• Advances in pediatric surgery
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• 제5권1호
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• pp.1-14
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• 1999

Among 60 children with teratoma, forty-three (71.7 percent) were girls and 17 (28.3 percent) boys, Primary sites were sacrococcygeal in 30 patients (50 percent), retroperitoneal in 12 (20 percent), ovarian in 11 (18.3 percent), testicular in 3 (5 percent), and one in each of nasopharyngeal, gastric, hepatic and pancreatic (1.6 percent, respectively). Fifty-five (91.7 percent) teratomas were benign and 5 (8.3 percent) malignant. Malignant teratomas W8,re detected only in the sacrococcygeal region (16.7 percent). Age greater than 2 mouths at diagnosis, presence of urinary or colonic obstructive symptoms, multiple masses and elevated serum alpha-fetoprotein were indicators of malignancy in the sacrococcygeal region. Tumor size, presence of calcification, and gross apperance (cystic or solid) did not correlate with malignancy. Thirteen (21.7 percent) cases were associated with other anomalies. For the immature teratoma, operative resection without adjuvant chemotherapy was adequate treatment. Three patients with malignant tumors survived, one who received chemotherapy survived 3 years and the others without chemotherapy survived for 5 and 10 years.

• Asian Pacific Journal of Cancer Prevention
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• 제16권7호
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• pp.3003-3007
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• 2015

Objective: To explore the application of multiplex nested methylated specific polymerase chain reaction (PCR) in the early diagnosis of epithelial ovarian carcinoma (EOC). Materials and Methods: Serum and fresh tissue samples were collected from 114 EOC patients. RUNX3, TFPI2 and OPCML served as target genes. Methylation levels of tissues were assessed by multiplex nested methylated specific PCR, the results being compared with those for carcinoma antigen 125 (CA125). Results: The serum free deoxyribose nucleic acid (DNA) methylation spectrum of EOC patients was completely contained in the DNA spectrum of cancer tissues, providing an accurate reflection of tumor DNA methylation conditions. Serum levels of CA125 and free DNA methylation in the EOC group were evidently higher than those in benign lesion and control groups (p<0.05). Patients with early EOC had markedly lower serum CA125 than those with advanced EOC (p<0.05), but there was no significant difference in free DNA methylation (p>0.05). The sensitivity, specificity and positive predicative value (PPV) of multiplex nested methylated specific PCR were significantly higher for detection of all patients and those with early EOC than those for CA125 (p<0.05). In the detection of patients with advanced EOC, the PPV of CA125 detection was obviously lower than that of multiplex nested methylated specific PCR (p>0.05), but there was no significant difference in sensitivity (p>0.05). Conclusions: Serum free DNA methylation can be used as a biological marker for EOC and multiplex nested methylated specific PCR should be considered for early diagnosis since it can accurately determine tumor methylation conditions.

• Asian Pacific Journal of Cancer Prevention
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• 제15권16호
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• pp.6749-6754
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• 2014

Background: There are limited data in the literature related to concomitant genital or extra-genital organ pathologies in patients with borderline ovarian tumors (BOTs). The aim of this study was to evaluate our experience with 183 patients to draw attention to the accompanying organ pathologies with BOTs. Materials and Methods: One hundred eighty-three patients with BOTs, diagnosed and/or treated in our center between January of 2000 and March of 2013 were evaluated retrospectively. Data related to age, tumor histology, lesion side, disease stage, accompanying incidental ipsilateral and/or contralateral ovarian pathologies, treatment approaches, and follow-up periods were investigated. Incidental gynecologic and non-gynecologic concomitant organ pathologies were also recorded. Results: The mean age at diagnosis was 40.6 years (range: 17-78). Ninety-five patients (51%) were ${\leq}40$ years. A hundred and forty-seven patients (80%) were at stage IA of the disease. The most common type of BOT was serous in histology. Non-invasive tumor implants were diagnosed in 4% and uterine involvement was found 2% among patients who underwent hysterectomies. There were 12 patients with positive peritoneal washings. Only 17 and 84 patients respectively had concomitant ipsilateral and concomitant contralateral incidental ovarian pathologies. The most common type of uterine, appendicular and omental pathologies were chronic cervicitis, lymphoid hyperplasia and chronic inflammatory reaction. Conclusions: According to our findings most of accompanying pathologies for BOT are benign in nature. Nevertheless, there were additional malignant diseases necessitating further therapy. We emphasize the importance of the evaluation of all abdominal organs during surgery.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.713-717
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• 2016

Background: To evaluate the prevalence and features of other gynecologic or surgical lesions in endometrial cancer (EMC) patients. Materials and Methods: Clinico-pathological data of EMC patients who were treated in the institution from 1995 to 2012 were collected. Data collected were age, stage of disease according to the FIGO 2009 criteria (FIGO), histopathology, tumor grade, adjuvant therapy, other gynecologic or surgical lesions, follow-up period, and living status. Results: The mean age of 396 patients was $56.7{\pm}10.64years$. Abnormal uterine bleeding was the most common presenting symptom (90.1%). Bleeding was accompanied with pelvic mass in 7.7% and 5.4% had only a pelvic mass. Abnormal cervical cytology was found in 3.8%. Approximately 75% had early stage diseases and 86% had endometrioid histology. We found 55.8% of EMC patients had other gynecologic lesions: 89.6% benign and 9.5% malignant. Some 4.5% had pre-invasive cervical/vulva/vagina lesions. The two most common gynecologic lesions were myoma uteri and ovarian tumors. Focusing on the latter, approximately 14% were benign while 8% were malignant. Among 364 patients with available data, surgical lesions were found in 11.8%, 5.7% benign and 9.2% malignant. The most common benign surgical condition was chronic appendicitis while breast and colon cancers were the two most common malignant lesions found. Conclusions: More than half of EMC patients had other gynecologic lesions including benign and malignant tumors. Surgical lesions were also found in more than one-tenth of patients. Careful pre-operative evaluation and intra-operative inspection are advised for proper management and better prognosis.

• Journal of Yeungnam Medical Science
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• 제18권2호
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• pp.293-296
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• 2001

Mature cystic teratomas, commonly called dermoid cysts, are the most common benign germ cell tumors of ovary in women of reproductive age. Mature cystic teratoma that constitutes 10-25% of ovarian tumors and 95% of teratoma, is germ cell tumor of the ovary. This occurs frequently in women less than 20 years old, but it can be found upto 10-20% in postmenopausal women. And in women over the age of 50, a mature cystic teratoma is likely to change into malignant form. Traditional surgical methods of mature cystic teratoma treatment include transabdominal cystectomy, oophorectomy, hysterectomy and(or) bilateral salphingooophorectomy. Recently laparoscopic approach replaces transabdominal surgeries in many cases. Vaginal removal of mature cystic teratoma is unique and rare. Compared with laparotomy, transvaginal approach is characterized by shorter hospital stay and lower morbidity rate. Compared with laparoscopic operation, transvaginal approach has advantages of no visible operative scar and lower intra-operative tumor spillage. The decision for surgical methods is related with patients' situations and surgeon's preference. We report 1 case of vaginal removal of mature cystic teratoma as a part of vaginal hysterectomy in old age patient.

• Nuclear Medicine and Molecular Imaging
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• 제42권3호
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• pp.201-208
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• 2008

목적; 복부 전산화단층촬영(CT) 및 종양표지자와 비교를 통하여 자궁경부암 및 난소암의 재발을 진단하고 치료에 대한 반응을 평가하는데 FDG를 이용한 양전자단층촬영(PET)이 어떤 역할을 하고 있는지 알아보고 앞으로 환자의 주요 추적검사방법이 될 수 있는지에 대해 알아보고자 하였다. 대상 및 방법; 2006년 5월 1일부터 2007년 10월 31일 사이에 FDG-PET를 시행한 환자 중 비슷한 시기에 복부 CT를 시행 받은 67명 환자 103예를 대상으로 하였다(자궁경부암 42예, 난소암 51예). PET, CT 및 혈중 종양표지자에 대한 판독을 후향적으로 서로 비교하였다. 세 검사에서 모두 양성을 보이거나 추적검사상 병변이 커지거나 조직검사 및 기타 검사에서 양성을 보일 때를 재발이라고 정의하여 세 검사방법의 판독에서의 차이를 분석하였다. 자궁경부암군과 난소암군으로 나누어 PET와 복부 CT 종양 표지자에 대한 진단의 민감도, 특이도, 양성 및 음성예측도를 알아보았다. 결과; 재발로 진단된 예는 37예였다. 자궁경부암에서 재발로 진단되었던 경우가 11예(9명)였으며 민감도는 각각 100%(11/11), 54.5%(6/11), 81.1%(9/11)로 PET가 가장 높았고, 특이도는 각각 93.6%(29/31), 93.6%(29/31), 100% (31/31)로 종양표지자가 가장 높았다. 난소암의 재발 진단은 26예(15명)였으며 민감도는 각각 96.2%(25/26), 84.6% (22/26), 80.8%(21/26)로 PET가 가장 높았고, 특이도는 세 검사에서 94.3%(33/35)로 동일하였다. CT에 비하여 PET에서 복강내 전이를 6예를 더 진단하였고 4예의 종격동임파절 및 폐전이를 더 진단할 수 있었으며 2예의 쇄골상와임파절과 1예의 액와임파절의 전이를 더 진단하였다. 재발환자의 분석에서 PET는 복부 외 장기의 재발을 발견할 수 있었고 복부내 재발의 경우에도 CT보다 더 민감하게 재발부위를 찾을 수 있었던 반면 CT의 도움 없이는 정확한 위치 측정이 어려웠다. CT는 잔여종양과 양성섬유화의 구분 및 조직간의 경계부위에서 종양의 구분이 어려웠고 복부 이외 장기의 전이를 발견할 수 없었다. 결론; PET는 자궁경부암과 난소암 진단에서 CT에 비해 적용 부위가 크고 조직 대조도가 커 민감도가 높은 검사법으로서 치료 후 잔여 종양의 여부나 재발을 진단하는 데 필수적이 검사법이 될 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권11호
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• pp.5445-5450
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• 2012

Although benign uterine leiomyomata (LMA) is the most common reproductive tumor in premenopausal women, its etiology is largely unknown. We aimed in the present study to demonstrate the potential role of environmental factors with estrogenic activity in tumor etiology by focusing on the role of aryl hydrocarbon receptor (AhR) which mediates the effects of many environmental endocrine disruptors and contributes to the loss of normal ovarian function in polluted environments. This case-control study aimed to compare the interactions between AhR and lifestyle factors in a clinical setting for the first time among 138 newly diagnosed LMA patients and 138 normal controls who lived in Tehran and Mashhad, respectively, during the last 10 years. To conduct immunohistochemical studies using appropriate monoclonal antibodies, 30 cases were selected retrospectively from 2009-2011 from the pathology departments of two university hospitals in Tehran. Although the levels of sex steroid receptors were similar in adjacent myometrium and uterine leiomyomas of all cases, AhR was significantly overexpressed (p=0.034, OR=1.667) in uterine LMA and this overexpression was correlated with living in Tehran [(p=0.04, OR=16 (1.216-210.58)], smoking[P=0.04, OR=2.085 (1.29-3.371)], living near polycyclic aromative hydrocarbon producing companies [p=0.007, OR=2.22 (1.256-3.926)] and eating grilled meat [p=0.042, OR=1.28 (1.92-3.842)]. Our study contributes to the understanding of the effects of EDCs on AhR levels as well as women's health and points out possible risk factors for the development and growth of uterine LMA. It seems that the development of LMA could be the result of interactions between hormonal and environmental factors.

• Investigative Magnetic Resonance Imaging
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• 제17권4호
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• pp.326-333
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• 2013

$H^1$ 자기공명분광술에서 악성 종양은 양성 병변보다 더 높은 농도의 대사물질들을 보여준다. 락테이트의 이중 첨단점은 악성 종양과 자궁내막증에서 나타났으며, 자궁내막증에서 더 높은 농도를 보였다. 자궁관난소농양과 난관염은 분명한 첨단점이 보이지 않는다. 유피낭종은 높은 수준의 지질 첨단점이 나타난다. 부난관 낭종 및 난포낭도 지질 첨단점을 보일 수 있지만, 지질의 농도는 유피낭종보다 현저히 낮다. $H^1$ 자기공명분광술은 낭성 난소병변의 대사 물 성분에 대한 유용한 정보를 제공할 수 있다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권5호
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• pp.1949-1953
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• 2014

Background: CA125 and HE4 are used in calculating Risk of Malignancy Algorithm (ROMA); and Risk of Malignancy Index (RMI). However, studies showed that normal levels of CA125, and HE4 differ among ethnicities such as between Asians and Caucasians, thus affecting the accuracy of the RMI score and ROMA in predicting ovarian malignancy. This study aimed to determine whether new or modified cutoff values for Ca125, HE4, the RMI score, and ROMA resulted in a better prediction of malignancy compared with the previous or standard ones. Materials and Methods: Serum level of CA125 and HE4 from 128 patients with diagnosis of ovarian tumor that had been collected before surgery at Cipto Mangunkusumo General Hospital (CMH) in Jakarta from November 2010 until May 2011 were reviewed and analysed. The standard cutoff values of these biomarkers, RMI, and ROMA were modified by using logistic regression model. The modified cutoff values were compared to the standard cutoff values in terms of sensitivity, specificity, and accuracy. Results: The modified cutoff value of CA125, HE4, RMI score and ROMA were 165.2 U/mL, 103.4 pM, 368.7, 28/54. The sensitivity and specificity of the modified cutoff values CA125, HE 4, RMI score and ROMA in differentiating benign from malignant and borderline were 67% and 75,4%; 73.1% and 85.2%; 73.1% and 80.3%; and 77.6% and 86.9%. While the sensitivity and specificity of the standard cutoff value of CA125; HE4; RMI score; and ROMA were 91% and 24.6%; 83.6% and 65%; 80.6% and 65.6%; and 91.0% and 42.6%. The accuracy of modified cutoff values compared with standard cutoff values were: 71.2% vs 59.3%, 78.9% vs 75% vs, 76.5% vs 73.4%, and 82% vs 67.9%. Conclusions: The new or modified cutoff values of Ca125, HE4, RMI score and ROMA resulted in higher accuracy compared to the previous or standard ones, at the cost of reduced sensitivity.

• Clinical and Experimental Pediatrics
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• 제54권5호
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• pp.224-227
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• 2011

A sclerosing stromal tumor of the ovary is an extremely rare benign tumor; it usually is found during the second and third decades of life. Patients present with pelvic pain or a palpable abdominal mass. Hormonal effects such as masculinization are uncommon. Here, an 11-year old premenarchal girl presented with deepening of the voice. In addition, clitoromegaly and hirsutism with a male suprapubic hair pattern were observed. The laboratory findings showed that the testosterone level was elevated to 3.67 ng/ml, andostenedione to above 10 ng/ml, dehydroepiandrosterone-sulfate to 346 ${\mu}g$/dl and 17-hydroxy progesterone (17-OHP) to 11.28 ng/ml. The chromosome evaluation revealed a 46,XX female karyotype. An adrenocorticotropic hormone stimulation test was performed. The 17-OHP to cortisol ratio in 30 minutes was 0.045, which suggested a heterozygote for the 21-hydroxylase deficiency. However, the CYP21A2 gene encoding steroid 21-hydroxylase showed normal. The pelvic ultrasound showed a heterogeneous mass consisting of predominantly solid tissue in the pelvic cavity. The pelvic magnetic resonance imaging revealed an $8.9{\times}6.2{\times}6.6$ cm mass of the left ovary. A left oophrectomy was performed and microscopic examination confirmed a sclerosing stromal tumor. Immunohistochemical studies showed that the tumor was positive for smooth muscle actin and vimentin, but negative for S-100 protein and cytokeratin. Following surgery, the hormone levels returned to the normal range and the hirsutism resolved.