An Immunohistochemical Study on the Macrophages in the Developing Corpora Lutea of the Rat / 대한해부학회지

Within the corpus luteum, macrophages exert luteotropic and luteolytic actions through secretion of TNF-alpha. However, the mechanisms of luteotropic actions on the development and maintenance of pregnant and nonpregnant corpora lutea are thoroughly unknown.In this experiment, TUNEL, macrophage, and TNF-alpha immunohistochemistry on the corpora lutea of pregnant and nonpregnant rats (Sprague-Dawley strain) were carried out to reveal the role of macrophages in the developing corpora lutea. The results were as follows; 1) In the nonpregnant corpora lutea, the number of macrophages was increased significantly, and the degree of ED1-immunoreactivity of macrophages was increased moderately. But lutein cells showed low-degree TNF-alpha-immunoreactivity. 2) In the pregnant corpora lutea, the number of macrophages was decreased significantly, and the degree of ED1- immunoreactivity of macrophages was low. But lutein cells showed moderate-degree TNF-alpha-immunoreactivity. Based on the above results, it was considered that macrophages in the nonpregnant corpora lutea exert phagocytic action mainly, and the macrophages in the pregnant corpora lutea exert TNF-alpha-secreting action to maintain the structure and function of lutein cells.

Malignant lymphoma of the uterine cervix treated by neoadjuvant chemotherapy / 부인종양

Non-Hodgkin's lymphoma presented as a malignancy of the uterine cervix is exceedingly rare disease and accounts for approximately only 0.12-0.6% of extranodal lymphomas. There is no consensus on the management and prognosis of the disease because of its extreme rarity. Previously, treatment of this disease has been radiation therapy, surgery or chemotherapy either alone or in combination. We present the case of a 45-year-old woman diagnosed with diffuse, large B-cell non-Hodgkin's lymphoma of the uterine cervix. We administered neoadjuvant chemotherapy according to CHOP protocol (cyclophosphamide, adriamycin, vincristine, and prednisone) followed by hysterectomy and bilateral salpingo-oophorectomy. The patient is alive 20 months after the initial diagnosis. We report the case with a brief review of literature.

Low-dose Radiation-induced Hormetic Effect in the Rat Ovarian Follicle / 체질인류학회지

Hormesis is the generally-favorable biological responses to low exposures to toxins and other stressors. Radiation hormesis is the theory that ionizing radiation is benign at low levels of exposure, and that doses at the level of natural background radiation can be beneficial. The purpose of this study is to reveal the hormetic effect of low-dose radiation of ionizing radiation on the ovarian follicles of 4-week old female mice. Mice were grouped into control group, 2 cGy irradiated group, 2 cGy and 2 Gy irradiated group (2 cGY pre-exposure group), and 2 Gy irradited group. Mice were sacrificed by cervical dislocation 24 hours after irradiation, removed ovaries, fixed in neutral formaldehyde solution for 24 hours, embedded with paraffin, stained with hematoxylin and eosin and TUNEL immunohistochemically, and observed light microscopically the atretic follicles and normal follicles in various follicular developmental stages. In this experiment, the ratrio of atretic follicles to entire follicles in an ovary increased significantly in 2 Gyirradiated group compared with 2 cGY pre-exposure group, and the ratio of normal follicles to the entire follicles in an ovary in all the developmental stages were increased significantly in the 2 cGY pre-exposure group compared with 2 Gy-irradiated group. These results mean that low-dose radiation pre-exposure can induce the hormetic effect in the developing ovarian follicle.

A case report of recurrent Meckel Gruber syndrome / 대한산부인과학회지

Meckel Gruber syndrome consisting of an occipital encephalocele, polycystic kidney disease and polydactyly is a rare autosomal recessive disorder with a recurrence risk of 25%. Targeted ultrasonography in late embryonic or early fetal stages of pregnancy has great importance in diagnosis and management of affected pregnancy in high risk groups due to incomplete genetic mapping of meckel syndrome gene (MKS). We present a case of prenatal diagnosis at 14 weeks' gestational age of Meckel Gruber syndrome in a woman, who experienced same disorder in her previous pregnancy.

A case report of Extragonadal endodermal sinus tumor occurring in the appendix and mesentery / 대한산부인과학회지

Endodermal sinus tumor (EST) is a rare malignant germ cell tumor arising usually in the gonads such as the testis or ovary. However, 10-15% of EST cases may arise in the extragonadal sites, such as sacrocoxygeal area, mediastinum, vagina, brain and retroperitoneum in a frequent occurring order. To our knowledge there are only 2 case reports of extragonadal EST, one originating from the omentum in 1998, and another which was localized in the pelvis in 2003. We report one case of extragonadal sinus tumor which arose in appendix and mesentery in the 19-year-old female with a review of the literature.

Distribution and Role of Ovarian Follicle Macrophage in Rat Ovarian Follicular Atresia / 대한산부인과학회지

OBJECTIVE: Ovarian follicular atresia is initiated from ovarian granulosa cell apoptosis and macrophages exert their effects directly and/or indirectly on follicular atresia by phagocytosis of apoptotic bodies and secretion of various cytokines. In spite of the abundant data on ovarian macrophages, the presence of these cells within the follicles (i.e., among granulosa cells) remains controversial and the elimination methods of apoptotic bodies of atretic follicles, and the time and methods of penetration of macrophages into the follicles are not known completely. The aim of the present study is to demonstrate the presence of macrophage within the ovary as related to follicular atresia and the process of elimination of apoptotic granulosa cells by light and electron microscopy. METHODS: Using rat ovaries, immunohistochemical studies with rat macrophage monoclonal antibody ED1 for macrophages, and light and transmission electron microscopic observations were performed. RESULTS: In the rat, follicular atresia was initiated by the granulosa cell apoptosis which occured randomly within the all granulosa layers. Macrophages were observed within normal follicles, in antrum, granulosa and theca cell layers of atretic follicels, in interstium and in corpus luteum. Ultrastructurally, apoptotic granulosa cells showed characteristics, pyknotic nucleus and apoptotic body formation. Apoptotic bodies were eliminated by intact neighboring granulosa cells and macrophages. Intact granulosa cells ingested apoptotic bodies transiently, soon after they fell into the apoptosis. Finally, apoptotic bodies and degenerating oocytes were phagocytosed by macrophages. Macrophages entered the ovarian follicle at the time of initiation of granulosa cell apoptosis, and migrated with the progression of apoptosis. By elimination of theca cells, macrophages contributed the completion of follicular atresia. CONCLUSION: This study demonstrates both intact neighboring granulosa cells and macrophages in the elimination of apoptotic bodies in atretic follicles of the rat ovary. Macrophages are present within normal follicles, in atretic follicles such as antrum, granulosa and theca cell layers and in corpus luteum but are in different appearances according to their location in ovary. A number of macrophages appearing in atretic follicles and in corpora lutea suggest a role for macrophages in follicular atresia and corpus luteum differentiation. The function of macrophage according to their location in follicular development should be further studied.

Changes of Macrophages in Rat Corpus Luteum: Immunohistochemical and Transmission Electron Microscopy Studies / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to assess morphologically the changes of macrophages during various developmental periods of the corpus luteum in the rat ovary. METHODS: The female rats (Sprague-Dawley strain) at age 8 weeks, ovulatory period; 6 days of gestation, early pregnancy period; 19 days of gestation, late pregnancy period; and postpartum 5 days, postpartum period were used. Removed ovaries were dissected and used for TdT-mediated dUTP biotin nick end labelling (TUNEL), macrophages immunohistochemistry, and Transmission Electron Microscopy (TEM). RESULTS: Macrophages were observed in all the developmental periods. The number of apoptotic bodies and macrophages was highest at the ovulatory period, and decreased at postpartum period, early pregnancy period and late pregnancy period in order. The immunoreactivity of macrophages was high at ovulatory period, moderate at late pregnacy and postpartum period, and low at early pregnancy period. In TEM observations, two types of macrophages were observed. One was non-phagocytic macrophage which has slender cell body and long cytoplasmic processes and contained no apoptotic bodies, and the other was phagocytic macrophage which contained apoptotic bodies, phagocytic vacuoles and many lipid droplets and located near the capillaries. CONCLUSION: In the rat corpus luteum, the number and the degree of immunoreactivity of macrophages changed according to the functional developmental periods of the corpus luteum. The functions of the macrophages were suggested as the elimination of apoptotic bodies at the ovulatory and postpartum periods, and luteotropic action at the early and late pregnancy periods. Ultrastructurally, two types of macrophages, phagocytic and non-phagocytic, were confirmed.

TNFalpha and TNFR2 Immunohistochemistry During Ovarian Follicular Development and Atresia in the Rat / 대한해부학회지

Tumor necrosis factor alpha (TNFalpha) is an intraovarian cytokine that may play a role in ovarian development and function. Identification of ovarian TNFalpha receptors provides support for establishing a role of TNFalpha in ovarian development and function. TNFalpha exerts its effects by binding to either TNF receptor 1 or 2 (TNFR1 or TNFR2). When TNFalpha binds with TNFR2, expression of survival genes is up-regulated, resulting in proliferation of granulosa cells. In the present study, the authors identified the changes in localization of TNFalpha and the expression of TNFR2 in granulosa cells during follicular atresia in rat ovaries. In healthy follicles, intense signals for TNFalpha and TNFR2 were found in the outer surface of the granulosa layer, where many proliferating cells and no apoptotic cells were observed. In atretic follicles, decreased expression of TNFalpha and TNFR2 was observed in the granulosa layer, where many apoptotic cells were seen. These findings suggested that TNFalpha acts as a survival factor in granulosa cells during follicular atresia in rat ovaries.

Morphological Study on the Radiation-induced Follicular Atresia and the Follicular Macrophage / 대한산부인과학회잡지

OBJECTIVE: It is well known that X-ray induces follicular atresia, but the exact mechanism of atresia is not still unveiled completely. In addition, the role of macrophage related with clean-up the dead granulosa cells and other functions within the ovarian follicle is emphasized recently. The aim of this study is to assess the radiation-induced morphological changes of ovarian follicles and follicular macrophages. METHODS: 8 Gy X-ray irradiated on the 3-week old rats (Sprague-Dawley strain), sacrificed at 6, 12, and 24 hours after irradiation, and performed morphological studies with light and transmission electron microscopy, TUNEL, and macrophage immunohistochemistry. RESULTS: Follicular atresia increased significantly (p<0.01) at 6 hours after X-irradiation, and it was decreased significantly (p<0.01) at 12 and 24 hours after irradiation. X-ray induced chromatin condensation in the nucleus and nuclear fragmentation of granulosa cells, which were the typical features of apoptosis. Apoptotic granulosa cells were phagocytosed by the neighboring normal granulosa cells and the macrophages. During atresia of follicles, radioresistant granulosa cells were found in some follicles, which showed similar features morphologically with the granulosa cells of normal follicles. Macrophages were found both within the antrum and at the follicular granulosa layer. CONCLUSION: X-radiation induced follicular atresia by means of granulosa cell apoptosis, and radioresistant granulosa cells which have similar features morphologically with the granulosa cells of normal follicles were observed in some follicles. And the macrophages which phagocytose the apoptotic granulosa cells were located within the follicular antrum and at the follicular granulosa layer.

Total Laparoscopic Hysterectomy using Modified Bae's Uterine Elevator / 대한산부인과학회잡지

OBJECTIVE: Hysterectomy is one of the most common gynecological operations. The objective of this study was to introduce a new uterine elevator for total laparoscopic hysterectomy. METHODS: Bae's uterine elevator was modified for laparoscopic hysterectomy. Modified Bae's uterine elevator was 5 cm longer than original one and handle was modified to vertical position and stopper, silicon tube and silicon adapter for colpotomizer was installed on the shaft. Three hundred and fifty seven cases of total laparoscopic hysterectomies using modified Bae's uterine elevator were performed from Jan 1999 to Jun 2000. RESULTS: Mean age of the patients was 41.8, operation time was 48.3 minutes and uterine weight was 245.5 gm. Leiomyoma was the most common cause of hysterectomies (70.9%), and followed by adenomyosis (16.2%), endometriosis (7.6%). There were no major operative complications such as vascular, bladder, ureter or intestinal injuries. CONCLUSIONS: Three hundred and fifty seven cases of total laparoscopic hysterectomies using modified Bae's uterine elevator were performed successfully without any major complications. Modified Bae's uterine elevator was very convenient for uterine manipulation during total laparoscopic hysterectomy.

A Case of Cellular Schwannoma of the Retroperitoneum / 대한부인종양콜포스코피학회잡지

Cellular schwannoma is a variant of schwannoma, and is diagnosed as malignant tumor in over one fourth of cases because of its cellularity, mitotic activity and the occasional presence of bone destruction. This tumor is a tumor with low malignant potential and usually occurs in peripheral nervous system, mainly in the posterior mediastinum and retroperitoneal space. But pelvic retroperitoneal cellular schwannoma is very rare. Recently, we experienced a case of pelvic retroperitoneal cellular schwannoma in a 42-year-old woman; in reporting the case a brief review of the literature is included.