Successful in vitro fertilization pregnancy and delivery after a fertility-sparing laparoscopic operation in a patient with a papillary thyroid carcinoma arising from a mature cystic teratoma / 대한생식의학회지

Malignant transformation of ovarian mature cystic teratomas is rare, and papillary thyroid cancer occurs in 0.1%–0.3% of ovarian teratomas that undergo malignant transformation. We describe a case of successful in vitro fertilization pregnancy and delivery after a fertility-sparing laparoscopic operation in a patient with papillary thyroid carcinoma arising from a mature cystic teratoma.

Delayed recovery of a patient with obstructive azoospermia and a history of acute epididymitis / 대한생식의학회지

Obstructive azoospermia caused by acute epididymitis is usually permanent, and microsurgical vasoepididymostomy is the only reconstructive treatment option. There have been no reports of delayed recovery of sperm count after over 1 year in a patient with obstructive azoospermia related to history of acute epididymitis. We present a young male patient who had azoospermia and a history of acute epididymitis who experienced delayed recovery, with complete restoration of sperm production and the ability to conceive naturally.

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system / 부인종양

OBJECTIVE: To determine whether less invasive endometrial (EM) aspiration biopsy is adequately accurate for evaluating treatment outcomes compared to the dilatation and curettage (D&C) biopsy in early-stage endometrial cancer (EC) patients treated with high dose oral progestin and levonorgestrel intrauterine system (LNG-IUS). METHODS: We conducted a prospective observational study with patients younger than 40 years who were diagnosed with clinical stage IA, The International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid adenocarcinoma and sought to maintain their fertility. The patients were treated with medroxyprogesterone acetate 500 mg/day and LNG-IUS. Treatment responses were evaluated every 3 months. EM aspiration biopsy was conducted after LNG-IUS removal followed D&C. The tissue samples were histologically compared. The diagnostic concordance rate of the two tests was examined with κ statistics. RESULTS: Twenty-eight pairs of EM samples were obtained from five patients. The diagnostic concordance rate of D&C and EM aspiration biopsy was 39.3% (κ value=0.26). Of the seven samples diagnosed as normal with D&C, three (42.8%) were diagnosed as normal by using EM aspiration biopsy. Of the eight samples diagnosed with endometrioid adenocarcinoma by using D&C, three (37.5%) were diagnosed with endometrioid adenocarcinoma by using EM aspiration biopsy. Of the 13 complex EM hyperplasia samples diagnosed with the D&C, five (38.5%) were diagnosed with EM hyperplasia by using EM aspiration biopsy. Of the samples obtained through EM aspiration, 46.4% were insufficient for histological evaluation. CONCLUSION: To evaluate the treatment responses of patients with early-stage EC treated with high dose oral progestin and LNG-IUS, D&C should be conducted after LNG-IUS removal.

Multifocal Polypoid Endometriosis Mimicking Malignancy in a Young Woman with a History of Hormonal Treatment

No abstract available.

A case of the rare variant of Klinefelter syndrome 47,XY,i(X)(q10) / 대한생식의학회지

Klinefelter syndrome is the most common genetic form of male hypogonadism, but the phenotype becomes evident only after puberty. It is characterized by infertility, small testes, sparse body and facial hair, increased body weight, gynecomastia, increased LH and FSH, and a low level of testosterone. Early recognition and treatment of Klinefelter syndrome can significantly improve the patient's quality of life and prevent serious consequences. Here, we report an infertile man with a rare variant of Klinefelter syndrome with a 47, XY, i(X)(q10) karyotype.

Long-Term Follow-Up Result of Benign Phyllodes Tumor of the Breast Diagnosed and Excised by Ultrasound-Guided Vacuum-Assisted Breast Biopsy / 한국유방암학회지

PURPOSE: Percutaneous removal of benign breast tumors using ultrasound-guided vacuum-assisted breast biopsy (VABB) has been recently regarded as a feasible and safe method without serious complications. The aim of this study was to evaluate the efficacy and safety of the VABB in the treatment of benign phyllodes tumors, and to identify whether or not surgical re-excision is necessary for benign phyllodes tumors diagnosed and excised by VABB. METHODS: From January 2003 to December 2011, a total of 6,923 VABB were performed in 5,434 patients. Out of 6,923 lesions, 53 were benign phyllodes tumors. Among these, 31 lesions, with a follow-up period of longer than 24 months, were enrolled in this study. Ultrasonography follow-up was performed at 3 to 6 month intervals in order to assess recurrence. The mean follow-up period was 75.9+/-13.5 months (range, 24-94 months). RESULTS: The mean patient age at presentation was 31.6+/-9.4 years. The mean size of the lesion was 1.60+/-0.88 cm. The majority of lesions, 74.2% (23 cases), were palpable, and 25.8% (8 cases) were non-palpable. Twenty-two lesions (71.0%) were classified as Breast Imaging Reporting and Data System category 3, and nine lesions (29.0%) were classified as category 4a, by ultrasonography. During the follow-up period, local recurrence developed in one lesion, making the local recurrence rate 3.2%. CONCLUSION: If a benign phyllodes tumor is diagnosed, and sufficiently excised by VABB, observing the clinical course may be considered as an alternative to performing immediate wide local excision; this is the case despite the fact that it would need to be observed for a prolonged period of time.

Cellular fibroma of the ovary containing Leydig cell hyperplasia: a case report / 부인종양

Ovarian stromal tumors containing Leydig cell components are rare. Only a few cases of ovarian stromal Leydig cell tumors characterized by clusters of Leydig cells have been reported to date. Here, we present the first case report of a 65-year-old woman with a cellular fibroma of the ovary containing Leydig cell hyperplasia. Microscopic examination revealed the proliferation of spindle cells arranged in intersecting bundles with mild nuclear atypia and an average of 2-3 mitotic figures per ten high-power fields. Multifocal nests of polygonal cells with abundant eosinophilic cytoplasm and round nuclei were seen within the spindle cells. Final pathology of the tumor revealed a cellular fibroma including Leydig cell hyperplasia.

Sonographic and Mammographic Features of Breast Apocrine Metaplasia

PURPOSE: To evaluate the sonographic and mammographic features of apocrine metaplasia of the breast. MATERIALS AND METHODS: We retrospectively evaluated the sonographic and mammographic findings of 16 lesions that were diagnosed with only apocrine metaplasia after mammotome excision. The age ranged from 27 years old to 57 years old (mean age; 40 years old). The sonographic features were interpreted by the ACR BI-RADS (American College of Radiology Breast Imaging Reporting and Data System) for shape, orientation, margin, boundary, echo pattern, posterior acoustic feature, calcification and special cases. The mammographic features were interpreted by the ACR BI-RADS (American College of Radiology Breast Imaging Reporting and Data System) for breast composition, shape, margin, density and calcification. RESULTS: Sonographic features were that the shapes were oval (n = 16) in 100%. The orientation was parallel (n = 15) in 94%. The margins were circumscribed (n = 8) in 50% and microlobulated (n = 8) in 50%. The echo patterns were hypoechoic (n = 8) in 50%, complex (n = 5) in 31% and anechoic (n = 3) in 19%. Posterior acoustic enhancement was seen in 69% (n = 11). There was internal microcyst (n = 4) in 25%. There was no calcification. Mammography performed for 12 cases demonstrated negative findings (n = 10) for 83%, obscured hypodense mass (n = 1) for 8% in 11 cases of breast composition 3 and 4, and circumscribed isodense mass (n = 1) for 8% in one case of breast composition 2. There was no calcification. The final assessment was category 4a (n = 7) in 44%, category 3 (n = 6) in 38% and category 2 (n = 3) in 19%. CONCLUSION: Although sonographic and mammographic features of apocrine metaplasia are occasionally suspicious malignancy such as microlobulation and complex echo. We consider the possibility of apocrine metaplasia if masses show internal microcyst and abrupt boundary.

Sonographic Findings of Thyroid Cancer Initially Assessed as No Suspicious Malignancy

PURPOSE: To review the retrospective imaging findings of thyroid cancer initially assessed as no suspicious malignancy. MATERIALS AND METHODS: Of 338 nodules confirmed to be thyroid cancer, this study included 38 patients with 39 nodules assessed as no suspicious malignancy on initial sonography. (mean age: 39 years, 36 females and 2 males). We evaluated sonographic findings by shape, margin, echogenecity, calcification, cystic degeneration and peripheral hypoechoic rim retrospecively. We analyzed whether sonographic findings were different according to the size (standard: 1 cm). RESULTS: The most frequent sonographic findings were ovoid to round shape 90%, well-defined smooth margin 64%, hypoechogenecity 54%, no calcification 92%, no cystic degeneration 77% and peripheral hypoechoic rim 56%. Suspicious malignancy findings were taller than wide shape 10%, well-defined spiculated margin 36%, markedly hypoechogenecity 10% and microcalcifications 8%. Isoechogenecity, cystic degenetaion and peripheral hypoechoic rim were common in 1 cm more than nodules. Well-defined spiculated margin was common in 1 cm less than nodules. In retrospective, 56% showed no suspicious malignancy finding. CONCLUSION: Although nodules assessed as no suspicious malignancy on initial US had many retrospectively suspicious malignancy findings, still many nodules showed no suspicious malignancy finding. Suspicious findings were ignored due to equivocal finding in small size, isoechogenecity, cystic degeneration or peripheral hypoechioic rim. We need careful observation.

Comparison of surgical outcomes after laparoscopy-assisted vaginal hysterectomy and total laparoscopic hysterectomy / 대한산부인과학회지

OBJECTIVE: To compare the surgical outcomes between laparoscopy-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). METHODS: The data were collected retrospectively from hospital records. Between September 2006 and August 2007, Patients undergone with LAVH (93 cases) and TLH (142 cases) with pathologic reports of leiomyoma or adenomyosis were enrolled. The characteristics and surgical results were compared according to the operation type. The correlations among the variables were analyzed with multiple linear regression. RESULTS: Between two groups, the characteristics of patients were similar such as age, body mass index, surgical history, and pathologic findings. In the univariate analysis, the differences of operation duration and blood loss between LAVH (129.0+/-34.5 min, 385.5+/-296.1 mL) and TLH (123.6+/-40.8 min, 294.7+/-285.4 mL) were significant (P0.050). In multivariate analysis, blood loss was correlated with operation duration and specimen weight (P=0.000) but not with operation type (P=0.213). CONCLUSIONS: LAVH tends to be selected in larger uteri and results in more blood loss and longer operation duration. Operation type (LAVH or TLH) does not affect blood loss which is related with operation duration and uterine weight.

Apocrine Carcinoma of the Breast: A Case Report

Apocrine carcinoma is a rare breast cancer and its frequency is about 0.4% of all breast cancers. Little is known about its clinical behavior and prognosis. To our knowledge, few studies have reported the radiologic appearances of apocrine carcinoma in the breast and there has been no such report from Korea. We describe the sonographic findings of a case of apocrine carcinoma in the breast. The sonographic findings are microlobulated heterogeneous hypoechoic lesion that has a central markedly hypoechoic portion and a peripheral mixture of iso and hypoechgenecity.

The Effects of Anti-Histamine and Mast Cell Stabilizer against Ischemia-Reperfusion Injury to TRAM Flap in Rat

PURPOSE: The purpose of this study was to evaluate the role of mast cell and histamine as typical product of mast cell in ischemia-reperfusion injury of muscle flap using H2 receptor blocker and mast cell stabilizer. METHODS: Thirty-five Sprague-Dawley rats weighing 250-300 gm were divided into four groups; Group I: Control group without ischemia, Group II: Normal saline injection group with ischemia, Group III: Cimetidine injection group with ischemia, Group IV: Sodium cromoglycate injection group with ischemia. Well established single pedicled transverse rectus abdominis musculocutaneous(TRAM) flap was designed in all rats and were rendered ischemia by clamping the artery for 150 minutes. All injections were applied intramuscular around gluteal area 30 minutes before reperfusion. The flap survival was evaluated at 7 days after operation. Neutrophil counts and mast cell counts were evaluated 24 hours after reperfusion. RESULTS: The difference of skin flap survival between control group and cimetidine injection group was not significant. In the normal saline injection group flap survival was markedly decreased compared to that of control group. The muscle flap survival was similar to the results of skin flap survival. The neutrophil counts were significantly decreased in control group and sodium cromoglycate injection group than normal saline injection group. The mast cell counts were significantly decreased in cimetidine injection group and control group than both normal saline injection and sodium cromoglycate injection groups. The protective effect of sodium cromoglycate was not seen in the skin flap, but the muscle flaps showed protective effects of sodium cromoglycate compared to normal saline injection group. CONCLUSION: It is suggests that commonly used antihistamine(H2 receptor blocker) has protective effect against ischemia-reperfusion injury to skin and muscle flaps by reducing neutrophil and mast cell. The mast cell stabilizer was not effective for skin flap but, possibly, for muscle flap.

Polymorphism in the DNA Repair Gene XRCC1 Associated with Squamous Cell Carcinoma and Basal Cell Carcinoma of the Skin in Koreans

PURPOSE: DNA in most cell is regularly damaged by endogenous and exogenous mutagens. Unrepaired damage resulted in apoptosis or may lead to unregulated cell growth and cancer. Inheritance of genetic variants at one or more loci results in an reduced DNA repair capacity. These polymorphisms are highly prevalent in the population, and therefore the attributable risks for cancer could be high. Several studies have documented that polymorphisms of XRCC1, XPD and XRCC3 are associated with skin cancer, especially, XRCC1 among of them has been reported frequently. So, this study involves the relationship between mutation of XRCC1 of squamous cell and basal cell cancer of the skin and risk of cancer development in Korean population. METHODS: In case control study, study population (n=100, each cancer) is patients who were pathologically diagnosed as skin cancer(squamous cell carcinoma and basal cell carcinoma) in Yonsei Wonju Christian Hospital and Bundang CHA General Hospital between 1998 and 2004. The samples of DNA from whom no history of premalignant skin lesion and other malignant diseases were reported belonged to the control group(n=210). Blood and tissue samples were analyzed for presence of XRCC1 Arg399Glu, Arg280His, Arg194Trp using PCR/ RFLP method. RESULTS: For Korean, there was a significant correlation between XRCC1 Arg399Gln gene mutation and risk of basal cell carcinoma development(Arg 399Gln(GA), p=0.012, OR=2.016, 95% CI; 1.230-3.305) /Arg399Gln (AA), p=0.011, OR=1.864, 95% CI; 1.149-3.026)). And, there was also significant correlation between XRCC1 Arg194Trp and risk of skin squamous cell carcinoma development (Arg194Trp (CT+TT), p=0.041, OR=0.537, 95% CI; 0.301-0.960)). In contrast, there was no significant correlation between XRCC1 Arg280His and risk of either basal cell carcinoma or squamous cell carcinoma development. CONCLUSION: Our result present that XRCC1 Arg399 Gln in basal cell carcinoma and XRCC1 Arg194Trp in squamous cell carcinoma have possibility of cancer risk and biomarker in Korean population. But XRCC1 Arg280 His known having cancer risk on other studies is not associated with cancer risk to squamous cell carcinoma and basal cell carcinoma in Korean population.

Is Mammotome Excision Feasible for Benign Breast Mass Bigger than 3 cm in Greatest Dimension?

PURPOSE: The aim of this study was to evaluate that a surgeon can safely remove all sonographic evidence of masses in the breast grater than 3.0 cm in greatest dimension using the 8 g hand held Mammotome (MT). METHODS: From Jan. 2003 to Mar. 2005, a total of 1,368 US-guided MT excision were performed in 1,112 patients at Kangnam Cha hospital. Of these 1,368 lesions 28 lesions with BI-RADS category 3 features by ultrasonography were included in this study. Ultrasonographic follow-up were performed on 3~6 months later to assess residual tissue and scarring. RESULTS: Mean patient age was 32.0 years (range 20~55 years). The average size of lesion was 3.5 cm (SD+-0.43 cm). All of the lesions were palpable and all of the specimens were benign. Most common pathologic features were fibroadenoma (75.0%) and breast abscess (14.3%). Mean time required to perform mammotome procedures was 12.2+/-8.2 minutes and mean number of cores removed were 35.1+/-30.2 pieces. No bleeding or infections occurred postoperatively and most complications were mild and anticipated. CONCLUSION: This study demonstrates that percutaneous removal of big breast benign mass above 3 cm in diameter using The MT system is feasible, effective and safe method for the therapeutic management with minimal morbidity without any additional procedures.

Excision of benign breast tumor by an Ultrasound-Guided hand held Mammotome biopsy device / 한국유방암학회지

PURPOSE: The mammotome (MMT) biopsy is a new surgical technique that is a minimally invasive, image guided procedure, and it requires just one small incision and there is no need for multiple insertions in the breast. The aim of this study was to evaluate the efficacy and the safety of the MMT biopsy device for percutaneous removal of breast masses with using ultrasound guidance. METHODS: From Jan. 2003 to Mar. 2005, a total of 1368 US-guided excisional MMT biopsies were performed in 1112 patients at Kangnam Cha Hospital. Those lesions with BI-RADS category 3 and 4a features by USG examination were included in this study. Lesions below 1.0 cm were removed by an 11 G probe, and lesions above 1.0cm were removed by an 8 G probe. Ultrasonographic follow-ups were performed 3-6 months later to assess the residual tissue and scarring. RESULTS: The mean patient age was 36 (range: 14-76) years. The average size of lesion was 1.14 cm (SD = 0.63 cm). Among the patients, 67.3% had nonpalpable lesion and 32.7% had palpable tumor. The majority of the specimens (98.3%) were benign. Most of benign specimens (77.7%) consisted of fibroadenoma and fibrocystic changes, although 23 lesions (1.7%) were malignant. The mean MMT procedure time was 6.2+/-3.9 minutes and the mean number of cores removed was 14.8+/-9.8. No serious bleeding or infection occurred postoperatively. CONCLUSION: This study demonstrates that percutaneous breast biopsy using the MMT system may be feasible and effective method for the diagnostic and therapeutic management of benign breast lesions with minimal morbidity. Complete MMT excision may be safely performed for the lesions those are less than 3 cm in size. A breast surgeon can use MMT instead of open or core needle biopsy for the initial biopsy of breast lesions.

A Case of Primary Cuteaneous CD30-Positive Lymphoproliferative Disorder of the Eyelid

PURPOSE: To report one case of lymphoproliferative disorder on the upper eyelid. METHODS: Primary CD30+ lymphoproliferative disorder on the skin is very rare. A 31-year-old female patient visited our clinic complaining of red, erosive papules on the right upper eyelid and on the left flank for two weeks. A 2.0 cm erythematous papule showed central ulceration. A 1.5 cm lymph node enlargement was palpated on the left groin. There was no abnormal finding on the slit-lamp test. Computed tomography showed a subcutaneous nodule on the anterolateral aspect of the flank and a lymph node enlargement on the left inguinal area. There was no evidence of other visceral involvement. Histopathologic finding showed diffuse infiltration of atypical cells with lobated nuclei showing multifocal positivity to CD30; a finding consistent with primary cutaneous CD30+ T-cell lymphoproliferative disorder and borderline lesion. RESULTS: This case seems to be a borderline case between CD30+ T-cell large cell lymphoma and lymphoid papulodesis. We are conducting conservative care and observing the progress on the skin lesion for further evaluation.

CT Findings of Surgically Verified Acute Invasive Small Bowel Anisakiasis Resulting in Small Bowel Obstruction

Acute invasive small bowel anisakiasis is an extremely rare cause of small bowel obstruction. The authors report a case of surgically verified small bowel anisakiasis resulting in small bowel obstruction. A 54-year-old man presented with suddenly developed diffuse abdominal pain after ingestion of raw fish. The peripheral blood examination showed leukocytosis without eosinophilia. CT showed a long segment of thickened small bowel accompanied by a focal narrowed portion and combined with ascites. When these findings are noted in patients with a history of recent ingestion of raw or undercooked fish, the diagnosis of small bowel anisakiasis should be considered in order to avoid application of unnecessary surgical treatment, in spite of the severity of the abdominal pain and bowel obstruction.

Relationship between Utrophin and Regenerating Muscle Fibers in Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is a dystrophinopathy, and its associated gene is located on Xp21. Moreover, utrophin, a recently identified structural homologue of dystrophin is reported to be up-regulated in DMD. In order to investigate the association between utrophin and muscle regeneration in DMD, an immunohistochemical study using antibodies to utrophin, dystrophin, vimentin and desmin was carried out in 17 cases of DMD, 3 cases of polymyositis and 1 case of dermatomyositis. Dystrophin was negative in almost all cases of DMD, but positive in all cases of inflammatory myopathy (IM). Utrophin was positive in 94.0% of DMD and in 75.0% of IM. 36.4% of the myofibers were positive in DMD, as compared to 10.5% in IM (p=0.001). In both groups, utrophin positivity was present most commonly in small regenerating fibers (p=0.001, 0.013). Vimentin and desmin were intensely positive in regenerating fibers in all cases of DMD and IM. 34.4% and 35.4% of myofibers were positive for vimentin and desmin in DMD, as compared to 21.8% and 20.9% in IM (p=0.001, 0.001). In both groups, vimentin and desmin positivity were present most commonly in small regenerating fibers (p=0.001, 0.001). The staining intensities of utrophin, vimentin and desmin were also higher in small regenerating fibers. These results show that utrophin up-regulation is regeneration-associated, and that it is proportional to the quantity of regenerating myofibers, but is not specific for DMD.

A Case of Multiple Schwannomas of the Trigeminal Nerves, Acoustic Nerves, Lower Cranial Nerves, Brachial Plexuses and Spinal Canal: Schwannomatosis or Neurofibromatosis?

In most cases, while schwannoma is sporadically manifested as a single benign neoplasm, the presence of multiple schwannomas in one patient is usually indicative of neurofibromatosis 2. However, several recent reports have suggested that schwannomatosis itself may also be a distinct clinical entity. This study examines an extremely rare case of probable schwannomatosis associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. Magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas. Following is this patient case report of multiple schwannomas presenting with no skin manifestations of neurofibromatosis.

Ultrasound Diagnosis of Bladder Exstrophy in the Second Trimester of Pregnancy: A Case Report / 대한산부인과학회잡지

Bladder exstrophy is a rare congenital malformation in which the anterior wall of the bladder is absent, and the posterior wall is exposed. Because of the poor prognosis, prenatal diagnosis is important. We present a case of bladder exstophy which was presented as a solid mass in the lower part of the fetal abdomen instead of fluid-filled urinary bladder, and confirmed at autopsy after termination of pregnancy. To the best of our knowledge, this is the first report of bladder exstrophy prenatally diagnosed in the Korean literature.