Multicystic benign mesothelioma of the pelvic peritoneum presenting as acute abdominal pain in a young woman

Multicystic benign mesothelioma (MBM) of the peritoneum is a very rare condition. Since the first description of MBM in 1979, approximately 100 cases have been reported. This is a case report of MBM of the pelvic peritoneum presenting as acute abdominal pain in a young woman. Laparoscopy confirmed multiple grapelike clusters of cysts that originated in the peritoneum of the rectouterine pouch and histopathologic diagnosis was confirmed as MBM of the pelvic peritoneum. We hope to alert gynaecologists of the diagnostic and therapeutic approaches to MBM which can be accomplished by laparoscopy.

A case of placental abruption diagnosed at 31 weeks by ultrasonography in bicornuate uterus / 대한산부인과학회지

Placental abruption is defined as the early separation a normal placenta from the wall of the uterus before delivery of the fetus. The incidence of it is known 1% of all pregnancies and perinatal mortality rates from abruption range from 20% to 40% in recent studies. The most common symptom is vaginal bleeding. The causes are associated with preeclampsia, other hypertensive disorders, and premature rupture of membranes. It is diagnosed by clinical symptom, sign, and ultrasonography. Recently we have experienced a case of placental abruption diagnosed at 31 weeks by ultrasonography in bicornuate uterus with a brief review of the literature.

A case of primary restless leg syndrome aggravated by pregnancy / 대한산부인과학회지

Restless leg syndrome (RLS) is characterized by intense restlessness and unpleasant creeping sensations deep inside the lower legs, occurring during periods of rest, evening and night. These symptoms can be improved by movement. There are two different phenotypes of RLS. One early-onset form starts before 36 years old. It has mostly a familial history, severe symptoms, and highly genetically determined. And it is a highly dependent to iron level of the brain. The other delayed-onset form starts after 36 years old, mostly secondary, without familial history, with a rapid evolution in two or three years. And it is associated with frequent low ferritin level of serum. Pathophysiology of RLS remains incompletely understood. However, advanced studies suggest that RLS may be generated by dopamine dysfunction locally within the central nervous system. Dopaminergic agonists are the treatment of choice, if the symptoms are severe. And iron therapy improves RLS symptoms in iron deprived patients. Early detection during pregnancy is needed because RLS gives an important impact on sleep efficiency and quality of life. Recently we have experienced a case of primary RLS patient diagnosed at 24+3 weeks, treated by dopaminergic agonist ropinirole and iron. We describe this case with a brief review of the literature.

Urodynamic Characterization of Postmenopausal Women with Stress Urinary Incontinence: Retrospective Study in Incontinent Pre- and Post-menopausal Women / 대한폐경학회지

OBJECTIVES: To compare the urodynamic characteristics between pre- and post-menopausal women with stress urinary incontinence. METHODS: Forty premenopausal women and 44 postmenopausal women with stress urinary incontinenece were enrolled. All of the patients underwent a detailed history, gynaecologic examination, urinalysis and urodynamics including cystometry and pressure-flow analysis. RESULTS: There was no difference in the body mass index between the two groups. The mean age of pre- and post-menopausal women was 40.9 +/- 6.4 years and 62.1 +/- 9.4 years, respectively. The parity in postmenopausal women was greater than premenopausal women (2.8 +/- 1.2 vs 2.2 +/- 0.8, P = 0.026). The valsalva leak point pressure (VLPP) in postmenopausal women was lower than that in premenopausal women (106.4 +/- 30.3 vs 88.2 +/- 25.1 cmH2O, P = 0.04). The maximal urethral closure pressure (MUCP) in postmenopausal women was lower than premenopausal women (44.9 +/- 21.4 vs 77.4 +/- 32.2 cmH2O, P < 0.001). The functional urethral length (FUL) in postmenopausal women was shorter than it in premenopausal women (29.0 +/- 9.7 vs 37.0 +/- 10.9 mm, P = 0.003). There were no significant statistical differences in maximal flow rate, residual urine, maximal bladder capacity and Q tip test. CONCLUSION: The VLPP and MUCP were lower, and the FUL was shorter in postmenopausal women with stress urinary incontinence than premenopausal women. The parity and number of vaginal deliveries were different between the two groups. Further investigation will be needed concerning these variables.

A case of laparoscopic treatment of collision tumor: Huge serous cystadenoma and dermoid cyst arising in the same ovary / 대한산부인과학회지

Collision tumor means the coexistence of two adjacent, but histologically distinct tumors without histologic admixture in the same tissue and is rare incidence involving ovary. Because of their incidence of occurrence, benign cystic teratomas often occur coincidentally with other abnormalities of the ovary. Most common histologic combination of collision tumor in the ovary is coexistence of teratoma with mucinous tumors. But its association with serous tumor has been noted rare and incidence is unknown. We have experienced a case laparoscopic treatment of a huge serous cystadenoma combined with ovarian benign cystic teratoma in right ovary, and report it with a brief review of literature.

A case of hemoperitoneum to spontaneous perforation of uterine leiomyoma with huge cystic degeneration / 대한산부인과학회지

Uterine leiomyoma is common benign tumor in reproductive age woman. And secondary degeneration of uterine leiomyoma can be occurred usually during midpregnancy and the puerperium. But, spontaneous perforation of uterine leiomyoma with cystic degeneration is very rare. We have experienced a case of spontaneous perforation of a huge cystic degenerative uterine leiomyoma associated with massive hemoperitoneum in a menopausal woman, and report it with a brief review of literature.

Acute renal failure associated with ureteral stone of the unilateral kidney and uterus didelphys with hemivaginal obstruction / 대한산부인과학회지

The unique clinical syndrome of the uterus didelphys, a unilateral partially or completely obstructed vagina, and ipsilateral renal agenesis is quite rare, and observed on the right side in greater frequency than on the left. The case of fifteen year old girl with uterus didelphys, unilateral partially obstructed vagina and acute renal failure associated with ureteral stone in unilateral kidney is described. Extracorporealshock wave lithotripsy (ESWL) and evacuation of the hematocolpos and excision of the vaginal septum were done. Aware of this relatively rare condition is mainstay of prompt diagnosis which will prevent permanent renal failure and unnecessary and destructive surgery.

A case of congenital agenesis of left ovary and salpinx diagnosed incidentally during laparoscopic treatment of right ovarian pregnancy / 대한산부인과학회지

Asymptomatic unilateral absence of a portion of a fallopian tube with or without adjacent ovarian agenesis is a very rare condition. The true incidence is unknown. Two etiologic causes are possible. Asymptomatic segmental torsion of the uterine tube and ovarian pedicle may occur for certain reasons during adulthood, in childhood, or even during the fetal stages. Consequently, torsion may give rise to necrosis and autoamputation. Alternatively, the absence of these organs may be congenital. Ovarian pregnancy is a rare form of ectopic pregnancy occurring in 0.5~1% of all ectopic pregnancies. Moreover, ovarian pregnancy in patient with congenital unilateral tubal and ovarian agenesis has not been reported. But, the presenting symptom is very similar and difficult to distinguish with other forms of ectopic pregnancy. Early detection is important role in preserving fertility to avoid the ablation of functional ovarian tissue. We report a case of congenital unilateral tubal and ovarian agenesis diagnosed during laparoscopic treatment of ovarian pregnancy.

Cornual pregnancy diagnosed at 9 weeks of atypical ultrasonographic findings / 대한산부인과학회지

A cornual pregnancy occurs when the conceptus implants at the cornus of the uterus which is the junction between the fallopian tube and uterine cavity. Cornual pregnancy is a rare form of ectopic pregnancy and its diagnosis is difficult. It accounts for 2 to 4% of tubal pregnancy and rupture usually occurs between 8 weeks and 16 weeks of gestation. The rich vascularity in this location makes the rupture particularly dangerous, resulting in higher maternal mortality. We have experienced a case of unruptured cornual pregnancy at 9 weeks of atypical ultrasonographic findings, which was hourglass appearance. We present this case with a brief review of the literature.

A case of cystic change of adenomyosis in adolescent girl complaining acute pelvic pain / 대한산부인과학회지

Cystic adenomyosis is a rare form of adenomyosis of the uterine myometrium that has been described in older adults. This condition has not frequently been reported in the adolescent girl. The adenomyotic cyst was located within the myometrium of a 15-year-old adolescent girl suffering from acute lower abdominal pain, not dysmenorrhea. After laparoscopic operation, patients's symptoms improved. On pathology finding, the cyst diagnosed adenomyotic cyst. We report a case of adenomyotic cyst of the uterus in adolescent girl with a brief review of literatures.

A case of pelvic retroperitoneal benign schwannoma presenting as a gynecologic malignancy with pulmonary thromboembolism / 대한산부인과학회지

Retroperitoneal schwannomas are rare tumors difficult to diagnose preoperatively. It may originate at the cranial nerves or nerves of the upper extremities, but origin along the nerves of the retroperitoneal space is very rare. Most of the retroperitoneal schwannomas are benign neoplasm. These tumor can be misdiagnosed as adnexal mass or carcinoma. Venous thromboembolism or pulmonary embolism is increasingly recognized as a common complication in patients with malignant disease. We report a 37-year-old woman presented with pulmonary thromboembolism and a pelvic mass which was incidentally found and misdiagnosed as ovarian cancer. Histopathologic results of the extirpated mass turned out to be a benign schwannoma.

The indications, effectiveness and complications of the selective arterial embolization in the management of obstetrical hemorrhage / 대한주산의학회잡지

PURPOSE:The objective of this study was to evaluate the indications, effectiveness and complications associated with uterine arterial embolization as an alternative treatment of obstetrical hemorrhage. METHODS:From January 2006 to December 2008, 25 patients who underwent angiographic embolization for the obstetrical hemorrhage that was not responsive to conventional treatments, like obstetric maneuvers and uterotonic drugs, were included in our study. All medical records were reviewed and detailed clinical data such as clinical status, underlying conditions, amount of transfusion, embolized arteries, hospital stay, the success rate and the complications were collected. RESULTS:We have experienced clinically successful embolization in 22 (88%) of 25 patients with obstetrical hemorrhage resulting from various causes. After embolization, the patients' vital signs were stabilized. The causes of hemorrhage were atony of uterus (n=10), myomectomy during cesarean section (n=6), abnormal placentation (n=5), arterio-venous malformation (n=3), and cervical pregnancy (n=1). The average amount of blood transfusion was 7.2 units (range; 0~39 units). The average length of the time for the procedure was 55 minutes (range: 25~96 minutes). The average duration of hospitalization was 5.5 days (range: 2~14 days). In 22 patients, menses resumed spontaneously after procedures. The main complications after embolization were numbness and pain on lower extremities (n=1), and hypomenorrhea (n=1). CONCLUSION:The atrerial embolization is one of the safe and effective procedures that offers patients an alternative to hysterectomy for the treatment of intractable postpartum hemorrhage.

A case of unusual premature ovarian failure with 46,X,dup(Xq) / 대한산부인과학회지

Premature ovarian failure (POF) is defined as the complete cessation of menses less than 40 years of age. The criteria are more than four months of amenorrhea, with serum follicle stimulating hormone value of >40 mIU/mL and the frequency of POF is about 1% of all women. Although the etiologies of POF remain unknown, suggested factors are genetic, autoimmune, chemotherapy, radiotherapy and environmental toxins. The cytogenetic abnormalities predominantly concern the X chromosome, including Turner syndrome, Fragile X syndrome and deletion, translocation, or duplication of X chromosome. We report a very rare case of premature ovarian failure with the following karyotype: 46,X,dup(Xq), and report it with a brief review of literature.

A case of treatment of peritoneal trophoblastic tissue implants after laparoscopic salpingectomy / 대한산부인과학회지

The incidence of ectopic pregnancy has increased considerably a decade. And treatment has changed from salpingectomy by laparotomy to conservative laparoscopic surgery or medical treatment. This procedure has many advantages, but there are also disadvantages with the conservative approach and several studies have reported a higher incidence of residual trophoblastic tissue remaining in the tube after treatment. Postoperative follow up of human chorionic gonadotropin (hCG) levels and ultrasonography are needed. This report describes a rare case of persistent trophoblastic implants to the ovary and peritoneum 40 days after laparoscopic salpingectomy. Treatment consisted of laparoscopic excision with biopsy forceps and bipolar, followed by medical treatments. So we report with a brief review of literatures.

A case of malignant Mixed Mullerian Tumor (MMMT) of the uterine cervix / 대한산부인과학회지

Malignant mixed mullerian tumors (MMMT) are rare biphasic malignant neoplasm with two components of carcinoma and sarcoma. The most common site of occurrence in female genital tract is the uterine corpus. MMMT of the cervix is extremely rare. MMMT of uterine corpus is highly malignant and the prognosis is poor. Surgery is treatment of choice of uterine cerivx MMMT. The clinicopathologic characteristics of tumor and treatment are uncertain because of lack of clinical data. We experienced one case of malignant mixed mullerian tumor of uterine cervix and report our experience with a brief review of literature.

Rupture of mucinous adenocarcinoma of ovary and pseudomyxoma peritonei with pregnancy: Case report / 대한산부인과학회지

The occurrence of ovarian cancer during pregnancy is a very rare, and the incidence is 1:10,000 to 1:50,000. However, this number is likely to increase since childbearing is more and more frequently delayed. The clinical outcome of patients with ovarian cancer is the same regardless of whether the diagnosis of ovarian carcinoma is done during pregnancy or in non-pregnant women; therefore, the same surgical staging procedures are recommended in the two groups. However, it should be considered to performed a diagnostic operation and preservation of pregnancy, advantage of the administration of chemotherapy, what time give birth to, what time perform a staging operation. We here report our experience with a case of advanced ovarian carcinoma during pregnancy, which was managed conservative surgery with chemotherapy until delivery.

Uterine prolapse complicating pregnancy / 대한산부인과학회지

Uterine prolapse is extremely rare during pregnancy. However in some cases significant complications such as urinary tract infection, voiding difficulty, abortion, and preterm labor may develop. Conservative management consisted of bed rest and use of a pessary. An elective cesarean section near term is the safest mode of delivery in cases where the cervix is edematous and elongated. We present a case of a patient developing uterine prolapse at 12 weeks of gestation, treated with bed rest and use of a pessary. A repeat cesarean section was performed at 38 weeks of gestation and report with a brief review of literatures.

Spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy / 대한산부인과학회지

Ectopic pregnancy and appendicitis in pregnancy are two most common causes of acute abdomen in young women and differenciation of these diseases is very difficult. Heterotopic pregnancy is a rare event, occuring less than 1:30,000 pregnancies in natural conception cycles. However, with assisted reproduction techniques, this incidence has increased. We experienced a case of spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy. So we report this case with brief review of literature.

Two cases of complete chorioamniotic membrane separation / 대한산부인과학회지

As chorion and amnion fusion usually occurs between 14 and 16 weeks of gestation, sonographic identification of chorion and amniotic membrane separation is a normal finding before 14 weeks. However, persistent separation after 16 weeks of gestation is considered rare and abnormal findings. Complete chorioamniotic membrane separation (CMS) may occur spontaneously, but has also been described as a complication of all invasive intrauterine procedures, including amniocentesis. Complete CMS have a significant morbidity and mortality due to intrauterine fetal death, cord complications, and preterm delivery. Aggressive treatment with hospitalization is necessary. We now report 2 cases of complete CMS identified by prenatal ultrasound; 1 in spontaneous complete CMS diagnosed at 24 weeks of gestation, and health premature child was born at 29+3 weeks of gestation, who was alive and well at present; 1 in complete CMS diagnosed at 21 weeks of gestation after amniocentesis, and fetal demise at 24 weeks of gestation due to cord strangulation by an amniotic band. We experienced two cases of complete CMS and report with a brief review of literatures.

Massive hemoperitoneum from spontaneous venous rupture overlying a uterine myoma: A case report / 대한산부인과학회지

Spontaneous intraperitoneal hemorrhage from uterine leiomyomas is rarely encountered. The cause of hemorrhage is mainly trauma and torsion of myoma. Massive intraperitoneal hemorrhage from spontaneous rupture of a superficial uterine vein overlying a subserous myoma is extremely rare. A 48-year-old woman complained general weakness, lower abdominal discomfort and lower back pain. On admission to the hospital, hypovolemic shock, severe anemia and ascites were noticed. Ultrasonography and CT scan showed huge pelvic mass and much amount of fluid in the pelvic cavity. During emergent laparotomy, 3,500 mL of blood were drained from the abdominal cavity and a ruptured superficial vein was noted, located on the serosal surface of a fundal myoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to spontaneous rupture of a superficial uterine vein overlying a subserous myoma.