D Y Chang

National Taiwan University Hospital, T’ai-pei, Taipei, Taiwan

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Publications (24)52.24 Total impact

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    ABSTRACT: To determine which clinicopathological factors influence the prognosis of cervical adenocarcinoma. Three hundred and two cases of primary adenocarcinoma of the uterine cervix, treated between 1977 and 1994, were studied retrospectively. Clinical data and pathological findings with respect to primary therapy were reviewed and evaluated. The 5-year survival rates for stages I, II, and III/IV were 75.9, 62.9, and 25.1%, respectively. International Federation of Gynecology and Obstetrics stage (P < 0. 0001), cell type (P = 0.0176), tumor grade (P = 0.023), lymph node status (P = 0.018), and bulky tumor (P = 0.007) were found to be independent factors using the stepwise Cox proportional hazards model. Old age (P = 0.0581), presence of hypertension (P = 0.46), diabetes mellitus (P = 0.18), obesity (P = 0.15), and oral contraceptive use (P = 0.42) were not found to adversely influence survival rates for cervical adenocarcinoma after adjusting for other covariates. Adenosquamous adenocarcinoma had a better prognosis than endocervical columnar cell adenocarcinoma in stages I and II (P = 0. 0235). Also, in cervical adenocarcinoma's early stages, multivariate modeling revealed that chances of survival were significantly better for patients treated by radical surgery than for patients treated by radiation therapy (P < 0.001). Survival rates for cervical adenocarcinoma were significantly influenced by stage, histologic subtype, tumor grade, the presence of a positive lymph node, and tumor size. Although a randomized prospective study is needed, our data imply that radical surgery may be considered a better primary modality of treatment than radiation therapy for the early stages of cervical adenocarcinoma. Further, the presence of hypertension, diabetes mellitus, or obesity may not adversely influence survival rates.
    Gynecologic Oncology 06/1998; 69(2):157-64. · 3.93 Impact Factor
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    ABSTRACT: Adenomyosis confined to the broad ligament is extremely rare. Herein we present a case of adenomyosis in the broad ligament with unusual gross features. This 41-year-old woman had been on tamoxifen therapy for 3 years due to breast cancer. Ten months after discontinuing tamoxifen, she underwent exploratory laparotomy for a right adnexal mass suspected as ovarian malignancy. At laparotomy, the mass was located in the right broad ligament with a fibrous stalk connecting to the uterus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathologic examination revealed adenomyosis with cyst formation and an unusual thick capsule. The possible effects of tamoxifen upon the uterus are discussed in this article, in view of reports of tamoxifen associated with endometrial carcinoma and endometriosis.
    Journal of Obstetrics and Gynaecology Research 03/1997; 23(1):69-73. · 0.84 Impact Factor
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    D Y Chang, R J Chen, S C Lee, S C Huang
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    ABSTRACT: Evaluation of human papillomavirus (HPV) diversity in various grades of cervical lesions is helpful for understanding the characteristics of HPV infection in the pathogenesis of cervical neoplasia. A total of 227 women with normal cervices (n = 72), low- and high-grade cervical squamous intraepithelial lesions (SILs) (n = 55 and 53, respectively) and cervical carcinomas (n = 47) were screened for human papillomavirus (HPV) types 6, 11, 16 and 18 infection by the polymerase chain reaction. The prevalence of multiple HPV infections in patients with normal cervices, low-grade SILs, high-grade SILs and cervical carcinomas was 22.2%, 61.8%, 41.5% and 21.3%, respectively, while the prevalence of a single-type infection was 36.1%, 21.8%, 30.2% and 61.7%, respectively. HPV 16/11 and 16/18 were the most common combinations observed in multiple infections. Multiple HPV infections were seen most frequently in patients with low-grade SILs, and the prevalence decreased with increasing severity of cervical neoplasia. In contrast, infection with a single HPV type was most commonly observed in patients with cervical carcinoma, and the prevalence decreased with decreasing severity of cervical neoplasia. HPV 16 was the predominant single-type infection in patients with cervical carcinoma and this prevalence decreased steadily with decreasing severity of cervical neoplasia. Conversely, HPV 11 was the predominant single-type infection in patients with normal cervices. This prevalence decreased with increasing severity of cervical neoplasia. Patients with low-grade SILs had a higher prevalence of HPVs, regardless of single or multiple infection status, and larger copy numbers of virus genome were seen more frequently in patients with more severe lesions.
    Journal of Medical Microbiology 02/1997; 46(1):54-60. · 2.30 Impact Factor
  • C W Tsai, H H Lin, D Y Chang, S C Huang
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    ABSTRACT: Paget's disease of the vulva is uncommon and accounts for 1-5% of all vulvar neoplasms (1). Due to its rarity and different disease patterns, we present a clinicopathologic study of five cases seen at our hospital from 1977 to 1995.
    Acta Obstetricia Et Gynecologica Scandinavica 12/1996; 75(10):946-9. · 1.85 Impact Factor
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    ABSTRACT: Although in the English literature, much has been published about ovarian teratoma, no large series has been reported in Taiwan. Therefore a retrospective study of 283 consecutive cases of mature cystic teratomas of the ovary, operated at National Taiwan University Hospital between 1988 and 1993, was undertaken. This series was based on a retrospective chart study at the Department of Obstetrics and Gynecology of the National Taiwan University Hospital from 1988 to 1993. All cases included in this study were proven by pathology review. The clinical data, pathology and complications are summarized. The incidence of mature cystic teratoma was 32.6% of primary ovarian neoplasm. As for the age distribution, the youngest patient was 12 years old and the oldest, 76. The largest number of cases was found in patients between the ages of 20 and 30 years; the mean age was 35.4 years. Pain, the most common complaint, was noted in 48.1% of the cases in whom it varied from a dull ache to the sharp, stabbing pain of torsion. Of greater interest was an unexpectedly high incidence (16.6%) of asymptomatic cysts found on routine physical examination. The right ovary was involved in 51.2%, the left ovary in 40.6% and bilateral ovaries were involved in 8.2%. The incidence of torsion was 9.2%, and was the highest in all complications. Ten concurrent pregnancies were noted, an incidence of 3.5%. The incidence of malignant transformation was 0.7%, with a pathology of squamous cell carcinoma. Mature cystic teratom is the most common germ cell tumor and accounts for about 33% of all ovarian neoplasm They occur primarily during the reproductive years, but may occur in the postmenopausal period or in childhood. A cystic teratoma can undergo malignant transformation; it occurs most frequently in postmenopausal women, and the prognosis is poor. However, it is a rare complicaiton, with an incidence less than 1%.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 11/1996; 58(4):269-74.
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    ABSTRACT: Adenocarcinoma in situ (AIS) of the uterine cervix is a rare disease. Some authors suggested that conization is a suitable treatment for AIS as for squamous cell carcinoma in situ. However, others did not agree. Four cases of AIS, from 1984 to 1994, have been diagnosed in the Hospital of National Taiwan University. If the diagnosis of the conization specimen showed AIS, abdominal total hysterectomy was performed days thereafter. The remaining uterine cervix was checked by histopathology to determine whether it was free of cancer lesions. AIS lesions remained in the uterine cervix, as shown by conization in two cases. AIS is not like lesion as squamous cell carcinoma in situ lesion which is easy to be removed by conization. It is suggested that conization is not an adequate treatment for AIS, rather, a total hysterectomy should be performed.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 11/1996; 58(4):294-8.
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    ABSTRACT: To evaluate the status of cone margins and the severity of cervical neoplasia as predictors of residual lesions in the remaining cervices. We performed a 7-year retrospective study and reviewed 172 patients who had undergone cervical conization followed by subsequent hysterectomy. Pathological findings of the cone margins and residual lesions in the postcone hysterectomy specimens were recorded for analysis. The prevalence rates of positive cone margins were 0, 18.6, 23.8, and 25%, respectively, in patients with low-grade squamous intraepithelial lesion (SIL) (n = 6), high-grade SIL (n = 129), stage IA1 cervical cancer (CC-IA1) (n = 21), and CC-IA2 (n = 16). The prevalence rates of positive residual lesions in postcone hysterectomy specimens were 0, 23.3, 23.8, and 43.8%, respectively, in those with low-grade SIL, high-grade SIL, CC-IA1, and CC-IA2. Residual lesions were significantly more frequently found in patients with positive cone margins (84.8%) than in those with negative margins (10.1%) (X2 = 76.81, P < 0.0001). All six patients with low-grade SIL had free cone margins. Positive predictive values of margin status for the presence of residual lesions were 83.3, 80, and 100%, respectively, in patients with high-grade SIL, CC-IA1, and CC-IA2. Only two (6.1%) of 33 patients with positive cone margins had more advanced residual lesions. Negative predictive values of margin status for the absence of residual lesions were 100, 90.5, 93.8, and 75%, respectively, in patients with low-grade SIL, high-grade SIL, CC-IA1, and CC-IA2. None of the 139 patients with negative margins had invasive residual lesion. (1) The prevalence of positive cone margin and residual lesion increased with higher severity of cervical neoplasia. (2) Patients with positive cone margins had significantly higher chances of having residual lesion than those with negative margins. (3) Free cone margin does not ensure the absence of residual lesion in the remaining cervix. However, the possibility of residual invasive cancer in the remaining cervix is remote. (4) Positive cone margin does not invariably indicate the presence and persistence of more severe residual lesion. Subsequent hysterectomy may be reserved for the patient with invasive cone pathology, the patient with concomitant morbid uterine condition, or the patient who is not reliable for continuous follow-up.
    Gynecologic Oncology 10/1996; 63(1):53-6. · 3.93 Impact Factor
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    ABSTRACT: To identify risk factors for cancer recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation. One hundred and eighty-seven patients with cervical carcinoma stage IB (n = 63), IIA (n = 43), and IIB (n = 81) disease who received abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation were followed-up for 2-10 years. The histologic type, grade, lymphovascular tumor emboli, tumor size, invasion sites, deep cervical stromal invasion, and pelvic lymph node metastases were assessed for correlation with cancer recurrence. Recurrence occurred in 45 cases (24%), of whom 40 had died of the disease at the 5-year follow-up period. Univariate proportional hazards analysis revealed that the significant risk factors were adenocarcinoma, bulky tumor size (4 cm or greater), lymphovascular tumor emboli, deep cervical stromal invasion, and lymph node metastases, especially iliac nodal metastases and bilateral nodal metastases. Multivariate proportional hazards analysis showed that bulky tumor size (hazard ratio 2.34), tumor emboli (hazard ratio 2.74) and iliac nodal metastases (hazard ratio 5.31) remained significant risk factors. In contrast, no deaths occurred in the other 142 cases who did not have recurrence. This retrospective study suggests that stage IB, IIA, and IIB cervical carcinoma cases with the above-mentioned pathologic factors are at higher risk of recurrence after abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelvic irradiation.
    Obstetrics and Gynecology 09/1996; 88(2):274-9. · 4.80 Impact Factor
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    ABSTRACT: Acardius is a rare occurrence in monozygotic multiple pregnancies. Triplet pregnancy composed of an acardiac fetus and a pair of conjoined twins is even more rare. The outcome of the acardius is invariably fatal, and the mortality rate of the other fetuses ranges between 50% and 70%. Perinatal mortality results mainly from complications of twin-twin transfusion syndrome. Intrauterine fetal death, caused by an umbilical cord accident, with twisting of the acardius's cord around the fused cords of conjoined twins is reported in this present work. An acardius should be thoroughly sought when monochorionic multiple pregnancies are found by ultrasound during prenatal care. The complications of pregnancy caused by an acardiac fetus can be avoided by using proper management.
    The Journal of reproductive medicine 07/1996; 41(6):459-62. · 0.75 Impact Factor
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    ABSTRACT: Cervical carcinoma spreads predominantly by lymphatic routes and lymph node metastases may occur even in early stages of disease. Metastases usually first appear in pelvic lymph nodes, then disseminate along the efferent lymphatic chain to the extrapelvic lymph nodes. Cases of positive lymph node metastases with negative pelvic nodes in invasive cervical carcinoma are extremely rare. We report a 50-year-old woman with bulky stage IIA cervical carcinoma who had scalene lymph node metastases in the absence of pelvic lymph node metastases after radical hysterectomy and postoperative pelvic irradiation. This rare "skipping" nodal metastasis was probably via posterior trunk lymphatic drainage of the bulky cervical carcinoma which mainly invaded the posterior vaginal cuff. Neoadjuvant or adjuvant chemotherapy is recommended to prolong survival of patients in such cases.
    Journal of the Formosan Medical Association 02/1996; 95(1):73-5. · 1.00 Impact Factor
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    ABSTRACT: An association between human papillomavirus (HPV) and cervical neoplasia has been widely reported and HPV DNA is commonly detected in cervical carcinoma tissues. However, estimates of the prevalence of HPV infection differs among various detection methods. Seventy cases of cervical carcinoma were screened for HPV 16 infection by Southern blot hybridisation (SBH) and nested polymerase chain reaction (PCR). According to SBH, the prevalences of HPV 16 DNA in stage I (n = 40) and stage II (n = 30) cervical carcinomas were 52.5 and 63.3%, respectively, and the overall prevalence was 57.1% (40 of 70). By nested PCR, the prevalences of HPV 16 infection in stage I and II cervical carcinomas were 87.5 and 93.3%, respectively, and the overall prevalence was 90.3%. The prevalence of HPV DNA detected by nested PCR was significantly greater than that detected by SBH. The combined concordance of positive and negative results between SBH and nested PCR was 61.4%. The discrepancy resulted mainly from 25 cases (35.7%) that were positive by PCR but negative by SBH. A small copy number of HPV DNA in the these 25 cases was documented by a semi-quantitative PCR method. The nested PCR was more sensitive than SBH and detected cases with low amounts of HPV DNA. The detection of HPV infection varied between these two prevailing detection methods and this should be kept in mind in assessing various epidemiological data concerning HPV infection.
    Journal of Medical Microbiology 01/1996; 43(6):430-5. · 2.30 Impact Factor
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    ABSTRACT: Our aim was to identify independent factors that correlated with colposcopically directed biopsy's reliability as a method for diagnosing early cervical cancer. One hundred ninety-one of a total of 2265 patients who had colposcopic examinations because of abnormal Papanicolaou smears were included in this study. These patients had all undergone a hysterectomy after being diagnosed as having cervical intraepithelial neoplasia grade III by colposcopically directed biopsy. By univariate analysis, old age (P = 0.0195), achievement of menopausal status (P = 0.0046), large lesion size (P = 0.0021), and unsatisfactory colposcopy (P = 0.0017) were found to be associated with the nondiagnosis of early cervical cancer. However, multivariate analysis using stepwise logistic regression revealed that large lesion size (P = 0.003) and unsatisfactory colposcopy (P = 0.0008) were the only independent factors that correlated with nondiagnosis. Our findings indicate that in order to reach a clear-cut diagnosis, cases with either unsatisfactory colposcopy or satisfactory colposcopy with large lesions (despite a lack of histologic evidence of invasions) should undergo a diagnostic conization.
    Gynecologic Oncology 10/1995; 58(3):356-61. · 3.93 Impact Factor
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    ABSTRACT: To remind gynecologists of the diagnosis of adenomatoid tumor of the female genital tract, a pathology which is often mistaken for leiomyoma, and in addition to warn of the malignant appearance of adenomatoid tumor. During the study period from January 1988 to May 1994, the clinical features and pathologic findings of 25 cases of adenomatoid tumor of the female genital tract were reviewed at the National Taiwan University Hospital. The age of the patients ranged from 26 to 55 years with a median of 41 years. Adenomatoid tumor was an incidental finding during the surgical treatment of myoma (16 cases), cervical intraepithelial neoplasm (two cases), invasive cervical cancer (one case), adnexal cyst (five cases), and pregnancy with myoma (one case). Twenty-three cases had tumors in the uterine corpus and two in the fallopian tubes. Twenty percent of the patients had multiple tumors. Their sizes ranged from 1.0 to 8.0 cm. The case with the largest tumor measuring 8 cm in diameter is presented in detail. Its histologic, immunohistochemical and ultrastructural characteristics strongly support the mesothelial origin of adenomatoid tumor. Some different results were obtained than those hitherto reported in the literature, such as younger age, frequency of multiple tumors, and fewer cases accompanied by leiomyomas.
    International Journal of Gynecology & Obstetrics 10/1995; 50(3):275-80. · 1.84 Impact Factor
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    ABSTRACT: A postmenopausal woman with torsion of the left ovarian mucinous cystadenoma with borderline malignancy is reported. Extremely elevated serum tumor markers such as carcinoembryonic antigen (CEA) (398.0 ng/mL, normal < 3.0 ng/mL), carbohydrate antigen 19-9 (CA 19-9) (240 U/mL, normal < 37 U/mL) and tissue polypeptide antigen (TPA) (1,918 U/L, normal < 110 U/L) were found preoperatively. Imaging studies such as ultrasound and computed tomogram favored a diagnosis of ovarian malignancy, and advanced ovarian cancer was suspected prior to operation. Diagnosis of borderline malignancy was first made by frozen section during laparotomy. The patient recovered following simple total hysterectomy and bilateral salpingo-oophorectomy. Serum levels of the tumor markers became normal gradually following operation. To present knowledge, this is the first reported case with extremely high serum tumor markers in a postmenopausal woman with torsion of a stage-Ia ovarian mucinous cystadenoma of borderline malignancy. Rapid release of these tumor markers into circulation secondary to necrosis and degeneration of the tumor cells following torsion might account for such an unusual finding.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 04/1995; 55(3):278-82.
  • D Y Chang, M Y Wu, S C Huang
    International Journal of Gynecology & Obstetrics 03/1995; 48(2):227-9. · 1.84 Impact Factor
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    ABSTRACT: Solitary tumors of the broad ligament are rare. The most frequent solid tumor of the broad ligament is leiomyoma. Leiomyosarcoma of the broad ligament (LBL) is an extremely rare malignant tumor. Nine cases of leiomyosarcoma of the broad ligament had been reported previously. A 59-year-old woman with LBL is reported. Treatment consisted of resection and total abdominal hysterectomy with bilateral salpingo-oophorectomy. No evidence of metastasis is noted after 12 months follow-up. We conclude that the management of LBL is excision of the leiomyosarcoma as completely as possible and postoperative adjuvant chemotherapy.
    Gynecologic Oncology 02/1995; 56(1):85-9. · 3.93 Impact Factor
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    ABSTRACT: Our study aims to make differential diagnosis by immunoelectrophoresis for some common conditions with elevated levels of serum alpha-fetoprotein (AFP). One hundred and nine cases with elevated AFP levels were included in this study: yolk sac tumor (n = 8), hepatocellular carcinoma (n = 26), gastric cancer (n = 12), chronic hepatitis (n = 27) and normal pregnancy (n = 36). Lectin agarose gel electrophoresis, antibody-affinity blotting, and immunoreaction were used to identify the specific patterns of AFP in the respective conditions. The results showed that there were three possible bands: L1, L2 and L3. Yolk sac tumor produced a prominent L2 band and a light L3 band. Hepatocellular carcinoma produced a prominent L1 band and a light L3 band. Gastric cancer produced only an L1 band. Chronic hepatitis had a light L1 band and a pronounced L3 band. In pregnancy, the AFP pattern is similar to that of hepatocellular carcinoma. Immunoelectrophoresis is a useful method facilitating the differentiation of AFP origins.
    Acta Oncologica 02/1995; 34(7):931-5. · 2.87 Impact Factor
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    ABSTRACT: The application of loop electrosurgical excision procedure (LEEP), a new method of conization of the uterine cervix used to diagnose cervical intraepithelial neoplasia (CIN) or cervical cancer is presented herein. A loop electrode consists of a thin wire that allows deep excision of the transformation zone (TZ). The cone-shaped tissue removed can be examined histologically. Over a period of one year, a total of 41 cases underwent LEEP. Without anesthesia, the patients did not have any noticeable pain during the procedure. There were no complications, such as fever, wound infection, massive bleeding or cervical stenosis. In low-grade CIN, follow-up colposcopy and cytology did not show persistence or recurrence. In two cases of high-grade CIN, subsequent hysterectomy revealed residual lesions on hysterectomized specimens. LEEP is a simple and quick procedure of diagnostic conization that can be done at the first visit without major complication. If the histopathology after LEEP is moderate- to high-grade CIN or invasive cancer, the conization cannot be regarded as a sufficient therapeutic procedure, and such a patient needs further treatment.
    Journal of the Formosan Medical Association 04/1994; 93(3):196-9. · 1.00 Impact Factor
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    ABSTRACT: It is recognized that a significant number of patients with vulvar neoplasia have had previous, concurrent, or subsequent genital tract neoplasia. This has resulted in speculation that there may be a common etiology and, in particular, of the possibility of an infection element. Among 59 cases of vulvar cancer diagnosed at the National Taiwan University Hospital from 1976 to 1991, there were seven cases (12%) associated with other primary malignancies. Carcinoma of the cervix was the most frequent other primary cancer (6/7, 86%). The possible role of human papilloma virus infection in genital neoplasia is discussed.
    Journal of the Formosan Medical Association 09/1993; 92(8):772-4. · 1.00 Impact Factor
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    ABSTRACT: Wild-type (wt) p53 acts as a tumor suppressor, while certain mutant type (mt) p53 may exhibit 'oncogenic' function. We have recently demonstrated that human papillomavirus type 18 (HPV-18) E6 can partially overcome the growth-suppressive effects of wt p53, but it remains unclear what role p53 plays in cervical carcinogenesis. In this report, we have examined nine HPV-immortalized human cervical epithelial cell lines and 13 HPV-positive and two HPV-negative primary cervical cancers for p53 mutations by polymerase chain reaction--single-strand conformation polymorphism (PCR-SSCP). None of them contained p53 mutations in exons 5-9 where most p53 mutations in human tumors have been found. The entire p53-coding region of the two HPV-negative cervical cancers was sequenced and no mutations were noted. In order to examine the effects of wt p53 and mt p53 on HPV-immortalized human cells, we transfected HPV-immortalized cell lines with wt p53 and a mt p53 (mtp53Val-135). The results indicate that HPV-immortalized cells cannot tolerate large amounts of exogenous wt p53, while mt p53Val-135 can enhance transformation of these cells. The results support the notion that inactivation of wt p53 by E6 may be important for HPV-associated transformation and also suggests that mt p53 can act as an oncogene in HPV-immoralized human cells.
    Oncogene 07/1993; 8(6):1511-8. · 7.36 Impact Factor