Cecal malakoplakia: A case report

Malakoplakia is a rare chronic granulomatous disease found in the genitourinary tract, mainly. It is considered to be related to immunosuppression and/or infectious processes. We would like to present an operative case of cecal malakoplakia in a patient with a history of surgical resection and chemotherapy for cervical cancer. A 74-year-old female patient visited our hospital for 1-year follow-up after operation and chemo-radiotherapy for cervical cancer. An infiltrative mass of 6 cm, between the cecal base and the right psoas muscle, was observed on computed tomography. An ileocectomy was performed for diagnosis. Histopathologic examination revealed cecal malakoplakia. After surgery, based on previous reports, antibiotics therapy was added. Then the patient was discharged and treated in the outpatient clinic. To our knowledge, a rare case has been described of cecal malakoplakia during observation after surgery and chemo-radiotherapy for cervical cancer. Malakoplakia is known to be related to immunosuppressive condition. Therefore, our case suggests that close observation should be made in patients on immunosuppressive condition, such as chemotherapy.

Cecal malakoplakia: A case report

Malakoplakia is a rare chronic granulomatous disease found in the genitourinary tract, mainly. It is considered to be related to immunosuppression and/or infectious processes. We would like to present an operative case of cecal malakoplakia in a patient with a history of surgical resection and chemotherapy for cervical cancer. A 74-year-old female patient visited our hospital for 1-year follow-up after operation and chemo-radiotherapy for cervical cancer. An infiltrative mass of 6 cm, between the cecal base and the right psoas muscle, was observed on computed tomography. An ileocectomy was performed for diagnosis. Histopathologic examination revealed cecal malakoplakia. After surgery, based on previous reports, antibiotics therapy was added. Then the patient was discharged and treated in the outpatient clinic. To our knowledge, a rare case has been described of cecal malakoplakia during observation after surgery and chemo-radiotherapy for cervical cancer. Malakoplakia is known to be related to immunosuppressive condition. Therefore, our case suggests that close observation should be made in patients on immunosuppressive condition, such as chemotherapy.

Prognostic factors after hepatic resection for the single hepatocellular carcinoma larger than 5 cm

PURPOSE: This study aimed to determine which factors affect the prognosis of hepatectomy for hepatocellular carcinoma (HCC) larger than 5 cm, including the prognostic difference between tumor sizes from 5–10 cm and larger than 10 cm. METHODS: The medical records of 114 patients who underwent hepatectomy for single HCC larger than 5 cm were reviewed and analyzed retrospectively. RESULTS: In the analysis of the entire cohort of 114 patients, the 5-year overall and diseases-free survival rates were 50% and 29%, respectively. In a comparison of survival rates between groups, tumor sizes of 5 to 10 cm and larger than 10 cm, the overall and disease-free survival rates were not significantly different, respectively (54% vs. 41%, P = 0.433 and 33% vs. 23%, P = 0.083). On multivariate analysis, positive hepatitis B, high prothrombin induced by vitamin K absence or antagonist-II levels over 200 mIU/mL, and vascular invasion (micro- and macrovascular invasion) were independent prognostic factors for recurrence after hepatic resection. However, tumor size larger than 10 cm was not significant for recurrence after resection. CONCLUSION: This study shows that surgical resection of solitary HCC larger than 5 cm showed favorable overall survival. And there is no survival difference with tumors between 5–10 cm and larger than 10 cm.

Prognostic factors after hepatic resection for the single hepatocellular carcinoma larger than 5 cm

PURPOSE: This study aimed to determine which factors affect the prognosis of hepatectomy for hepatocellular carcinoma (HCC) larger than 5 cm, including the prognostic difference between tumor sizes from 5–10 cm and larger than 10 cm. METHODS: The medical records of 114 patients who underwent hepatectomy for single HCC larger than 5 cm were reviewed and analyzed retrospectively. RESULTS: In the analysis of the entire cohort of 114 patients, the 5-year overall and diseases-free survival rates were 50% and 29%, respectively. In a comparison of survival rates between groups, tumor sizes of 5 to 10 cm and larger than 10 cm, the overall and disease-free survival rates were not significantly different, respectively (54% vs. 41%, P = 0.433 and 33% vs. 23%, P = 0.083). On multivariate analysis, positive hepatitis B, high prothrombin induced by vitamin K absence or antagonist-II levels over 200 mIU/mL, and vascular invasion (micro- and macrovascular invasion) were independent prognostic factors for recurrence after hepatic resection. However, tumor size larger than 10 cm was not significant for recurrence after resection. CONCLUSION: This study shows that surgical resection of solitary HCC larger than 5 cm showed favorable overall survival. And there is no survival difference with tumors between 5–10 cm and larger than 10 cm.

Mesenteric desmoid-type fibromatosis causing secondary hypertension in a young woman

This report describes an 18-year-old woman presenting with abdominal distension, left flank pain, and hypertension. She had a huge abdominal mass, diagnosed as a mesenteric desmoid-type fibromatosis, causing compression of the left external iliac vessels and ureter, as well as elevated renin concentration and hypertension. After surgical removal of the mass, all signs improved including hypertension.

Expression of aromatase in endometiosis and its relation to clinical laboratory and surgical parameters / 대한산부인과학회지

OBJECTIVE: Aromatase is the key enzyme for the conversion of C19 steroids into estrogen in certain human tissues. We studied to evaluate the aromatase expression in eutopic endometirum and endometriotic lesion and its relationship to clinical and laboratory parameters. METHODS: The study included 78 cases of endometriotic lesion and 14 cases of eutopic endometrium and 30 cases of normal uterine endometrium obtained through laparoscopic surgery and curettage. The frozen tissue specimens were examined by immunohistochemistry using aromatase. Clinical symptoms, laboratory findings, and operative findings were analyzed and compared in according to aromatase expression. RESULTS: We observed positive immunohistochemical expression for aromatase in endometriotic lesion from 46/78 patients (59.0%). Aromatase expression was elevated in comparison to eutopic endometrium (5/14 patients, P=0.032) and the difference was more pronounced when eutopic endometriums from patients with endometriosis were compared with those of healthy controls (2/30 patients, P<0.001). Aromatase-positive patients had more moderate-to-severe chronic pelvic pain, higher CA-125 level significantly. Also in operative findings, severe grade endometriosis, bilateral endometriomas, and associated leiomyoma and adenomyosis were more frequent in aromatase positive patients. High values of white blood cell count, erythrocyte sedimentation rate, CA 19-9 were more frequent in aromatase positive patients notwithstanding insignificant differences. CONCLUSION: Unopposed local biosynthesis of estrogens by increased expression of aromatase in eutopic endometrium and endometrial tissue could be involved in the development or maintenance of endometriosis and other uterine estrogen-triggered diseases. Our findings suggest increased expression of aromatase may be related with severity, activity, and chronic pelvic pain in patients with endometriosis.

A Case of Primary Aldosteronism due to Remnant Adenoma after Adrenalectomy in Pregnant Woman / 대한신장학회지

Primary aldosteronism is present in approximately 1 percent of hypertensive patients, and is rarely associated with pregnancy. We report a case of unilateral aldosterone producing adenoma in a pregnant woman. A 29-year-old woman was referred to with hypertension and proteinuria at 14 weeks' gestation. She had known that she had unilateral aldosterone producing adenoma for 18 months and refused medical or surgical treatment. She was prescribed antihypertensive medication and preformed laparoscopic adrenalectomy in left adrenal gland at 22 weeks' gestation. After adrenalectomy, her blood pressure was normal. At 29 weeks' gestation, she complained headache, and her blood pressure was 200/100 mmHg with pitting edema. We thought preeclampsia and performed cesarean section. After the baby was delivered, she had uncontrolled hypertension, hypokalemia with persistent proteinuria. We checked plasma renin activitity, aldoterone and abdminopelvic computed tomography. We found remnant left adrenal adenoma and perfomed laparoscopic operation. After reoperation, her blood pressure was normal and no proteinuria.

A case of port site implantation of borderline mucinous tumor of ovary after the laparoscopic operation / 대한산부인과학회지

Borderline tumor of ovary is epithelial proliferation without stromal invasion, first reported by Taylor in 1929. Borderline ovarian tumor occurs in younger women and is detects in early stage. Laparosocopy is alternative treatment of younger women for postoperative quality of life because it reduces postoperative adhesion. But it is limited to incomplete staging, tumor cell dissemination and recurrence. We report a case of port site implantation of mucinous borderline tumor after the laparoscopic operation; usually recurrence of borderline tumors were occurred after ten or fifteen years later, this case a direct evidence of cause of metastasis after the laparoscopic operation.

A case of small bowel obstruction during pregnancy / 대한주산의학회잡지

Small bowel obstruction is an unusual complication of pregnancy, but it is associated with high fetal and maternal mortality. Diagnosis is often delayed due to confusion over symptoms by both the patient and physicians, because symptoms such as colicky abdominal pain, vomiting and constipation are all common at various stages of pregnancy. If is small bowel obstruction of gravid patient suspected, prompt abdominal radiological evaluation and surgical intervention to reduce both maternal and fetal mortality are warranted. We report a recently report a recently experienced case of small bowel obstruction with brief review of literatures.

A study on association of progesterone receptor gene polymorphism (PROGINS) with Endometriosis

PURPOSE: Endometriosis is a steroid dependent disease with a particular genetic background but the location of possible genomic aberrations are still poorly clarified. This study was designed to investigate the associations between the polymorphism of the progesterone receptor gene (PROGINS) and endometriosis. METHODS: 100 women with surgically diagnosed and histologically confirmed endometriosis were enrolled as a patient population and a total of 110 female control subjects undergoing health examination were enrolled as control population. DNA extraction and polymerase chain reaction (PCR) were used to genotype women for the presence of the PROGINS polymorphism in peripheral blood samples. The x2-test was used to compare genotype distributions between endometriosis and controls. RESULTS: T1/T2 heterozygote was found to be one patient in each group, and the rest of the subjects were all T1/T1 homozygotes. There was no difference in the genotype distribution between the endometriosis group and the control group. CONCLUSION: These results suggest that the progesterone receptor gene PROGINS is not associated with the risk for endometriosis.

A case of ovarian endometriosis after laparoscopically assisted vaginal hysterectomy / 대한산부인과학회지

Endometriosis is defined as the presence of endometrial tissue outside the uterus and located usually within the pelvis. It may be detected as a rare complication associated with surgery. Endometriosis following obstetric and gynecologic procedure, which is localized mostly in the surgical scar including Cesarean section scar, hysterotomy scar, trocar scar, Bartholin cyst exision scar, or episiotomy scar, may caused by implantation of endometrial gland and stroma. Endometriosis developing after hysterectomy, especially, is a quite rare condition except a recurrent disease. We have experienced a case of a 47-year-old woman who had diagnosed ovarian endometriosis two years after laparoscopically assisted vaginal hysterectomy for a large leiomyomatous uterus with no evidence of endometriosis, so we report this case with a brief review of literature.

The Effect of Vero Cell Coculture on the Development of Mouse Embryos Exposed to Monoclonal Antibodies Specific for Mammalian Heat Shock Protein 60

Heat shock proteins (HSP) have been identified as an important factor of a very complex and highly conserved cellular defense mechanism to preserve cell survival under adverse environmental conditions. HSP 60 are immunodominant antigens of microbe such as Chlamydia trachomatis and have a potentiality to become a target antigen due to antigenic similarity between chlamydial and human HSP. This study was conducted to investigate the effects of Vero cell coculture to anti-HSP 60 on the early mouse embryo development in vitro. The 2-cell mouse embryos (ICR) were cultured and mouse embryo development was observed every 24 hr for 3 days. 45% and 22.1% of the embryos cultured in Ham's F-10 plus anti HSP 60 with Vero cells developed to the 4- to 8- cell stage (day 1) and morular stage (day 2) as compared with 29.2% and 2.7% of those cultured without Vero cells respectively. But at day 3, the beneficial effect of Vero cells was not noted. These findings suggest that Vero cells have some roles to overcome the detrimental effect of anti-HSP 60 to some degree. These results suggest that Vero cells coculture will promote reproductive outcome in patient previously sensitized to microbial (e.g. Chlamydia trachomatis) HSP 60.

Association of Progesterone Receptor Gene Polymorphism (PROGINS) and Estrogen Receptor Gene Polymorphism with Endometriosis in Korean Population / 대한산부인과학회지

OBJECTIVE: Endometriosis is defined as the presence of endometrial tissue outside the uterus, causing diverse progressive diseases such as infertility, pelvic pain, and dysmenorrhea. Although the mechanisms responsible for its pathogenesis and progression remain poorly understood, it is well established that endometriosis grows and regresses in an estrogen-dependent fashion and that administration of progestin can relieve the symptoms caused by endometriosis. Some genetic studies have demonstrated the association between the estrogen or progesterone receptor gene polymorphism and the susceptibility to endometriosis. This study was designed to investigate the associations of the polymorphism of the progesterone receptor gene (PROGINS), PvuII and XbaI polymorphism of estrogen alpha receptor gene with endometriosis in the Korean population. METHODS: A total of 100 women with surgically diagnosed and histologically confirmed endometriosis of stage III-IV were enrolled as a patient population and a total of 110 female control subjects undergoing health examination were enrolled as control population. Following isolation of genomic DNA from peripheral blood, polymerase chain reaction-sequence specific primer assays were performed for analyzing progesterone receptor gene polymorphism (PROGINS) and polymerase chain reaction-restriction fragment length polymorphism assays were performed for analyzing estrogen alpha receptor gene PvuII and XbaI polymorphism. The chi-square-test was used to compare genotype distributions between endometriosis and controls. RESULTS: Only one patient in each group was found to be T1/T2 heterozygote, and the rest of the subjects were all T1/T1 homozygotes. Analysis of PvuII has shown that the significantly lower number of patients had (pp) genotypes and (p) alleles in the endometriosis group compared with the control group (32 (32%) vs. 50 (45.5%), P<0.05; 109 (54.5%) vs. 142 (64.5%), P<0.05, respectively). There was no difference in the genotype distribution or allele frequency in XbaI polymorphism between the endometriosis group and the control group. CONCLUSION: These results suggest that the PvuII polymorphism of the estrogen receptor-alpha gene is associated with the risk for endometriosis in the Korean population.

Three Cases of Immature Teratoma of the Ovary / 대한산부인과학회잡지

The immature teratoma is the 3rd most common germ cell tumor and represents 10-20% of all ovarian malignancies occurring in the first two decades of life. The initial clinical manifestation is abdominal/pelvic mass with pain. This tumor is usually unilateral and large, and has a prominent solid component with cystic elements. It is composed of mature and immature tissues derived from the three germ cell layers. Tumor grading is based on the amount of immature tissues which mostly derives from neuroectodermal origin. The prognosis and treatment depend on the clinical stage and histological grade of the tumor. The initial treatment should include unilateral salpingo-oophorectomy and removal of as much extraovarian tumor as possible. Adjuvant chemotherapy is not necessary for the patients with stage IA, grade 1 tumor or those with mature glial implants. Combination chemotherapy is recommended for the patients with grade 2 or 3 tumors or those with immature metastases. Although the immature teratoma was considered aggressive tumor type before the prevalent use of chemotherapy, the advances in combination chemotherapy have leaded to the better prognosis than before. We have experienced three cases of immature teratoma and report them with brief review of literatures.

A Case of Huge Ovarian Tumor Associated with Hypothyroidism / 대한산부인과학회잡지

In adult women, hypothyroidism has significant effect on reproduction. Hypothyroidism is associated with oligomenorrhea, amenorrhea, anovulation, hypermenorrhea, menorrhagia, infertility, spontaneous abortion, stillbirth or preterm delivery. It can cause ovarian tumor, which clinically resembles ovarian hyperstimulation syndrome or multicystic ovarian tumor. We have experienced a case of spontaneously regressed huge ovarian tumor which was found in patient. With hypothyroidism. So we report this case with a brief review of literature.

A Case of Peripartum Cardiomyopathy / 대한산부인과학회잡지

Peripartum cardiomyopathy is relatively uncommon form of heart failure that occurs from one month before, to 5 months after delivery. The causes of this disease are unknown and mortality rate may be as high as 20-50%. We recently experienced one case of this disease and summarized here with brief review of literatures.

A Case of Primary Carcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary carcinoma of the fallopian tube is very rare and accounts for less than 1% of all gynecologic malignancies. Nonspecific symptoms are presented, so primary carcinoma of the fallopian tube was confirmed postoperatively on the basis of the pathologic examination. The evaluation and treatment are similar to that of the ovarian cancer. We have experienced a case of primary carcinoma of the fallopian tube, especially fimbrial portion and report with a brief review of the literature

Two Cases of Primary Peritoneal Serous Papillary Carcinoma / 대한산부인과학회잡지

Primary peritoneal serous papillary carcinoma (PPSPC) is very rare and not well identified. Because of developmental, biological and histologic similarity to papillary serous carcinoma of ovary its diagnosis and treatment, prognosis and post treatment follow up schedule is similar that of epithelial ovarian cancer. We have experienced two cases of primary peritoneal serous papillary carcinoma and report this with brief review of the concerned literatures.

Two Cases of Primary Peritoneal Serous Papillary Carcinoma / 대한산부인과학회잡지

Primary peritoneal serous papillary carcinoma (PPSPC) is very rare and not well identified. Because of developmental, biological and histologic similarity to papillary serous carcinoma of ovary its diagnosis and treatment, prognosis and post treatment follow up schedule is similar that of epithelial ovarian cancer. We have experienced two cases of primary peritoneal serous papillary carcinoma and report this with brief review of the concerned literatures.