Preoperative serum levels of cancer antigen 125 and carcinoembryonic antigen ratio can improve differentiation between mucinous ovarian carcinoma and other epithelial ovarian carcinomas

OBJECTIVE: The main aim of this study was to evaluate cancer antigen 125 (CA125)/carcinoembryonic antigen (CEA) ratio (CCR), as a reliable marker to differentiate ovarian mucinous carcinoma from other epithelial ovarian carcinomas (EOCs), namely serous, clear cell, and endometrioid carcinomas. METHODS: Female patients suffering from different kinds of EOCs whom were subjected to elective surgery at the Gangnam Severance Hospital between January 2008 and December 2016, were included in this study. The serum levels of CA125 and CEA were assayed using commercially available kits per the manufacturer's instructions. RESULTS: The CCR in mucinous carcinoma (mean 32.1) was significantly lower than that of clear cell (mean 235.0) and endometrioid carcinoma (mean 427.0) in stage I (all P < 0.05). In stage II–IV, CCR in mucinous carcinoma (mean 37.6) was significantly lower than that of serous carcinoma (mean 148.0) (P < 0.01). The sensitivity and specificity of CCR in detecting mucinous carcinoma from other types of EOC was 75.0% and 77.5%, respectively in stage I and 100.0% and 84.4%, respectively in stage II–IV (both cut-off value < 90.7). CONCLUSION: The present results suggest that pretreatment CCR might provide higher specificity and clinically relevant information as a criterion for the differentiation between ovarian mucinous carcinoma and other types of EOC.

HBsAg screening test of Korean pregnant women during antenatal period / 대한산부인과학회지

OBJECTIVE: To evaluate and improve the method in management of HBsAg positive mothers in Korea by the screening time and method. METHODS: From January 2003 to March 2003, questionnaires were obtained using mail or telephone from total 848 hospitals or clinics handling more than 100 deliveries in year 2001 and 341 of them (40.2%) returned their answers. 279,734 out of 507,151 (55.2%) were investigated in number of delivery cases. The screening time and method for HBsAg in antenatal period were analyzed. RESULTS: Most of hospitals tested for HBV infectivity more than once during antenatal period. 99.1% of hospitals tested for HBsAg and 96.1% of hospitals tested for HBsAb. 87.1% of pregnant women were tested for HBsAg on the first visit. HBsAb was tested at the same time with HBsAg in 96.2%. 41% of hospitals repeated test in third trimester for those with negative HBsAg and 54% of HBsAg positive mothers were retested in third trimester. For those who admitted only for delivery, 45.9% of hospitals tested for HBsAg irrespective of their history. Clinics used RPHA for test method in 38.1% which was higher in proportion compare to hospitals. CONCLUSION: HBV infectivity must be screened in all pregnant women. Repeating test in third trimester may be unnecessary and a policy should be made for those who admit for delivery alone. EIA method is recommended instead of RPHA method.

A case of low-grade endometrial stromal sarcoma with multiple metastasis / 대한산부인과학회지

Uterine sarcomas are rare tumors of mesodermal origin and constitute 2-6% of uterine malignancies. They are classified into leiomyosarcoma (LMS), malignant mixed mullerian tumors (MMMTs), and endometrial stromal sarcoma (ESS) by histologic types. Endometrial stromal sarcomas account for about 7-15% of uterine sarcomas, about 0.2% of female genital tract malignancies. Endometrial stromal sarcomas are divided into endometrial stromal nodule, low-grade endometrial stromal sarcoma, and high-grade endometrial stromal sarcoma on the basis of mitotic activity and vascular invasion. Clinical outcome of low-grade endometrial sarcoma is better than that of high-grade endometrial stromal sarcoma and has a propensity for slow metastasis. We have experienced a case of low-grade endometrial stromal sarcoma with multiple metastasis in a 41-year-old woman and was treated by surgical resection and combination chemotherapy, which is presented with a review of brief literature.

Acute fatty liver of pregnancy complicating acute respiratory distress syndrome: A case report with survival of mother and child / 대한산부인과학회지

We report our experience with the diagnostic, clinical and biochemical findings, complications and maternal-perinatal outcome in a case of acute fatty liver of pregnancy. A 31-year-old multipara presented herself at 35 weeks' gestation with general malaise, gastroesophageal reflux, jaundice, hepatorenal dysfunction and disseminated intravascular coagulation. An abdominal ultrasound revealed a mild fatty liver. A tentative diagnosis of acute fatty liver of pregnancy was made, and immediately a healthy male infant weighing 2330 gm was delivered by emergency cesarean section. On 1, 2 and 6 days after delivery, oliguria, acute respiratory distress syndrome and pancreatitis developed, respectively. Abnormal levels of AST/ALT, creatinine, fibrinogen, PT/PTT and platelet recovered to normal ranges 7-10 days after delivery. Serum amylase and lipase became normal 24 days after delivery with conservative treatment. Ventilator care for acute respiratory distress syndrome continued up to 49 days after delivery, when total bilirubin, ammonia, alkaline phosphatase, r-GT, and AST/ALT began to normalize. The discharge was recommended on the 88th postpartum day. Our result suggests that acute fatty liver of pregnancy can be diagnosed on the basis of clinical and laboratory findings. Prompt delivery, intensive supportive care and awareness of its complications can markedly improve maternal and perinatal outcome.

Laparoscopic management of asymptomatic ovarian steroid cell tumors, not otherwise specified: A case report and literature review / 대한산부인과학회지

The steroid cell tumor, not otherwise specified, constitutes only 0.1% of ovarian malignancies and was asymptomatic in 3.3-25% In Korea, three reported cases of steroid cell tumors were endocrinologically symptomatic and were managed with laparotomy. However, there was no reports of such case without any endocrinologically symptoms. We present a 17 years old patient with huge pelvic mass that were managed with combined ultrasonographically guided drainage and laparoscopically excision and proven to be an asymptomatic steroid cell tumor of ovary, with brief review of literature.

A case of primary parovarian cystadenocarcinoma of borderline malignancy / 대한산부인과학회지

Parovarian tumors may be of mesothelial, mesonephric (Wolffian), or paramesonephric (Mullerian) origin. An estimated 10% of adnexal masses are parovarian cysts, most commonly mesothelial or paramesonephric in origin. Benign neoplasms such as cystadenomas may occasionally develop in parovarian cysts. Malignancy has been reported in 2.0% to 2.8% of parovarian cystic masses, but it seems to be even less frequent in masses smaller than 5 cm. The histologic appearance of the tumor is identical with that of tumors of ovarian origin. However, their similarity of biologic behavior is uncertain. The appropriate therapy for this unusual lesion has not been fully defined, since a minimal amount of follow-up data is available on the few cases which have been reported. We had experienced a case of papillary serous cystadenocarcinoma of borderline malignancy arising from a parovarian paramesonephric cyst and report this case with a brief review of literature.

Transabdominal embryofetoscopy in 6 cases of first trimester prenatal diagnosis for congenital anomalies / 대한산부인과학회잡지

OBJECTIVE: To demonstrate the efficacy of first trimester embryofetoscopy for prenatal diagnosis of congenital anomalies in continuing pregnancies. METHODS: Under ultrasound guidance, six patients at 12+6-14+6 weeks of gestation underwent endoscopic procedures. Indications included history of 2 recurrent major genetic syndromes, history of cleft lip/palate in 2 cases, each one of the patient itself and the previous fetus and each family history of syndactyly and polydactyly. A 1 mm semirigid fiberoptic endoscope with a 18 gauge examination sheath and a single-chip digital camera were used for transabdominal embryofetoscopy. RESULTS: Excellent visualization of the external fetal anatomy was obtained in 83% of cases (5/6) with the duration of procedures ranging 15 to 40 minutes. A diagnosis of Meckel-Gruber syndrome was made at 13+1 weeks of gestation by visualizing postaxial polydactyly and an occipital encephalocele. Subsequently the pregnancy was terminated. Three full-term infants were delivered with no gross limb or facial abnormalities. Amniotic fluid leakage after the procedure occurred in 2 cases resulting in termination of pregnancy. CONCLUSION: Our experiences confirm the efficacy of embryofetoscopy for early diagnosis in the first trimester of pregnancy. Procedure-related risks are to be established by multicenter studies.