Polypoid Endometriosis, a Benign Tumor with Perplexing Radiologic Features: A Case Report

Polypoid endometriosis is a rare form of endometriosis. It is a benign variant but its radiologic findings trick clinicians into concern about the tumor being malignant. A 42-year-old patient with a history of dysmenorrhea and adenomyosis presented a 60 mm-sized mass in the Douglas pouch with irregular echogenicity. The patient went under the first surgery for tumor removal, and its histopathologic diagnosis was endometriosis. We started daily dienogest medication to suppress tumor recurrence, but after 10 months we decided to stop the medication due to the side effects. Four months after the cessation, a new tumor recurred and after few months of observation, we performed the second surgery of tumor removal and total hysterectomy because of adenomyosis. The tumor was located in the retroperitoneal space in the Douglas pouch with severe adhesions. After the second surgery, the tumor marker Cancer antigen-125 level was normalized and the histopathologic result was endometriosis, which we concluded as polypoid endometriosis.

Peritoneal carcinomatosis mimicking a peritoneal tuberculosis

Symptoms of a peritoneal progression from ovarian cancer are nonspecific such as abdominal pain, abdominal distention and more. Many imaging studies and serum CA-125 help diagnosis. However, it is difficult to exclude the instances of the diffuse peritoneal diseases that mimic carcinomatosis. The elevated CA-125 level usually correlates with the peritoneal carcimatosis, but it is often found in other peritoneal diseases. Therefore, the pathologic confirmation is necessary because of other mimicking diseases. In our case, CA-125 levels were elevated. Abdominal computed tomography finding was suspected a peritoneal tuberculosis but the pathologic result was the peritoneal carcimatosis, eventually.

Misdiagnosed Rhabdomyosarcoma of the Vulva

Vulvar carcinoma is a rare disease that accounts for 5% of gynecologic cancers. Sarcomas of the vulva are extremely rare, and account for only 1% to 3% of all vulvar malignancies. We report of a case of a 26 years woman with a vulva mass. Excision was done and histopathologic result showed rhabdomyosarcoma.

Prevalence of Osteoporosis and Osteopenia in Women in Gumi Gyeongbuk Province / 대한폐경학회지

OBJECTIVES: The aim of the present study was to determine the prevalence of osteopenia and osteoporosis in women aged 20 years and older in Gumi province. METHODS: We recruited a total of 2,347 women aged 20 years and older in Gumi province who visited the health care center in Soonchunhyang University Gumi hospital from January 2010 to December 2011. The bone mineral densities in the calcaneus were measured by an ultrasound bone densitometry. Osteoporosis and osteopenia were defined by World Health Organization criteria. Age-specific prevalence of osteoporosis and osteopenia in Gumi province were determined and compared with the prevalence of osteoporosis and osteopenia from other provinces within Korea. The prevalence of each was described by %. RESULTS: Age-specific prevalence of osteoporosis was less than 2% in women younger than 50 years but it rapidly increased in those older than 55 years and up to about 50% in women older than 70 years. The prevalence of osteoporosis in women in Gumi province was lower than that of Kangwon province. However, its results were higher than Jung-up province. In addition, the prevalence of osteoporosis in women in Gumi province was lower than other provinces including: Gang-hwa, Chun-cheon, Chung-ju, Jungnang and Gangseo in Seoul, Korea Health Statistics 2009. CONCLUSION: The age-specific prevalence of osteoporosis in women in Gumi province increased with ages, especially in those older than 55 years. Also, the prevalence of osteoporosis in women in Gumi province was lower than Kangwon and other provinces within Korea as stated by Korea Health Statistics 2009. However, its results were higher than Jung-up province.

Fibroepithelial Polyps on an Unusual Genital Site during Menopausal Transition / 대한폐경학회지

Fibroepithelial polyps (FEPs) on the vulvovaginal region are rare lesions of the lower genital track and differential diagnosis can be wide. When faced with FEPs, gynecologists and pathologists have to consider a wide range of diagnoses, because overlapping morphologic features and management of these lesions has been observed. We report a case of fibroepithelial polyps that developed on an unusual genital site, and provide a brief review of the literature.

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 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.

Torsion of the paratubal cyst in an adolescent female: A case report / 대한산부인과학회지

Torsion of the paratubal cyst is a rare but significant cause of acute or recurrent lower abdominal pain in adolescent females that is difficult to recognize preoperatively. Early diagnosis is very important in adolescent because of the risk of decreased fertility if it is not treated at an early stage. We report a case of torsion of the paratubal cyst that has resulted in hemorrhagic infarction of the paratubal cyst and fallopian tube in an adolescent female with brief review of literatures.

Bilateral Uterine Arterial Embolization for Treatment for Uterine Myoma / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate the effectiveness and safety of uterine artery embolization for the treatment of symptomatic leiomyomas in the patients who want to preserve uterus, want fertility or feel fear for operation. METHODS: From January 2003 to June 2005, among the patients with symptomatic uterine leiomyoma, fifteen women who wanted to preserve uterus or wanted fertility or had fear for operation were included in this retrospective study. Bilateral Uterine artery embolization (UAE) was performed. At the preprocedure and at 2, 6, and 12 weeks of postprocedure, transvaginal ultrasonography was performed for all patients. Clinical symptoms and follow-up information for each patient were evaluated. RESULTS: 15 leimyomas were treated with UAE. The initial mean volume of leiomyomas was 55.4 (46.3-67.4) cm3. The mean volume decrease was 58.6+/-9.7%, 77.5+/-12.3%, 86.8+/-23.5% at 2, 6, 12 weeks. The outcome of clinical symptoms were as followed; 'much improved' 20% (3/15), 'somewhat improved' 60% (6/15), 'no improvement' 20% (3/15), 'somewhat worsen's 0% (0/15), and 'much worsen' was 0% (0/15). There was no case of hysterectomy or myomectomy after UAE. And also no case of increasement of volume nor worsening of clinical symptoms were found. Lower abdominal pain was the most common symptoms after UAE, but complications were not detected. CONCLUSION: In this study, UAE to treat patients with uterine leiomyoma is proved to be effective not only in volume reduction, but also in symptom improvement. And it is a relatively less-invasive procedure which decreases the risk of side effects of operation. Above all things, it preserves fecundity in young women. Therefore, UAE is very effective and safe procedure in the treatment of symptomatic uterine leiomyoma.

A Case of Transvaginal Expulsion of Intramural Leiomyoma after Uterine Artery Embolization / 대한산부인과학회지

Uterine artery embolization for the treatment of uterine leiomyomas is gaining acceptance as an effective alternative to surgical treatment in preserving uterus and reducing symptoms. Vaginal expulsion of leiomyomas after UAE is uncommon, and has been regarded as a side effect of the procedure, as well as a natural phenomenon of treatment response. A-28-year-old unmarried woman who has been suffered from menorrhagia underwent UAE. MRI revealed the remnant leiomyomas were reduced in size and volume and also symptoms of leiomyomas were much improved. After 6 month, We've made sure about non-visualization of leiomyoma on follow-up pelvic dynamic MRI. We report this rare case of vaginal expusion of intramural leoimyoma with a brief literature.

A comparison of intravaginal misoprostol with intravenous oxytocin for labor induction at term / 대한산부인과학회잡지

OBJECTIVE: To compare the safety and efficacy of intravaginally administered misoprostol (PGE1 analogue) versus intravenously administered oxytocin for labor induction at term. METHODS: Among 63 patients over 37 weeks, randomly selected 42 patients were vaginally administered 25 micro gram of misoprostol every 3 hours and the other 21 patients were intravenously administered every minute from 1 mIU/min to 10 mIU/min increasingly. RESULT: The average interval from initiation of induction to labor was notably shorter in oxytocin group than in misoprostol group (204.5+/-332.6 min versus 528.1+/-591.8 min, p<0.02). The average interval from initiation of induction to vaginal delivery was shorter in oxytocin group than in misoprostol group (414.4+/-309.4 min versus 528.1+/-519.8 min, P<0.01) and the difference has statistical meaning. Procedure of labor were divided by 3 stages. We checked the duration of each stage between the two comparative groups. 1st stage (242.7+/-150.14 min versus 605.5+/-805.8 min, P<0.05) 2nd stage (12.6+/-11.9 min versus 19.5+/-11.2 min, P<0.05) The stage duration of oxytocin group was shortened. There was no difference between two groups at the third stage. The incidence of tachysystole, hypertonics, hyperstimulation, meconium passage, abnormal fetal heart rate, fetal weight, apgar score, neonatal morbidity were not different between two group. CONCLUSION: Intravenously administered oxytocin was more effective in shortening labor time than intravaginally administered misoprostol in overall induction labor, but there was no notable difference in the effects on mothers and babies. Considering various situational factors, careful selection should be administered.

Immunohistochemical Study on the Expression of Thymidine Phosphorylase and Ki-67 in the Uterine Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: We evaluated the relationship between the expression of Ki-67 and thymidine-phosphorylase (TP) according to the cancerous progression of uterine cervical cancer with immunohistochemical method. METHODS: The material was obtained from hysterectomized uterus and punched cervical specimen for two years from 1998 to 1999 at the Soonchunhyang Chunan hospital. The material included 15 normal epithelium, 13 CIN I/II, 21 CIN III, 15 microinvasive carcinoma and 13 invasive carcinoma. Monoclonal antibodies of Ki-67 and TP were used for immunohistochemical determination of cellular proliferation and angiogenic activity. RESULTS: 1. The positive rate of thymidine phosphorylase in each group of normal epithelium, CIN I/II, CIN III, microinvasive carcinoma and invasive carcinoma were 6.7%, 23.1%, 38.0%, 73.3%, 84.6% respectively. 2. The labeling indexes of Ki-67 in each group of normal epithelium. CIN I/II, CIN III, microinvasive carcinoma and invasive carcinoma were 2.0+/-0.7, 26+/-5.4, 41.2+/-10.1, 74.7+/-9.3 respectively. 3. There was statistically significant relationship between TP and Ki-67 expression. CONCLUSION: The above results indicates that the angiogenic activities and cellular proliferation indices increase according to the invasiveness of cervical cancer. We were able to reveal the expression of TP and Ki-67 and their relationship in cervical carcinoma.