자궁경부암

이효표,Lee, Hyo-Pyo 한국건강관리협회 1994 건강소식 Vol.18 No.10

최신임상강좌 : 한국 부인암의 현황: 1991~2004년까지의 동향

이효표 ( Hyo Pyo Lee ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.12

Korean Society of Obstetrics and Gynecology estimates the number of new gynecologic cancer cases and deaths expected in Korea in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the Gynecologic Cancer Registry Program every one or two years. Recently, gynecologic cancer registry gathering clinical data in 2005~2006 is in progress. In this article, we provide an overview of cancer statistics, including recent trends in gynecologic cancer incidence, mortality, and survival rates from 1991 through 2004.

Radiotherapy of Recurrent Uterine Cervical Cancer

하성환,박찬일,채규영,강순범,이효표,신면우,Ha Sung Whan,Park Charn Il,Chai Kyu Young,Kang Soon Beom,Lee Hyo Pyo,Shin Myon Woo The Korean Society for Radiation Oncology 1987 Radiation Oncology Journal Vol.5 No.2

수술후 골반강내에 국소재발된 자궁경부암의 진단하에 1979년부터 1984년까지 6년 간 서울대학교병원 치료방사선과에서 방사선치료를 시행한 47명의 환자에 대하여 후향적 분석을 시행하여 다음과 같은 결과를 얻었다. 1. 방사선치료 후 완전관해를 보인 환자는 35명으로 완전관해율은 $74.5\%$이었다. 2. 완전관해를 보인 35명중 7명에서 국소재발 또는 원격전이를 보여 전체적으로 19명 $(40.4\%)$의 환자에서 치료실패를 나타내었다. 3. 4년 무병생존을 및 전체생존율은 각각 50.1 및 $55.2\%$이었다. 4. 병소의 범위를 자궁경부암에 적응되는 FIGO병기 결정기준에 의하여 분류한 결과 각 병기에 따른 4년 생존율은 IIa기에서 $80.4\%$, IIb기에서 $73.0\%$, IIIb기에서 $25.0\%$, IVa기에서 $0\%$이었다. 따라서 수술 후 골강내에 국소재발된 자궁경부암의 경우 적절한 방사선치료를 시행함으로써 좋은 결과를 얻을 수 있음을 알 수 있었다. Forty seven patients with locally recurrent uterine cerival cancer after surgery were treated with radiation during the 6 year period from 1979 through 1984 at the Department of Therapeutic Radiology of Seoul National University Hospital. In 30 out of the 47 patients, recurrence was diagnosed within 2 years after surgery. Site of recurrence was vagina in 19 patients, vagina and parametrium in 21 patients and parametrium only in 7 patients. Complete tumor control was achieved in 35 patients $(74.5\%)$; the complete response rates were $94.7\%(18/19)$ in vaginal recurrences, $57.1\%(12/21)$ in combined vaginal and parametrial recurrences and $71.4\%(5/7)$ in parametrial recurrences. Overall and disease free survival rates at 4 years were 55.2 and 50.1 percent, respectively, for entire group. Overall 4 year survival rates were $77.0\%$ for vaginal recurrences, $44.1\%$ for vaginal and parametrial recurrences and $42.9\%$ for parametrial recrrences. When the disease extent was classified in the same way as the staging system of FIGO, the 4 year survival was 80.4, 73.0, 25.0 and 0 percent for stage IIa, IIb, IIIb and IVa, respectively.

자궁경부 상피내종양 및 자궁경부암 조직에서 bcl-2 및 c-myc 암유전자 발현과 세포증식 및 apoptosis와의 상관관계에 관한 연구

김병기(Byoung Gie Kim),이효표(Hyo Pyo Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

bcl-2 prevents cell death from a wide variety of stimuli and provides survival of cells with accumulated genetic alterations and c-myc can promote both cell proliferation and cell death through the transcriptional regulation of target genes. Although several studies have been reported on the expression of bcl-2 or c-myc separately, little has been known about the role of coexpression of bcl-2 and c-myc to cell proliferation and apoptosis, as well as the frequency of these coexpression in cervical cancer specimens. In this study, we have examined the expression of bcl-2 and c-myc in cervical cancer specimens and cervical intraepithelial neoplasia(CIN) to determine the role of coexpression of bcl-2 and c-myc during progression into cervical cancer. Proteins and transcripts of bcl-2 and c-myc were evaluated by immunohistochemistry in 60 clinical specimens(20 cervical cancer, 30 CIN, and 10 normal cervix). In addtion, we evaluated kinetic indices of cell proliferation and apoptosis simultaneously. The cell proliferation index was determined by detection of the Ki- 67 in immunohistochemistry. Apoptotic index was determined by the detection of apoptotic cells with TUNEL staining. Medical records including pathologic reports were reviewed. Overexpression of bcl-2 and c-myc was identified in 7(35%) and 10(50%) of 20 cervical cancer specimens respectively, but none in normal cervix and CIN samples. In addition, coexpression of bcl-2 and c-myc was found in 5(25%) of 20 cervical cancer specimens. The cell proliferation index increased with progression from normal to CIN and invasive cancer(normal cervix, 10.2; CIN 1, 24.1; CIN 2/3 59.7; cervical cancer, 71.2; p <0.01). The apoptotic index also increased with grade of lesions(normal cervix, 0; CIN 1, 0.33; CIN 2/3, 1.85; cervical cancer, 3.89; p <0.01) and showed a significant correlation with proliferation index(r=0.7451, p=0.0002). However, there was no significant difference in apoptotic index between bcl-2 positive and bcl-2 negative group in cervical cancer(p=0.4765). In addition, there was also no significant difference in cell proliferation between c-myc positive and c-myc negative group(p=0.6891). Furthermore, there was no significant difference in cell proliferation and apoptosis between bcl-2 and c-myc positive group and others in cervical cancer(p=0.6311 and p=0.7600 respectively). The well-known clinicopathologic parameters, including tumor diameter, FIGO clinical stage, lymph node metastasis, did not correlate with simultanuos positive immunoreactivity for bcl-2 and c-myc proteins in cervical cancer. In conclusion, the cell proliferation and apoptosis increase with increasing lesion grade of cervical neoplasia and apoptosis correlates with cell proliferation. In addition, overexpression of bcl-2 and/or c-myc may be genetic alteration found only in cervical cancer and may not play a role in the development and progression of CIN. However, neither bcl-2 nor c-myc immunoreactivity correlated with the proliferation index or apoptotic index. These results suggest that other factors may also play a role in controlling the cell proliferation and apoptosis of cervical cancer.

난소 섬유종과 포막종의 호르몬 분비능에 관한 연구

이숭덕,서진석,한영미,김정란,서정욱,함의근,이효표,Lee, Soong-Deok,Suh, Jin-Suk,Han, Young-Mee,Kim, Jung-Ran,Seo, Jeong-Wook,Ham, Eui-Keun,Lee, Hyo-Pyo 한국현미경학회 1989 Applied microscopy Vol.19 No.1

Six cases of ovarian fibrous stromal neoplasm were studied clinically, light microscopically and ultrastructurally for the clinico-pathological evidences of hormone production. Of the six cases, two cases were fibroma, three cases were fibrothecoma, and one case was thecoma. Two cases of fibroma and one fibrothecoma were associated with clinical history of menstrual abnormality, however fat staining of the tumor was negative or weakly positive. Two cases of fibrothecoma and one thecoma were negative for the clinical history of hormone imbalance. Fat stain of those cases revealed positive in varying intensity. Ultrastructural examination of fibroma-thecoma group revealed dark and pale cells by their nuclear characteristics. The dark cells had indented nucleus and abundant cytoplasmic organelles of rough ER, Golgi apparatus and mitochondria. Intracytoplasmic cisternal spaces were seen in the dark cell cytoplasm and some lipid droplets were seen around the cisternae. Pale cells had pale swollen nucleus and fine chromatins. Their cytoplasm showed scanty amount of organelles. Fibroma-thecoma spectrum showed varying degree of population of dark cells, light cells and intervening collagenous stroma. Lipid droplet was structurally associated with intracytoplasmic cisterna and they were frequently seen in thecoma and two of the fibrothecoma. But clinical history of hormone imbalance was poorly related to the light microscopic morphology and ultrastructural organization.

한국인 여성에서 자궁경부암의 위험요인에 관한 환자-대조군 연구

구혜원,유근영,김동현,송용상,박노현,강순범,이효표,안윤옥,이채언,Koo, Hye-Won,Yoo, Keun-Young,Kim, Dong-Hyun,Song, Yong-Sang,Park, No-Hyun,Kang, Soon-Beom,Lee, Hyo-Pyo,Ahn, Yoon-Ok,Lee, Chae-Un 대한예방의학회 1996 예방의학회지 Vol.29 No.2

A hospital-based case-control study was carried out to investigate the risk factors of uterine cervical cancer in Korea. Information on a wide-range of life-styles, which might be related with uterine cervix cancer, has been routinely collected through a dual application of the self-administered questionnaire and the direct interview by a well-trained nurse at the Department of Gynecology, Seoul National University Hosiptal since 1992. The number of cervical cancer cases, histologically confirmed at the hospital, were 284. Included were 939 women as controls, who were free of past history of any malignancies. Adjusted odds ratio and 95% confidence limits were based on the unconditional logistic regression model. The multivariate logistic model was constructed under the consideration of biologic characteristics on the natural history of the malignancy. In the multivariate results, the uterine cervical cancer risk was higher in women of shorter height$(P_{trend}<0.05)$, less educated spouse$(P_{trend}<0.001)$(0.001), multiple marriages(adjusted OR=2,70, 95% C.I. $1.64\sim4.47$), ever had a family history (adjusted OR=2.14., 95% C.I. $1.18\sim3.89$), multiparity$(P_{trend}<0.001)$, and early age at first $(P_{trend}<0.001)$. These results strongly suggest that the uterine cervix cancer might be related to the reproductive factors, and probably with sexual behaviour of both women and men in Korea.

천골부에 재발한 후복막강 신경초종

오경준 ( O Gyeong Jun ),박노현 ( Park No Hyeon ),성효숙 ( Seong Hyo Sug ),김재원 ( Kim Jae Won ),송용상 ( Song Yong Sang ),강순범 ( Kang Sun Beom ),이효표 ( Lee Hyo Pyo ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.1

Retroperitoneal Schwannomas are mostly benign encapsulated neoplasms originating from the Schwann cells of the retroperitoneal peripheral nervous systems. They are rare, but when the tumors occur, they can be large and difficult to diagnose because of a w

한국인 자궁경부암에서 인유두종 바이러스 16 형 E6 , E7 서열 변이 분석 및 면역조절 유전자 발현과의 상관관계

김재원(Jae Won Kim),박인애(In Ae Park),이효표(Hyo Pyo Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.11

Objectives : As one of the possible mechanisms of viral evasion in the HPV-infected cervical cancer cells, the role of amino acid sequence change in epitope region has not been reported yet. In this study, sequence variations of HPV 16 E6, E7 gene, especially focused on epitope region, were analysed, the status of immunomodulatory factors were documented, and finally the possible correlation between the sequence variations and the loss of HLA class I expression was examined. Methods : The entire ORF(open reading frame)s of HPV 16 E6, E7 were sequenced by the fluorescent dideoxy termination method. In addition proteins and transcripts of HLA-ABC, β2-microglobulin(β2-m), TAP (transporter associated with antigen processing), and LMP(large multi-functional proteasome) were evaluated by immunohistochemistry and RT-PCR, respectively in 40 clinical specimens of primary cervical cancer and 6 cervical cancer cell-lines. Medical records including pathologic reports were reviewed. Results : Among the 27 cases confirmed as harboring HPV 16 DNA, only one(3.7%) found as a prototype. Among 11 kind of variants identified in total, 4 variants(5 nucleotide sites) which were never reported before has been found, registered firstly to GenBank. The most frequently found one(16 cases, 59.3%) contains D25E, N29S in E6, E7 region, respectively and the most common variation in E6, E7 ORFs found concurrently(P<0.05). Down-regulation of HLA-ABC and β2-m was identified in 32(86.5%) and 35 cases(89.7%), respectively and transcripts of TAP, LMP were identified in over 85% of cases. However, there was no significant difference in HPV 16 infection, D25E in E6 and so on between HLA-ABC, β2-m positive and negative groups. The well-known clinicopathologic parameters did not correlate with sequence variations and immunomodulatory factors. Five sequence variations in HPV 16 E6, E7 ORFs that were not previously reported worldwide were found, registered firstly to GenBank. Conclusion : It seems that multiple mechanisms are operated in down-regulation of HLA class I molecules and the phenotypic profile of immunomodulatory factors seems to be unrelated in vivo to the naturally occurring HPV 16 E6, E7 variations in epitope region.

부인과 질환에서의 진단적 복강경술의 임상적 효용성 - 1994~2005년까지의 8.335예와 이전 11.665예와의 비교 -

강순범 ( Soon Beom Kang ),정현훈 ( Hyun Hoon Chung ),이효표 ( Hyo Pyo Lee ),이진용 ( Jin Yong Lee ),장윤석 ( Yoon Seok Chang ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.3

바르톨린선의 선양낭포성암 2 예

김선미(Sun Mie Kim),김건우(Kun Woo Kim),이정렬(Jung Ryeol Lee),이효표(Hyo Pyo Lee),강순범(Soon Bum Kang) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.2

We report two cases of adenoid cystic carcinoma of Bartholin's gland. One of these patients had positive margin on operation and is scheduled for adjuvant radiotherapy. The other was first diagnosed 13 years ago and presented with her second recurrence without distant metastasis. Adenoid cystic carcinoma of the Bartholin's gland is a rare tumor of the vulva. When diagnosed, the treatment should be individualized to the patient. When the surgical margin is found to be positive, adjuvant radiotherapy seems to be beneficial.