1995년 1월부터 2003년 12월까지 제일병원에서 난소의 악성 배세포 종양으로 진단받고 치료받은 35명의 환자를 대상으로 환자의 나이, 주증상, 조직학적 특징, 종양표지물질, FIGO 병기, 종양의 최대직경, 치료, 생존율, 향후 임신에 대한 결과를 의무기록을 토대로 후향적으로 분석하였다. 결과: 환자의 나이는 8세부터 34세까지 분포하였고 평균 23.4세였으며, 2명은 초경이전이었다. 추적관찰기간은 최소 16개월부터 최대 118개월로 평균 59.6개월이었다. 촉지되는 하복부 종괴와 통증이 가장 흔한 증상이었다. 수술전에 시행한 CA-125 검사는 32명에서 시행하였으며 이 중 23명에서 상승되었다. 종양의 최소직경은 7 cm, 최대직경은 27 cm이었으며 평균 16.5 cm이었고, 종양의 위치는 우측이 17명 (48.6%), 좌측이 15명 (42.9%), 양측이 3명 (8.6%)이었으며 양측성은 모두 미분화세포종이었다. 수술후 병기는 I기가 28명 (80.0%)으로 가장 많았으며, II기가 4명 (11.4%), III기가 3명 (8.6%)이었고 IV기는 없었다. 조직학적 분류는 미성숙 기형종이 14명 (40%)으로 가장 많았으며, 미분화세포종이 10명 (28%), 내배엽동 종양이 9명 (26%), 혼합 배세포종이 2명 (6%)이었다. 수술적 치료는 일측 부속기 절제술을 시행받은 환자가 9명, 종양절제술만 시행한 환자가 4명, 병기수술을 시행받은 환자가 22명이었으며, 이중 16명은 가임력을 보존하는 수술을 시행받았다. 수술후 항암화학요법은 30명에서 시행하였으며, TIP를 시행받은 1명을 제외하고는 모든 환자에서 BEP를 사용하였다. 내배엽동 종양환자 2명이 재발하였는데 1명은 병기 Ic였고, 1명은 IIIb였으며, 각각 첫 수술 후 59개월과 16개월 후에 각각 사망하였다. 추적관찰 기간 중 8명의 환자에서 임신이 되었으며, 그 결과는 만삭분만이 4명, 유산이 2명, 포상기태 1명, 그리고 현재 임신 20주인 산모가 1명이었다. 결론: 대부분의 악성 배세포 종양이 초기에 발견되며, 보존적 수술과 복합항암화학요법으로 상대적으로 높은 생존율을 보여준다. Objectives: The aim of this study was to evaluate the clinicopathologic characteristics of malignant germ cell tumors of ovary. Methods: Thirty five patients who were dignosed as malignant germ cell tumors of ovary and treated in Cheil General Hospital from January 1995 to December 2003, were retrospectively analyzed. The age, chief complaints, histologic type, tumor marker, FIGO stage, maximal tumor diameter, management, survival and future pregnancy outcome were reviewed. Results: The mean age was 23.4 years (8-34) and 2 patients were premenarche. The mean follow-up period was 59.6 months (16-118). Palpable lower abdominal mass and pain were the most frequent symptoms. Preoperative CA125 were checked in 32 patients and elevated in 23 patients. The tumors were ranging from 7cm to 27cm in diameter (mean : 16.6). The site of tumors was right-sided in 17(48.6%), left-sided in 15(42.9%), and bilateral in 3(8.6%) which were dysgerminomas only. Post-surgical FIGO stage was stage I in 28 cases (80.0%), stage II in 4 cases (11.4%), and stage III in 3 cases (8.6%). Histologically, immature teratomas were found most frequently (n=14, 40.0%), followed by dysgerminoma (n=10, 28.6%), endodermal sinus tumor (n=9, 25.7%), and mixed form (n=2, 5.7%). Unilateral salpingo-oophorectomy was performed in 9, cystectomy in 4, and staging operation in 22, which included 16 patients of fertility sparing operation. Postoperative chemotherapy was administered in 30 and most were BEP except one TIP. Two patients had recurred, who were stage Ic and IIIb EST at diagnosis and expired at 59 and 16 months after first operation. Recurrence rate was 5.7% and 5-year survival rate was 94.7%. During follow-up period, 8 patients were pregnant and the results were 4 normal deliveries at term, 1 missed abortion, 1 therapeutic abortion due to acne medication, 1 H-mole and 1 current pregnant state at 20 weeks without problem. Conclusion: These results shows that most malignant germ cell tumors of ovary is detected in early stage and have relatively excellent survival with conservative operation and combination chemotherapy.

자궁내막증에서 기원한 음문의 투명세포암종

조혜진 ( Hye Jin Cho ),이금정 ( Keum Jung Lee ),차선화 ( Sun Hwa Cha ),성석주 ( Seok Ju Seong ),박종택 ( Chong Taik Park ),이기헌 ( Ki Heon Lee ),전이경 ( Yi Kyeong Chun ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.4

Since Sampson first described the development of ovarian carcinoma in endometriosis in 1925, numerous case reports have documented the development of malignancies arising from foci of endometriosis. Clear cell carcinoma arising from endometriosis is very

자궁내막에서 발생한 유두양 장액성 자궁내막암 25예의 임상적 고찰

이현정 ( Hyun Jung Lee ),이금정 ( Keum Jung Lee ),김민지 ( Min Ji Kim ),서백경 ( Back Kyung Seo ),유영 ( Young Yu ),임경택 ( Kyung Taek Lim ),성석주 ( Seok Ju Seong ),박종택 ( Chong Taik Park ),심재욱 ( Jae Uk Shim ),이기헌 ( Ki 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.5

자궁내막암 환자의 수술 전 자궁경부 세포진 검사 - 임상병리학적 연관성

성석주(Seok Ju Seong),김태진(Tae Jin Kim),임경택(Kyung Taek Lim),정환욱(Hwan Wook Chung),이기헌(Ki Heon Lee),박인서(In Sou Park),심재욱(Jae Uk Shim),박종택(Chong Taik Park),김혜선(Hye Sun Kim),김희숙(Hy Sook Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.10

목적 : 자궁내막암 환자에서 수술 전에 악성 예후인자를 미리 알 수 있다면 치료 계획을 세우는데 많은 도움이 된다. 이 연구의 목적은 자궁내막암 환자에서 수술 전에 시행한 자궁경부 세포진 검사 결과와 악성 예후인자와의 상관관계를 알아보는 것이다. 연구 방법 : 1989년 1월부터 2000년 6월까지 삼성제일병원에서 수술을 시행받은 자궁내막암 환자 중에서 수술 전에 자궁경부 세포진 검사를 하였던 163예의 환자를 대상으로 하였다. 모든 환자에서 전자궁적출술 및 양측 부속기 절제술과 복강 내 세포진 검사를 시행하였고, 골반 림프절 절제술은 79예에서, 또 부대동맥 림프절 절제술은 81예에서 시행하였다. 이들 환자의 수술 전에 시행한 자궁경부 세포진 검사 결과를 정상, AGUS, adenocarcinoma로 나누어 자궁내막암의 예후인자와의 상관관계를 검토하였다. 통계는 카이 제곱 테스트를 이용하였다. 결과 : 163예 환자의 평균 나이는 49세 (24-75세)였고, 50세 미만이 65예 (39.9%)이고 50세 이상이 98예 (60.1%)였다. 수술 전 자궁경부 세포진 검사에서 72예 (44.2%)는 정상, 38예 (23.3%)는 AGUS, 53예 (32.5%)는 adenocarcinoma였다. 자궁경부 세포진 검사는 고령 (p=.014), 나쁜 조직학적 분화도 (p=.000), 자궁경부 침윤 (p=.015), 심부 자궁근층 침윤 (p=.000), 림프-혈관 침윤 (p=.000) 및 진행된 수술병기 (p=.049)와 통계적으로 유의한 상관관계를 보였고, 조직학적 분류 (p=.328), 복강내 세포진 검사 (p=.067), 자궁부속기 침범 (p=.602), 골반 림프절 침윤 (p=.266) 및 부대동맥 림프절 침윤 (p=.220)과는 통계적으로 유의하지 않았다. 결론 : 자궁내막암 환자에서 수술 전 자궁경부 세포진 검사상 발견된 AGUS나 adenocarcinoma는 예후인자 중 고령, 나쁜 조직학적 분화도, 자궁경부 침윤, 심부 자궁근층 침윤, 림프-혈관 침윤 및 진행된 수술병기와 통계학적으로 유의한 상관관계가 있었다. 따라서 자궁경부 세포진 검사는 자궁내막암 환자의 수술 전 평가방 법으로 중요시되어야 할 것이다. Objective : The aim of this study was to evaluate the correlation between preoperative Pap smears and known poor prognostic factors in patients with endometrial carcinoma. Methods : Between January 1989 and June 2000, preoperative evaluation of Pap smears were done in 163 patients with endometrial carcinoma who underwent total abdominal hysterectomy with bilateral salpingooophorectomy, peritoneal cytology, and pelvic and/or para-aortic lymphadenectomy. All Pap smears and histologic sections were reviewed. Pathologic parameters of hysterectomy specimens were evaluated and correlated with the findings of Pap smears. Chi-square test was used for statistical analysis. p-values<0.05 were considered significant. Results : The mean age of patients was 49 years with range between 24 and 75 years old. 72 patients (44.2%) had normal, 38 patients (23.3%) had atypical glandular cells of undetermined significance (AGUS), and 53 (32.5%) had adenocarcinoma on preoperative Pap smears. Statistically significant associations were found between Pap smears and age (p=.014), histologic grade (p=.000), cervical involvement (p=.015), depth of myometrial invasion (p=.000), lymph-vascular space invasion (p=.000), and surgical stage (p=.049). Patients with malignant cytology were more likely to have older age, poorly differentiated malignancies, deeper myometrial invasion, cervical metastases, lymphvascular invasion and higher surgical stage. However, histologic subtypes (p=.328), peritoneal cytology (p=.067), adnexal involvement (p=.602) and pelvic and/or para-aortic lymph node metastases (p=.266 and p=.220) were not statistically significant. Conclusion : This study revealed that preoperative abnormal Pap smears in patients with endometrial carcinoma were significantly associated with age, histologic grade, cervical involvement, depth of myometrial invasion, lymphvascular space invasion and surgical stage. Therefore, Pap smears could be an important part of the preoperative evaluation in patients with endometrial carcinoma.

자궁경부암 조직을 이용한 유전자 칩 인유두종바이러스 검사

이제훈 ( Je Hoon Lee ),이기헌 ( Ki Heon Lee ),이인호 ( In Ho Lee ),우혁준 ( Hyuk Jun Woo ),성석주 ( Seok Ju Seong ),김태진 ( Tae Jin Kim ),임경택 ( Kyung Taek Lim ),심재욱 ( Jae Uk Shim ),박종택 ( Chong Taik Park ),홍성란 ( Sung R 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.4

최근 15년간 한국에서의 자궁 내막암의 생존율 및 치료 방법의 변화

민경진 ( Kyung Jin Min ),송승훈 ( Seung Hun Song ),이재관 ( Jae Kwan Lee ),이낙우 ( Nak Woo Lee ),강재성 ( Jae Sung Kang ),이규완 ( Gyu Wan Lee ),류기성 ( Ki Sung Ryu ),김병기 ( Byung Gie Kim ),박종택 ( Chong Taik Park ),유희석 ( 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.10

목적: 이 연구는 최근 15년간 한국에서 자궁 내막암 환자의 치료 방법의 변화 및 생존율을 알기 위해 시행하였다. 연구 방법: 1990년 1월부터 2005년 3월까지 국내 9개 기관에서 자궁 내막암으로 진단받은 환자의 의무기록을 검토하여 740명을 대상으로 일부 기본 기록이 누락된 환자는 제외하였다. 생존율은 대한 통계청의 사망 자료를 바탕으로 구하였다. 결과: 환자 나이의 평균값은 51.5세였으며 임신력과 분만력의 평균값은 3.3과 2.1이었다. 진단 당시 자궁 내막암의 병기와 분화도는 FIGO 병기 1기와 분화도 1이 가장 많았으며 조직학적 분류는 자궁내막양 선암이 87.2%로 가장 많았다. 치료 방법으로는 병기 1기에서는 수술만 시행한 경우가 59.8%로 가장 많았으며 병기 2기에서는 수술-보조 방사선 요법 (55.1%), 병기 3기에서는 수술-보조 방사선 요법과 수술-보조 항암화학 방사선 요법이 많이 사용되었고 4기에서는 수술-보조 항암화학 요법이 55.6%로 가장 많이 시행되었다. 분화도에 따라서는 분화도 1에서는 수술이 (69.0%), 2와 3에서는 수술-보조 방사선 요법이 많이 시행되었다 (43.4%, 53.2%). 1998년 이전에는 수술이 가장 많이 사용되는 치료 방법이었으나 이후 점차 감소하여 2004-2005년에는 수술-보조 방사선 요법과 수술-보조 항암화학 요법이 가장 많이 사용되고 있으며 수술-보조 항암화학-방사선 요법도 두 배 이상 증가하였다. 전체 환자의 5년 생존율은 81.3%였으며 병기 1기 환자의 생존율은 89.0%, 각 분화도에 따라 각각 96.0%, 92.0%와 80.0%로 나왔다. 1998년 이전에는 생존율이 77.0%였으나 이후는 생존율이 증가하여 83-88%로 나타났으며 2000-2001년에는 88.0%로 가장 높게 나타났다. 결론: 자궁 내막암의 생존율은 최근 15년간의 비교에서 향상되고 있으며 치료방법도 변화하고 있다. 자궁 내막암의 생존율 향상을 위해서는 유전인자, 환경 요인 등을 포함한 자궁 내막암의 발병 기전 규명 및 위험 인자들에 대한 역학 연구가 병행되어야 할 것이다. Objective: This study was performed to evaluate the overall survival and the change in treatment modalities in patients with uterine endometrial cancer in Korea. Methods: From January 1990 to March 2005, medical records of 740 patients with endometrial cancer in nine hospitals were reviewed. The overall survival was determined supported by the death statistics of Korea National Statistical Office. Results: The mean age of patients was 51.5 years (range: 21-82 years). The mean gravidity and parity were 3.3 and 2.1 (range: 0-18, 0-9), respectively. The most common stage, grade and histological type at diagnosis were FIGO stage I, grade 1 and endometrioid adenocarcinoma (76.5%, 56.4% and 87.2%), respectively. The main treatment modalities was surgery on stage I (59.8%), surgery-adjuvant radiotherapy on stage II (55.1%), surgery-adjuvant radiotherapy or surgery-adjuvant chemoradiation on stage Ⅲ (38.3%) and surgery-adjuvant chemotherapy on stage IV (55.6%). The preferred treatment modality was surgery only on grade 1 (69.0%) and surgery-adjuvant radiotherapy on grade 2-3 (43.4% and 53.2%). Surgery had been the most common method of therapy before 1998 but its prevalence gradually decreased. As a result, surgery-adjuvant radiotherapy and surgery-adjuvant chemotherapy were most widely performed in 2004-2005 and surgery-adjuvant chemoradiation also increased more than a twofold. The overall 5 years survival rate (5YSR) for all 740 patients was 81.3%. The overall 5YSR of stage I was 89.0%. The overall 5YSR of grade 1, grade 2, grade 3 were 96.0%, 92.0%, 80.0%. Before 1998, the survival rate was 77.0%. Since then it increased to 83-88% and in 2000-2001 it increased to 88.0%, and it was the highest survival rate. Conclusion: The survival rate of endometrial cancer has been improving for the past 15 years and the method of treatment is also being changed currently. In order to improve the survival rate of endometrial cancer, a close investigation including genetic and environmental factors of the pathophysiology of endometrial cancer along with the epidemiology of risk factors, should be carried out.