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Preoperative diagnosis of Gastrointestinal Stromal Tumors (GISTs) in the small intestine is often delayed until complications such as hemorrhage, bowel obstruction or perforation develop. Such GISTs are usually asymptomatic and tumor perforation is an uncommon clinical presentation. In this report, we review the diagnosis, pathology and treatment of a 32-year-old male with a perforated GIST in the jejunum who presented with symptoms of acute abdomen. Abdominal computed tomography (CT) showed a ruptured huge tumor with inhomogeneous density in the small intestine. The patient underwent a complete tumor excision and jejunal segmental resection. A histopathological examination of the tumor confirmed that it was a GIST. Postoperatively, the patient received medical treatment, using oral Imatinib 400 mg daily for 10 months without any signs of disease recurrence. Prognosis is worse in ruptured GISTs and in these cases, complete surgical resection of the tumor must be followed by adjuvant therapy with Imatinib. [ABSTRACT FROM AUTHOR]

To compare the nutritional quality of TPG (Teleaulax / Plagioselmis / Geminigera) clade species of cryptomonads with that of RHO (Rhodomonas / Rhinomonas / Storeatula) clade species 6 Teleaulax amphioxeia (TA) and 1 Rhinomonas sp. strains were mass-cultured in newly designed 500-L photobioreactors to the end of exponential growth phase. Intraspecific variations (IVs) in terms of one standard deviation among the 6 TA strains in the compositions of the three macronutrients were 41.5 (protein), 89.8 (lipid), and 15.6% (carbohydrate) of the mean. When harvested from stationary growth phase mean compositions of essential amino acids (EAAs, 47.3%) and non-EAAs (52.7%) of the 2 TA strains, CR-MAL07 and CR-MAL08-2, were similar to those of a Chroomonas strain. The IVs between the 2 TA strains in the composition of EAAs (10.3 and 2.4) and non-EAAs (8.5 and 2.1% of the mean) were rather smaller than those of saturated fatty acids (30.3 and 26.1) and unsaturated fatty acids (UFAs, 12.0 and 12.5% of the mean) in f/2-Si and urea-based compound fertilizer (UCF) culture media, respectively. Mean compositions of eicosapentaenoic acid (EPA, 17.9%) and docosahexaenoic acid (DHA, 12.7%) of total fatty acids of the 2 TA strains were higher than those that of a Chroomonas strain. EPA and DHA compositions exhibited similar level of IVs between the 2 TA strains in f/2-Si (14.6 and 11.0) and UCF media (12.6 and 13.5% of the mean). Thus, the nutritional quality in terms of amino acids, UFAs, EPA, and DHA in a TPG clade species, T. amphioxeia was comparable to those of RHO clade species with notable IVs. Practically, biotechnological targets for TPG clade cryptomonad strains might be subspecies or clone level. [ABSTRACT FROM AUTHOR]

Objective: Extramammary Paget's disease (EMPD) of the vulva is a rare disease which predominantly presents in postmenopausal Caucasian women. As yet, no studies on Asian female patients with EMPD have been performed. This study aimed to identify the clinical features of patients with vulvar EMPD in Korea, and to evaluate the risk factors of recurrence and postoperative complications in surgically treated EMPD. Methods: We retrospectively reviewed 47 patients with vulvar EMPD who underwent wide local excision or radical vulvectomy. The clinical data and surgical and oncological outcomes following surgery were extracted from medical records and analyzed. Univariate and multivariate analyses for predicting recurrence and postoperative complications were performed. Results: 21.3% of patients had complications after surgery, and wound dehiscence was the most common. 14.9% of patients experienced recurrence, and the median interval to recurrence from initial treatment was 69 (range 33-169) months. Vulvar lesions larger than 40 mm was the independent risk factor of postoperative complications (odds ratio [OR]=7.259; 95% confidence interval [CI]=1.545-34.100; p=0.012). Surgical margin status was not associated with recurrence in surgically treated vulvar EMPD patients (OR=0.83; 95% CI=0.16-4.19; p=1.000). Conclusion: Positive surgical margin is a frequent finding in the patients with vulvar EMPD, but disease recurrence is not related with surgical margin status. Since EMPD is a slow growing tumor, a surveillance period longer than 5 years is required. [ABSTRACT FROM AUTHOR]

Objective: We investigate a real-world feasibility of whether clinical trial participation impacts overall survival in women with advanced recurrent cervical cancer. Methods: This study was a retrospective study conducted at a single institution, and was conducted on patients with advanced or recurrent cervical cancer from August 2018 to November 2023. A total of 75 patients were included in three types of phase 2 trials and five phase 3 clinical trials. Survival analysis was conducted in three types of phase 3 trials that allowed comparative analysis. Results: Among the 75 patients enrolled in the clinical trial and available for analysis, 51 patients were enrolled in the phase 3 trial. Survival analysis was conducted on 37 patients in three phase 3 clinical trials in which comparative analysis was possible. In the three phase 3 trial data available for comparative analysis, there were no significant differences between the study group and the control group in age, (mean 55 vs. 48 years, p=0.125), histological classification (p=0.564), stage (p=0.286), and previous treatments (surgery: p=0.286, radiation: p=0.478, chemotherapy: p=0.513, respectively). On univariate analysis, the study group was associated with significantly improved OS from the control group (median survival 27.1 vs. 8.7 months, hazard ratio=0.347; 95% confidence interval=0.138-0.877; p=0.007). Conclusion: This study shows that patients with advanced or recurrent cervical cancer improve their survival rate when they participate in clinical trials, which is considered to be good evidence for patients to actively participate in clinical. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prognostic impact of L1 celladhesion molecule (L1CAM), β-catenin, estrogen receptor (ER), and progesterone receptor (PR) in early-stage endometrial cancer (EC) patients undergoing fertility-sparing management, aiming to refine risk assessment beyond the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE). Methods: This retrospective study analyzed EC patients treated at a single center (January 2011-December 2020). In this study, patient categorization was achieved using immunohistochemical (IHC) staining to detect mismatch repair (MMR) proteins and p53. Simultaneously, DNA polymerase epsilon (POLE) mutations were identified through hotspot sequencing with droplet digital polymerase chain reaction. The study also measured L1CAM, β-catenin, ER, and PR expression levels through IHC staining and assessed the complete response (CR) rate and progression-free survival (PFS) in each subgroup. Results: Out of 104 patients, one exhibited a POLE mutation, another showed mismatch repair deficiency (MMRd), and a third had a P53 abnormality, leaving 101 with no specific molecular profile (NSMP). A correlation was observed between β-catenin positivity and a higher rate of CR (p=0.022). Further analysis of PFS in the 64 patients who achieved CR revealed that L1CAM is a negative prognostic factor for PFS (p=0.039). Positivity for β-catenin, ER, and PR did not show a link to recurrence. Conclusion: β-catenin emerges as a positive marker for CR, and L1CAM as a negative prognostic factor for PFS in early-stage EC patients choosing fertility-sparing options. These results support incorporating these IHC markers into molecular classifiers like ProMisE for enhanced risk stratification and personalized treatment in EC. [ABSTRACT FROM AUTHOR]

Objective: To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer. Methods: We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010. Results: About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT. Conclusion: Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result [ABSTRACT FROM AUTHOR]

The article presents a study that compares the surgical and oncological outcomes pf laparoscopic radical hysterectomy and open radical hysterectomy in obese women with early-stage cervical cancer. It shows that the five-year overall survival rate was 97% for the laparoscopic radical hysterectomy group and 90% for the open radical hysterectomy group. It suggests that laparoscopic radical hysterectomey was a preferred alternative to open radical hysterectomy in obese women.

We analyzed recurrences with regard to symptom duration, volumetric excision, and surgical margin in 11 women with Paget's disease of the vulva. Data concerning demographics, surgical margin, and current state were collected. In addition, the three-dimensional excisional skin and lesion size was determined from surgical and pathology reports. Recurrence was observed in 6 women where the symptom duration was longer than in those without recurrence (33 vs. 11 months, p < 0.02). During the initial operation, the fraction of removed normal skin was 85.3% in all the women, and 79.8% (range 67–97%) in those with recurrence and 92.0% (range 86–96%) in those without ( p < 0.04). Of 11 women, 8 had positive margins of whom 4 developed recurrence and 4 did not. Of the 3 patients with negative margins, 2 experienced recurrence but the third did not ( p = 0.58). Recurrence was not associated with positive margins, but correlated with symptom duration and volumetric excision. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the effectives of human papillomavirus (HPV) test performed after cercix uteri conization in predicting residual disease in patients who underwent hysterectomy. It was found that the HPV test after conization was significantly more accurate than resection margin for predicting residual disease. It is noted that the predictive value of resection margin used for predicting residual disease was improved when used in combination with the HPV test.

Objective: We investigated the feasibility and safety of fertility-sparing surgery (FSS) in patients with epithelial ovarian cancer (EOC) with dense adhesions. Methods: Patients were divided into cases with and without dense adhesions in this retrospective study. Results: Of the 95 eligible patients, 29 patients had dense adhesions. Mean age, proportion of staging procedure, distribution of histologic type, and co-presence of endometriosis were different (p=0.003, 0.033, 0.011, and 0.011, respectively). The median follow-up period was 57.8 (0.4-230.0) months. There were no differences in the rates of recurrence (21.2% vs. 20.7%, p=1.000) or death (16.7% vs. 6.9%, p=0.332) between the 2 groups. There was no difference in the pattern of recurrence or in disease-free survival (DFS) and overall survival (OS) between the 2 groups. In multivariate analysis, pretreatment cancer antigen-125 >35 U/mL and International Federation of Gynecology and Obstetrics stage IC were significant factors of worse DFS and OS, while dense adhesion was not a prognostic factor for both DFS (hazard ratio [HR]=0.9; 95% confidence interval [CI]=0.3-2.7; p=0.792) and OS (HR=0.2; 95% CI=0.1-1.8; p=0.142), nor were age, proportion of staging procedure, histologic type, and co-presence of endometriosis. Moreover, the distribution of those 2 significant prognostic factors was not different between the 2 groups. Dense adhesions were subgrouped into nontumor and tumor associated dense adhesions for further analysis and the results were same. Conclusion: FSS is feasible and safe in EOC, regardless of the presence of dense adhesions. [ABSTRACT FROM AUTHOR]

Objective: To investigate the expression of androgen receptor (AR) and its correlation with disease status and survival outcome in uterine leiomyosarcoma with other hormone receptors. Methods: The medical records and paraffin blocks of 42 patients were reviewed. The immunohistochemical expression of AR, estrogen receptor (ER), progesterone receptor (PR), gonadotropin releasing hormone (GnRH), and cytochrome P450, family 19, subfamily A, polypeptide 1 (CYP19A1) were assessed using tissue microarray. Results: In total, AR expression was observed in 11 patients (26.2%). International Federation of Gynecology and Obstetrics (FIGO) stage and AR were independent factors for disease-free survival (DFS) in multivariate regression analysis (odds ratio [OR]=5.8; 95% confidence interval [CI]=1.2-28.4 and OR=0.2; 95% CI=0.05-0.90; p=0.029 and 0.032, respectively). There were no deaths in the AR expression group, whereas the 5-year overall survival (OS) was 54.8% in the no expression group (p=0.014). Co-expression of ER and/ or PR with AR was associated with significantly better 5-year DFS and OS than those with negative AR (72.7% vs. 28.6% and 100% vs. 64.3%; p=0.020 and 0.036, respectively). AR may be an independent prognostic marker regardless of ER/PR. Conclusion: AR can be a potential prognostic biomarker in uterine leiomyosarcoma. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prognostic value of metabolic parameters measured by preoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/ computed tomography (CT) in patients with uterine carcinosarcoma (UCS). Methods: Data of 55 eligible patients with UCS who underwent preoperative 18F-FDG PET/ CT and surgical staging were analyzed retrospectively. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV2.5), and total lesion glycolysis (TLG2.5) of the primary tumors were measured using a SUV threshold of 2.5. The optimal cutoff value of each parameter was determined by time-dependent receiver operating characteristic curve, and its impact on progression-free survival and overall survival was evaluated by Cox proportional hazards model. Results: During a median follow-up period of 29 (range, 1.5-109.4) months, 47.3% (26/55) of the patients experienced disease progression, and the disease-associated mortality rate was 43.6% (24/55). Univariate analysis determined that hazard ratios (HRs) for disease progression for SUVmax (≥8.33), MTV2.5 (≥63.92 mL), and TLG2.5 (≥396.16) were 1.930 (95% confidence interval [CI]=0.793-4.701), 3.264 (95% CI=1.466-7.268), and 2.692 (95% CI=1.224-5.924), respectively. And, HRs for death were 1.979 (95% CI=0.774-5.060), 2.764 (95% CI=1.217-6.274), and 2.721 (95% CI=1.198-6.182), respectively. While peritoneal cytology, histology, and tumor diameter were independent prognostic factors in multivariate analysis, MTV and TLG were not. Conclusion: Though MTV and TLG of primary UCS were not independent predictors compared to surgically obtained data, MTV and TLG of primary UCS may provide useful information on prognosis especially in patients who are not able to undergo surgical staging. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the efficacy and the safety of uterine preservation in patients with early-stage uterine adenosarcoma who want to preserve future fertility. Methods: We performed a retrospective review of patients with stage I uterine adenosarcoma diagnosed and treated at a single institute from 1998 through 2014. Results: Among the total of 31 patients, uterine preservation surgery was performed in 7 of the nulliparas. Of the 7 patients receiving uterine preservation surgery, 3 showed no evidence of disease (NED), 2 had persistent disease confined to the uterus, and 2 were alive with disease (AWD) after recurrence. One patient with an NED status had a vaginal delivery at term. In the uterine preservation group, 1 patient had sarcomatous overgrowth at the time of diagnosis and experienced disease recurrence. In the hysterectomy group, 3 of 24 patients had tumor recurrence. Of the five patients with tumor recurrence, four (80%) had sarcomatous overgrowth at diagnosis and it was significantly associated with recurrence by univariate analysis (OR 13.3, p = 0.027). Conclusions: Uterine preservation represents a possible treatment option for young female patients who want to maintain fertility. However, a detailed explanation of the risk of recurrence is necessary, especially in patients with sarcomatous overgrowth, which seems to be associated with a higher risk of recurrence. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare responses to single-agent chemotherapies and evaluate the predictive factors of resistance in low risk (LR) gestational trophoblastic disease (GTD). The chemotherapy agents included methotrexate (MTX) and actinomycin D (ACT-D). Methods: We conducted a retrospective study of 126 patients with GTD who were treated between 2000 and 2013. A total of 71 patients with LR GTD were treated with MTX (8-day regimen or weekly regimen, n=53) or ACT-D (bi-weekly pulsed regimen or 5-day regimen, n=18). The successful treatment group and the failed treatment group were compared and analyzed to identify prognostic factors. Results: The complete response rates were 83.3% for ACT-D and 62.2% for MTX, with no statistically significant difference. There was no severe adverse effect reported for either group. Longer interval durations from the index pregnancy (>2 months, p=0.040) and larger tumor size (>3 cm, p=0.020) were more common in non-responders than in responders; these results were statistically significant. Conclusion: Based on our results, ACT-D may be a better option than MTX as a first-line single chemotherapy agent for LR GTD. The bi-weekly pulsed ACT-D regimen had minimal, or at least the same, toxicities compared with MTX. However, due to the lack of strong supporting evidence, it cannot be conclusively stated that this is the best single agent for first-line chemotherapy in LR GTD patients. Further larger controlled trials will be necessary to establish the best guidelines for GTD treatment. [ABSTRACT FROM AUTHOR]

Objective To analyze the oncologic and reproductive outcomes of pediatric and young adolescents with malignant ovarian germ cell tumors (MOGCTs). Methods Pediatric or young adolescent girls aged 16 years or under with MOGCT were eligible for this study. Results Forty-two pediatric or adolescent girls with MOGCT met the inclusion criteria. The median age was 12 years (range, 6-16 years) and 29 patients were premenarchal. The most common histologic type was immature teratoma, and 30 patients (54.3%) had stage I MOGCT. All patients underwent fertility-sparing surgery, which was defined as the preservation of at least one adnexa and the uterus. No patient had residual disease after surgery. Thirteen patients had tumor spillage, two patients had a positive peritoneal cytology, and two patients had lymph node metastasis. After surgery, 31 patients received adjuvant chemotherapy with bleomyocin, etoposide, and cisplatin (BEP) (median, 4 cycles; range, 1-6 cycles). After a median follow-up time of 93 months (range, 22-217 months), six patients had a recurrence of the disease, and one patient died. The 5-year disease-free and overall survival rates were 85% and 97%, respectively. Among the surviving 41 patients, seven were premenarchal, 30 had regular menstruation, and three had irregular menstruation. No patient had premature ovarian failure. Conclusion All patients received uniform treatment consisting of fertility-sparing complete cytoreductive surgery followed by BEP chemotherapy. Regardless of histologic type and FIGO stage, the oncologic outcomes were excellent and the reproductive outcomes were favorable. [ABSTRACT FROM AUTHOR]

Objective Accurately predicting cytoreducibility in advanced-ovarian cancer is needed to establish preoperative plans, consider neoadjuvant chemotherapy, and improve clinical trial protocols. We aimed to develop a positron-emission tomography/computed tomography-based nomogram for predicting incomplete cytoreduction in advanced-ovarian cancer patients. Methods Between 2006 and 2012, 343 consecutive advanced-ovarian cancer patients underwent positron-emission tomography/computed tomography before primary cytoreduction: 240 and 103 patients were assigned to the model development or validation cohort, respectively. After reviewing the detailed surgical documentation, incomplete cytoreduction was defined as a remaining gross residual tumor. We evaluated each individual surgeon's surgical aggressiveness index (number of high-complex surgeries/total number of surgeries). Possible predictors, including surgical aggressiveness index and positron-emission tomography/computed tomography features, were analyzed using logistic regression modeling. A nomogram based on this model was developed and externally validated. Results Complete cytoreduction was achieved in 120 patients (35%). Surgical aggressiveness index and five positron-emission tomography/computed tomography features were independent predictors of incomplete cytoreduction. Our nomogram predicted incomplete cytoreduction by incorporating these variables and demonstrated good predictive accuracy (concordance index = 0.881; 95% CI = 0.838-0.923). The predictive accuracy of our validation cohort was also good (concordance index = 0.881; 95% CI = 0.790-0.932) and the predicted probability was close to the actual observed outcome. Our model demonstrated good performance across surgeons with varying degrees of surgical aggressiveness. Conclusion We have developed and validated a nomogram for predicting incomplete cytoreduction in advanced-ovarian cancer patients which may help stratify patients for clinical trials, establish meticulous preoperative plans, and determine if neoadjuvant chemotherapy is warranted. [ABSTRACT FROM AUTHOR]

Objective To compare outcomes after radical hysterectomy in patients with stage IB1 adenocarcinoma (AdCa) and adenosquamous carcinoma (AdSCCa) of the uterine cervix. Methods We performed a retrospective analysis of 265 patients with AdCa and 72 patients with AdSCCa. Demographic, clinicopathologic, surgical, and follow-up data were compared. Results There were no differences in demographic and clinicopathologic characteristics between the two histologic types (AdCa vs. AdSCCa). Only mean size of tumor and lymphovascular space invasion was larger and more frequent in AdSCCa (2.7 cm vs 2.3 cm, P = 0.019 & 29.2% vs 14.7%, P = 0.008). After a median follow-up time of 68 months, 39 (14.7%) and 13 (18.1%) AdCa and AdSCCa patients, respectively, had recurrent disease (P = 0.467), and 33 (12.5%) and 11 (15.3%) patients, respectively, died of their disease (P = 0.555). 5-year RFS rates were 89% and 85% (P = 0.582), respectively, and 5-year OS rates were 93% and 89% (P = 0.787). Histologic type had no clinical impact on RFS and OS in multivariate analysis adjusting for significant prognostic factors. There were no differences in pattern of recurrence and time to recurrence between the two histologic types. When patients were stratified into three risk groups according to the criteria of GOG protocols 92 and 109, histologic type had no clinical impact on RFS and OS in any of the risk groups. Conclusion There are no differences in clinicopathologic factors, patterns of recurrence, time to recurrence, RFS and OS between patients with AdCa and AdSCCa. [ABSTRACT FROM AUTHOR]

Background: Anterior gradient 2 (AGR2) has been implicated in tumor-associated phenotypes such as cell viability, invasion and metastasis in various human cancers. However, the tumor promoting activity of AGR2 has not yet been determined in biliary tract cancers. Thus, we examined the expression of AGR2 and its tumor-promoting activity in biliary tract cancer cells in this study. Methods: Expression of AGR2 mRNA and protein was analyzed by real time RT-PCR and western blotting, respectively. MTT assay was employed to measure cell viability and pulsed BrdU incorporation by proliferating cells was monitored by flow cytometry. Soft agar colony formation assay and transwell invasion assay were employed to determine anchorage-independent growth and in vitro invasion of the tumor cells, respectively. In vivo tumor formation was examined by injection of tumor cells into immunocompromised mice subcutaneously. Statistical analysis was performed with 2-tailed unpaired Student's t-test for continuous data and with one-way ANOVA for multiple group comparisons. Bonferroni tests were used for post hoc 2-sample comparisons. Results: AGR2 mRNA was detected in SNU-245, SNU-478, and SNU-1196 cell lines, and its protein expression was confirmed in SNU-478 and SNU-245 cell lines by western blot analysis. Knockdown of AGR2 expression with an AGR2-specific short hairpin RNA (shRNA) in SNU-478, an ampulla of Vater cancer cell line resulted in decreased cell viability and in decreased anchorage-independent growth by 98%. The AGR2 knockdown also increased the sensitivity of the cells to chemotherapeutic drugs, including gemcitabine, 5-fluorouracil and cisplatin. In addition, SNU-478 cells expressing AGR2-shRNA failed to form detectable tumor xenografts in nude mice, whereas control cells formed tumors with an average size of 179 ± 84 mm³ in 3 weeks. Overexpression of AGR2 in SNU-869 cells significantly increased cell viability through enhanced cell proliferation and the number of Matrigel™-invading cells compared with AGR2-negative SNU-869 cells. Conclusions: Our findings implicate that AGR2 expression augments tumor-associated phenotypes by increasing proliferative and invasive capacities of the ampulla of Vater cancer cells. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to estimate the reproductive outcome of young women with early-stage cervical cancer who underwent fertility-sparing laparoscopic radical trachelectomy (LRT). Methods: We performed a retrospective review of the medical records of patients with early-stage cervical cancer who underwent LRT. Clinicopathological data were obtained from patient medical records, and reproductive outcome data were obtained from patient medical records and telephone interviews. Results: Fifty-five patients who underwent successful LRT were included in this study. The median age of patients was 32 years (range, 22 to 40 years), and the median follow-up time after LRT was 37 months (range, 3 to 105 months). Menstruation resumed in all patients after LRT, with fifty patients (90.9%) and five patients (9.1%) reporting regular and irregular menstruation, respectively. Six patients (10.9%) presented with cervical stenosis, which was manifested by regular but decreased menstrual flow and newly-developed dysmenorrhea. These patients underwent cervical cannulation and dilatation. Eighteen patients (32.7%) attempted to conceive, with six out of 18 patients receiving fertility treatments. Fourteen pregnancies (i.e., four missed abortions, six preterm births and four full-term births) occurred in 10 patients after LRT. Nine out of 10 patients gave birth to 10 healthy babies. The pregnancy rate after LRT was 55.6% (10/18). The spontaneous abortion rate and live birth rate were 28.6% (4/14) and 71.4% (10/14), respectively. The preterm birth rate was 60% (6/10). Conclusion: Pregnancy and live birth rates after LRT were promising; however, the preterm birth rate was relatively high. Cervical stenosis also occurred in a small percentage of patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate the oncologic and pregnancy outcomes after oral progestin treatment of women of reproductive age with stage IA endometrial adenocarcinoma with stage IA, grade 1 differentiation with superficial myometrial invasion or stage IA, grade 2-3 differentiation with or without superficial myometrial invasion. METHODS: Medical records of 48 women (age 40 years or younger) with endometrioid adenocarcinoma of the uterus who met inclusion criteria and were treated conservatively with oral progestin were reviewed. Follow-up was performed primarily with imaging techniques followed by endometrial biopsy when indicated. RESULTS: The median age was 30 years (range, 23-40 years). Fourteen patients (29.2%) received daily oral megestrol acetate (median dose 160 mg per day, range 40-240 mg per day) and 34 (70.8%) received daily oral medroxyprogesterone acetate (median dose 500 mg per day, range 80-1,000 mg per day). Complete responses were observed for 37 patients (77.1%) after the median treatment duration of 10 months (range 3-20 months). Complete response rates were 76.5%, 73.9%, and 87.5% for patients with stage IA, grade 2-3 without myometrial invasion (n = 17), for patients with stage IA, grade 1 with superficial myometrial invasion (n=23), and for patients with stage IA, grade 2-3 with superficial myometrial invasion (n=8), respectively (P=.731). Recurrence rates for 37 patients who achieved complete response after a median follow-up time of 48 months (range 7-136 months) were 23.1%, 47.1%, and 71.4%, respectively (P=.104). None experienced disease progression or died of the disease. Nine patients gave birth to 10 healthy newborns. CONCLUSION:Progestin treatment appears to be reasonably effective for patients with stage IA, grade 2-3 differentiation without myometrial invasion and patients withstageIA grade1 differentiation withsuperficial myometrial invasion. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic submucosal dissection (ESD) is accepted as a treatment for gastric neoplasms and usually requires deep sedation. The aim of this study was to evaluate the safety and efficacy profiles of deep sedation induced by continuous propofol infusion with or without midazolam during ESD. Methods: A total of 135 patients scheduled for ESDs between December 2008 and June 2010 were included in this prospective study and were randomly assigned to one of two groups: the propofol group or the combination group (propofol plus midazolam). Results: The propofol group reported only one case of severe hypoxemia with no need of mask ventilation or intubation. Additionally, 18 cases of mild hypotension were observed in the propofol group, and 11 cases were observed in the combination group. The combination group had a lower mean total propofol dose (378 mg vs 466 mg, p<0.012), a longer mean recovery time (10.5 minutes vs 7.9 minutes, p=0.027), and a lower frequency of overall adverse events (32.8% vs 17.6%, p=0.042). Conclusions: Deep sedation induced by continuous propofol infusion was shown to be safe during ESD. The combination of continuous propofol infusion and intermittent midazolam injection can decrease the total dose and infusion rate of propofol and the overall occurrence of adverse events. [ABSTRACT FROM AUTHOR]

Background/Aims: Intussusception is uncommon in adults compared with children. The present study aimed to review our experience of adult intussusceptions and discuss the preoperative diagnosis and management. Methods: A retrospective review was performed for 25 patients, at least 18 years old. These patients were diagnosed as intestinal intussusceptions at Hallym University Sacred Heart Hospital from January 1999 to October 2010. Results: There were 14 male and 11 female with a mean age of 55 years. The most common symptom was abdominal pain. The preoperative diagnostic rate was 92% because of the use of an abdominal computed tomography (CT) and an ultrasound. A total of 9 (36%) patients had enteroenteric intussusception, 8 had ileocolic, 1 had ileocecal and 7 patients had colocolic intussusception. A discrete pathologic process was present in 22 (88%) patients and the remaining 3 (12%) patients were idiopathic. There were 12 small bowel lesions and 10 colonic lesions. Neoplasms were the most common etiology of intussusceptions. Of the cases with a defined colonic cause, 8 (80%) were malignant. Overall, 12 (48%) patients underwent primary resection of the intussusception without prior reduction, 11 (44%) patients had reduction of their intussusception followed by resection. Conclusions: Adult colonic intussusception is usually associated with malignancy. All patients with obstruction of unknown cause or lead point on CT should consider surgical exploration. [ABSTRACT FROM AUTHOR]

Objective. This study sought to determine if relative neutropenia (RN) following six cycles of paclitaxel/carboplatin could serve as a prognostic factor in patients with ovarian cancer. Design. A single institution, retrospective study. Setting. Tertiary academic referral center, Seoul, Korea Population. A total of 179 patients who underwent primary cytoreductive surgery, followed by six cycles of paclitaxel/carboplatin chemotherapy to treat epithelial ovarian cancer. Methods. Relative neutropenia was defined by an absolute neutrophil count < 1000 neutrophils/mm3 at chemotherapy cycle nadir. To eliminate the effects of dose reduction (DR) and schedule delay (SD) on the outcome of analysis, 49 patients who had this were excluded, and a subset analysis of 130 patients who received standard doses and schedules of chemotherapy was performed. Main outcome measures. Progression free and overall survival. Results. The median progression free survival (PFSs) of neutropenic and non-neutropenic patients was 34 and 22 months, respectively; the median overall survival (OS) times were 67 and 56 months, respectively, with no significant differences in PFS and OS ( p = 0.26, 0.59). Multivariate analysis revealed that stage, clear cell histology, and ≥1 cm residual tumor mass were independent prognostic predictors, while RN was not. In the subset analysis confined to the patients without DR and SD, the results were not changed. Conclusion. Chemotherapy-induced neutropenia was not a significant prognostic indicator in ovarian cancer patients treated with paclitaxel/carboplatin as first-line chemotherapy. [ABSTRACT FROM AUTHOR]

Objective. This study evaluated the reliability of magnetic resonance imaging (MRI) in assessing the absence of myometrial invasion in endometrial carcinoma patients, to identify candidates for conservative hormonal treatment. Methods. A total of 301 endometrial carcinoma patients who showed Stage I findings on preoperative MRI, and had received staging operations were reviewed retrospectively. We compared MRI findings of myometrial invasion with myometrial invasion levels reported by pathologists when surgical specimens were examined. Design. A descriptive study. Setting. Tertiary care gynecologic oncology clinic, Seoul, Korea. Population. A total of 301 endometrial carcinoma patients who showed Stage I findings on preoperative MRI, and had received staging operations. Main outcome measure. We compared MRI findings of myometrial invasion with myometrial invasion levels reported by pathologists when surgical specimens were examined. Results. Of 301 patients, 17 showed higher stages (FIGO Stages IIA through IIIC) on the final pathology of surgical specimen. Among the 284 patients with Stage I on histology reports, 124 showed no myometrial invasion on preoperative MRI (FIGO Stage IA). The negative predictive value (probability of absence of myometrial invasion) was 49.2%. MRI showed an accuracy of 59.2%, a sensitivity of 68.8%, a specificity of 74.4%, and an 86.9% positive predictive value, for myometrial invasion. Conclusions. MRI had a rather weak predictive value when used to assess absence of myometrial invasion. This should be borne in mind when choosing patients for conservative treatment of endometrial carcinoma. [ABSTRACT FROM AUTHOR]

Abstract  Clonorchiasis is associated with bile duct malignancy and the subsequent development of cholangiocarcinoma. Although this is likely caused by adult Clonorchis sinensis and its excretory–secretory products (ESP), the precise molecular mechanisms remain obscure. To evaluate the effect of C. sinensis infection on differential gene expression in host hepatocytes, we examined the kinetics of changes in gene expression in the human cholangiocarcinoma cell line HuCCT1 treated with ESP at different times. Using complementary DNA microarrays containing 23,920 human genes of known function, we initially identified 435 genes altered by ESP treatment. Of these, 31 were up-regulated and 35 were down-regulated more than twofold in a time-dependent manner following ESP treatment. Clustering of these genes by function revealed that several were involved in the cell cycle, oncogenesis, protein modification, immunity, signal transduction, cell structure, and developmental processes. These findings should provide a fundamental basis for further analysis of the molecular pathways and mechanisms involved in C. sinensis infection of host cells. [ABSTRACT FROM AUTHOR]

Objective. To investigate the efficacy of conization followed by conservative management for treating stage IA1 microinvasive carcinoma of the uterine cervix. Design/Setting. Retrospective study. Population. Seventy-five patients treated for stage IA1 microinvasive carcinoma of the cervix. Patients underwent conization followed by hysterectomy (Group 1, 53 patients), or were followed by conservative management (Group 2, 22 patients). Methods. Medical and histopathological record review. Results. For Group 1, pathology results showed that 30 had no residual tumor, one had cervical intraepithelial neoplasia (CIN) I, 11 had CIN III/cervical carcinoma in situ (CIS), nine had microinvasive carcinomas, and one had an invasive carcinoma (outcome for one patient not recorded). For Group 2, secondary procedures involved only cervical smears for 12 (48%) patients, of whom nine had normal cytology, one had low-grade squamous intraepithelial lesion and two had high-grade squamous intraepithelial lesions. For 13 (52%) patients in Group 2, secondary procedures involved repeat conization on whom six had no residual tumor, one had CIN II, four CIN III/CIS, and two microinvasive carcinoma and a negative resection margin. Therefore, conization followed by conservative management was an effective treatment for 90.9% (20/22) of Group 2. In neither group was recurrence recorded. There was no relation between lymphovascular invasion and follow-up cytology or pathology results, or between resection margin status and follow-up examination results. Conclusion. Conization alone with careful follow-up appears to be an effective and safe treatment for patients with stage IA1 microinvasive carcinoma of the uterine cervix, regardless of resection margins status or lymphovascular invasion. [ABSTRACT FROM AUTHOR]

To determine the dose-limiting toxicity (DLT) and activity of combination with docetaxel and S-1 on unresectable gastric cancer. Docetaxel was administered intravenously on day 1 and S-1 was administered orally on days 1–14, every 3 weeks. Doses of each drug in phase I study were docetaxel 60–75 mg/m2 and S-1 60–80 mg/m2. A phase II study was conducted with the recommended dose (RD) based on phase I. Sixty-five patients (median age 54 years) were enrolled. The DLTs were neutropenia with fever or stomatitis. The RD was docetaxel 75 mg/m2 and S-1 60 mg/m2. Two patients (aged 66 and 64 years) developed septic shock during the initial part of phase II study. A phase I study at lower dose (docetaxel 60 mg/m2 and S-1 80 mg/m2) was conducted for patients older than 60 years, and this dose was determined as the RD for these patients. In the phase II study, frequent grade 3/4 toxicities were neutropenia (47%) and febrile neutropenia (26%). The overall response rate was 50% (95% CI, 35–66%) and median survival was 15.3 months (95% CI, 10.0–20.6 months). Combination with docetaxel and S-1 was active against advanced gastric cancer and gave manageable toxicities. [ABSTRACT FROM AUTHOR]

To explore the feeding ecology of the Pfiesteria-like dinoflagellate (PLD) Luciella masanensis (GenBank Accession no. AM050344, previously Lucy), we investigated the feeding behavior and the kinds of prey species that L. masanensis fed on and determined its growth and ingestion rates of L. masanensis when it fed on the dinoflagellate Amphidinium carterae and an unidentified cryptophyte species (equivalent spherical diam., ESD=5.6 μm), which were the dominant phototrophic species when L. masanensis and similar small heterotrophic dinoflagellates were abundant in Masan Bay, Korea in 2005. Additionally, these parameters were also measured for L. masanensis fed on blood cells of the perch Lateolabrax japonicus and the raphidophyte Heterosigma akashiwo in the laboratory. Luciella masanensis fed on prey cells by using a peduncle after anchoring the prey with tow filament, and was able to feed on diverse prey such as cryptophytes, raphidophytes, diatoms, mixotrophic dinoflagellates, and the blood cells of fish and humans. Among the prey species tested in the present study, perch blood cells were observed to be the optimal prey for L. masanensis. Specific growth rates of L. masanensis feeding on perch blood cells, A. carterae, H. akashiwo, and the cryptophyte, either increased continuously or became saturated with increasing the mean prey concentration. The maximum specific growth rate of L. masanensis feeding on perch blood cells (1.46/day) was much greater than that of A. carterae (0.59/day), the cryptophyte (0.24/day), or H. akashiwo (0.20/day). The maximum ingestion rate of L. masanensis on perch blood cells (2.6 ng C/grazer/day) was also much higher than that of A. carterae (0.32 ng C/grazer/day), the cryptophyte (0.44 ng C/grazer/day), or H. akashiwo (0.16 ng C/grazer/day). The kinds of prey species which L. masanensis is able to feed on were the same as those of Pfiesteria piscicida, but very different from those of another PLD Stoeckeria algicida. However, the maximum growth and ingestion rates of L. masanensis on perch blood cells, A. carterae, H. akashiwo, and the cryptophyte were considerably lower than those of P. piscicida. Therefore, these three dinoflagellates may occupy different ecological niches in marine planktonic communities, even though they have a similar size and shape and the same feeding mechanisms. [ABSTRACT FROM AUTHOR]

The planktonic ciliate Parastrombidinopsis shimi n. gen., n. sp. is described from both living cells and quantitative protargol-stained (QPS) preparations and the sequence of the small subunit rDNA (SSU rDNA) is reported. This species is almost oval when the cells are alive; when stained, it is cylindrical for the upper two-fifths, half-bowl shaped for the middle two-fifths, and narrow rodshaped for the lower one-fifth. The ranges (and mean±standard deviation, n=20) of cell length, cell width, and oral diameter of living cells were 112–221 μm (168±39), 88–176 μm (121±30), and 53–110 μm (80±14), respectively, while those of the QPS-stained specimens (n=54) were 88–225 μm (162±29), 55–163 μm (102±19), and 53–98 μm (69±9), respectively. Thirty-six to 48 external oral polykinetids had cilia 25–40 μm long. However, unlike Strombidinopsis species sensu stricto, P. shimi has an external oral polykinetid zone that is an open circle. This species has two shorter polykinetids associated with the end of the oral polykinetid zone, deep in the oral cavity. Like Strombidinopsis species in the subclass Choreotrichia, 36–50 somatic kineties were equally spaced around the cell body and extended from the oral to the posterior regions with 68–105 dikinetids per kinety. Both kinetosomes of each kinetid bore cilia 3–10 μm long. Parastrombidinopsis shimi had 2 (1–4) ovoid macronuclei of 20–82 × 15–32 μm. When properly aligned, the sequence of the SSU rDNA of P. shimi (GenBank Accession No. AJ786648) was approximately 5% different from that of Strobilidium caudatum and 6% different from that of two Strombidinopsis species. Based both on morphology and gene sequence divergence, we establish this is as a new species in a new genus belonging to the family Strombidinopsidae. [ABSTRACT FROM AUTHOR]

Focuses on dinoflagellate Stoeckeria algicida from the Coastal Waters off Southern Korea. Morphology and small subunit ribosomal DNA gene sequence; Remarks on culturing behavior; Morphological characteristics.

Discusses the mixotrophy in the phototrophic harmful alga Cochlodinium (C.) polykrikoides and investigation of the kinds of prey species and the effects of prey concentration on the growth and ingestion rates of C. polykrikoides. Calculation of the grazing coefficients by the combination of field data on abundances of C. polykrikoides; Increase in growth rates of C. polykrikoides on a cryptophyte; Growth and ingestion rates of C. polykrikoides; Grazing impact of C. polykrikoides on populations of cryptophytes.

Colonoscopy is a good diagnostic tool and facilitates treatment of various colonic diseases. Nevertheless, it can induce many serious complications such as perforation and hemorrhage. Diverticulitis has also been reported as a serious complication of colonoscopy, with an incidence ranging from 0.04% to 0.08%. A 44-year-old male with chronic hepatitis B was presented with general weakness, myalgia, and febrile sensation. After admission for evaluation, pneumonia detected in the left upper and lower lobe and treated. We performed colonoscopy for screening and found multiple colonic diverticula in the right side of the colon. After 48 hours, the patient complained of abdominal pain and febrile sensation. Physical examination revealed tenderness in the right side of the abdomen. Abdomen-pelvis computed tomography showed bowel wall thickening of the cecum and ascending colon and multiple inflamed diverticula at the cecum with pericolic fat infiltration and fluid collection. We diagnosed the patient with acute diverticulitis after colonoscopy. Thereafter, he was treated with bowel rest and broad-spectrum intravenous antibiotics, and recovered. With a review of the relevant literature, we report a case of acute colonic diverticulitis as a complication of colonoscopy. [ABSTRACT FROM AUTHOR]

Background/Aims With the aging population, about 20% of patients diagnosed with colorectal cancer (CRC) are ≥80 years old. Elderly CRC patients tend to avoid standard treatment, especially curative surgical resection, due to concerns of surgical complications or underlying diseases. The aim of this study is to compare clinical characteristics and prognosis between patients who underwent surgical resection and who received supportive care, and to determine the usefulness of surgical treatment in elderly patients. Methods A total of 114 patients aged ≥80 years who were diagnosed with CRC between March 2007 and November 2017 were analyzed retrospectively. Of these patients, 73 patients underwent surgical resection for malignancy and 41 patients received supportive care. Clinicopathological factors and overall survival (OS) rates were compared. Results Surgical resection group had better Eastern Cooperative Oncology Group (ECOG) performance status and American Society of Anesthesiologists (ASA) physical status, and lower stage than supportive care group. The 3-year OS rate of surgical group was significantly higher than that of supportive group (60.7% vs 9.1%, p<0.001). In extreme- elderly patients (age ≥85 years), surgical group showed better 3-year OS rate than supportive group (73.9% vs 6.3%, p<0.001) although ECOG performance status and ASA physical status were not different. The postoperative mortality rate of elderly group and extreme-elderly group was 4.1% and 8.7%, respectively. In the analysis of risk factors related to survival, surgical resection was a good prognostic factor in both elderly group (hazard ratio [HR], 0.223; p=0.015) and extreme-elderly group (HR, 0.083; p=0.009). Conclusions Surgical treatment in elderly CRC patients showed survival benefit, even in the extreme-elderly patients. Surgical resection for CRC in elderly patients can be performed to improve survival. [ABSTRACT FROM AUTHOR]