Superficial Angiomyxoma of the Vulva in a Postmenopausal Woman: A Case Report and Review of Literature

Superficial angiomyxomas (SAMs) are rare benign cutaneous tumors that involve the subcutaneous layer. They are commonly located in the trunk, lower limbs and head or neck of women of reproductive age. SAMs in the vulva of postmenopausal women are especially rare case. Herein, we report a vulvar SAM in a postmenopausal 60-year-old woman. The patient presented with a palpable cutaneous mass in the right labium majora that had appeared 3 months earlier. The mass was slow growing and approximately 5 cm in size and resembled a soft tissue malignancy. It appeared as a well-defined multilocular cystic mass in magnetic resonance images. The preoperative diagnosis was a benign cystic lesion such as an epidermoid cyst. Grossly, the completely excised mass was 6 × 5 cm in size and well circumscribed with a multilocular outer surface, a yellowish-gray gelatinous cut surface, and a smooth rubbery inner surface. Histologic review revealed that the mass contained small to moderate amount of cellular angiomyxoid nodules and bland-looking spindle-shaped to ovoid cells without atypia. Neutrophil infiltration, which is a diagnostic feature of SAMs, was observed. Immunohistochemistry showed expression of CD34, but not of estrogen receptors, progesterone receptors, or desmin in the SAM. The patient has been followed up for 12 months without recurrence.

Uterine Lipoleiomyoma in Peri or Postmenopausal Women

Lipoleiomyoma is an uncommon neoplasm of the uterus, composed of smooth muscles intermixed with mature adipocytes. These tumors are considered a benign variant of uterine leiomyomas. Herein, we report six cases of lipoleiomyoma experienced in our institution from January 2005 to March 2015. The patients ranged in age from 45 to 70 years; the etiology may be related to estrogen deficiency occurring after menopausal transition. Except for one lipoleiomyoma in the broad ligament, all others were found in the uterine corpus. The presenting symptoms were nonspecific, and most cases were incidentally diagnosed during surgery for other reasons. We performed preoperative imaging studies, including abdominal and pelvic computed tomography and magnetic resonance imaging. Preoperatively, four patients were diagnosed as having a pelvic mass and one patient was diagnosed as having a right ovarian mature teratoma. In one case, we found a gynecologic malignancy (cervical cancer 1A1). Histologically, there was no gross or microscopic contiguity between the lipoleiomyoma and the malignancy. Lipoleiomyomas seem to have a benign clinical course. In our study, there were no recurrences of or deaths attributed to the lipoleiomyomas during a mean follow-up period of 16.17 +/- 23.80 months.

Metabolic Syndrome Emerging from Menopause / 대한폐경학회지

Metabolic syndrome (MS) in women, which is characterized with central obesity, insulin resistance, and dyslipidemia, is associated with high risk of cardiovascular disease (CVD) and diabetes. Menopause may be related with the prevalence of MS and increased CVD risk through effects on central obesity, lipid metabolism, and prothrombotic state. The emergence of these risk factors may be a direct result from the failure of estrogen production. Alternatively, metabolic changes with estrogen deficiency may be the indirect cause of those risks. Additionally, most women may have a few chances of developing MS during their life, such as pregnancy-related weight gain, hormonal contraceptive use and polycystic ovary syndrome. Therefore, it is difficult to conclude that menopause itself can be the cause of MS. Representative managements of MS are life style modification and use of lipid lowering medication. This article will review the relationship between the development of MS and menopause. A better understanding on the metabolic changes with menopause will help identify women with risk factors of CVD and provide appropriate interventions

Lower growth factor expression in follicular fluid undergone in-vitro fertilization / 대한생식의학회지

OBJECTIVE: This study was performed to identify whether growth and differentiation factor-9 (GDF-9) and transforming growth factor-beta1 (TGF-beta1) expressions would be lower in the follicular fluid (FF) of those over age 35 who underwent IVF than under age 35. METHODS: A total of 24 IVF cycles (20 patients) were included in this study. All of patients were stimulated for IVF by the GnRH short protocol and divided into two groups for analysis, according to their age: or =35 group (10 cycles, 9 patients). The expression levels of GDF-9 and TGF-beta1 were determined by western blotting and quantitative enzyme-linked immunosorbent assay. RESULTS: The numbers of retrieved oocytes and metaphase II oocytes were significantly lower in the > or =35 group. Lower expression of GDF-9 and TGF-beta1 by western blotting in the > or =35 group were observed as well. The mean GDF-9 and TGF-beta1 levels by enzyme-linked immunosorbent assay were lower in the > or =35 group. The values were 6,850.5+/-928.4 ng/L vs. 3,333.3+/-1,089.2 ng/L of GDF-9 (p<0.05) and 3,844.1+/-571.1 ng/L vs. 2,187.7+/-754.0 ng/L of TGF-beta1 (p<0.05). A negative correlation between GDF-9 and age was observed (r=-0.546, p=0.006). CONCLUSION: GDF-9 and TGF-beta1 production from stimulated ovaries during IVF appears to decrease with age.