Clinical evaluation and management of endometriosis: guideline for Korean patients from Korean Society of Endometriosis

Endometriosis is one of the most common diseases in reproductive ages, and it affects patients' quality of life and fertility. However, few Korean guidelines are available for the evaluation and management of endometriosis. Korean Society of Endometriosis reviewed various literatures and trials, and to provide seventy-one evidence-based recommendations. This review presents guidelines for the diagnosis and management of endometriosis with emphasis on: it's role in infertility, treatment of recurrence, asymptomatic women, endometriosis in adolescents and menopausal women, and possible association of endometriosis with cancer.

The effect of combined treatment of Mirena(R) and Provera(R) (MPA) for chronic pelvic pain due to endometriosis / 대한산부인과학회지

OBJECTIVE: The degree of pain relief and complications after treatment for chronic pelvic pain due to endometirosis were evaluated. METHODS: This study was performed in sixty three patients of endometriosis who have diagnosed by laparoscopy. They were divided in three groups by treatment regimen, Mirena(R) only group (Group A), Mirena(R) plus low-dose MPA group (Group B) and high-dose MPA only group (Group C). After six months, we evaluated the result of treatment by the degree of pain relief and complications of each treatment regimen. RESULTS: The degree of pain relief in Group B was significantly higher than in Group A (p<0.05), and significant difference was not found between Group B and Group C. The frequency of irregular bleeding in Group B was significantly lower than Group A (p<0.05), but not than Group C. The frequency of weight gain in Group B was significantly lower than Group C (p<0.01), but not than Group A. However the frequency of breast tenderness in Group B was significantly higher than Group A (p<0.01), but not than Group C. CONCLUSION: Mirena(R) plus low-dose MPA combined treatment is as effective as high-dose MPA treatment in pain relief with lower side-effects.

The Management of Chronic Pelvic Pain

Chronic pelvic pain (CPP) is defined as lower abdominal pain lasting for at least 6 months. There are two forms of CPP: cyclic or continuous. The usual cyclic pain is dysmenorrhea. Dysmenorrhea is classified into primary and secondary. The primary dysmenorrhea is painful menstruation without any other pelvic disease. It can be treated by fat-free or omega-3-rich diet, quitting of smoking, nonsteroidal antiinflammatory drugs (NSAIDs), oral contraceptive pills, and long-acting injectable progestins. The most common origin of secondary dysmenorrhea and CPP is endometriosis. The management of pain of endometriosis can be controlled with stepby-step management of the original lesion by medical and surgical treatment, postoperative medical treatment, trigger point injection, NSAIDs, and immune therapy. Other etiologies of CPP are adenomyosis, pelvic congestion syndrome, abnormalities of uterus and ovary, psychological problems, gastrointestinal diseases (e.g. irritable bowel syndrome), urinary diseases (e.g. interstitial cystitis or chronic urethral syndrome), and musculoskeletal diseases. They can be treated by the management of the underlying diseases. The special form of CPP is chronic myofacial syndrome of the abdominal wall, which can be treated by trigger point injection. The other supportive treatments for CPP are laparoscopic adhesiolysis, uterine suspension, laparoscopic uterosacral nerve ablation (LUNA), presacral neurectomy, and hysterectomy. The treatment of CPP is very difficult. Therefore the exact diagnosis of its origin is necessary, and the combination treatment in various aspects is needed.

Clinical study of complications in the surgical management of stress urinary incontinence using Transobturator tape (TOT) / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the complications of Transobturator tape (TOT) in the surgical treatment for stress urinary incontinence and their management. METHODS: From March 2005 to October 2007, 206 patients diagnosed with stress urinary incontinence were operated using TOT at Chonnam National University Hospital. We reviewed medical records and analyzed the data according to age, parity, menopausal state, concomitant operations and complications. RESULTS: Mean age of the patients was 52.6+/-10.5 years and mean parity was 2.9+/-1.4. 91 patients (44.2%) were in postmenopausal state and 201 patients (97.6%) had other concomitant gynecologic operations. There were no intraoperative complications such as vaginal injury or bladder perforation. Postoperatively, there were 2 cases (1.0%) of vulva hematoma, 6 cases (2.9%) of urinary retention, 4 cases (1.9%) of de novo urgency and 4 cases (1.9%) of vaginal erosion. CONCLUSION: The surgical treatment using TOT is thought to be safe and effective means for the management of stress urinary incontinence. Although rare, complications may occur, therefore surgeons must be aware of the management of each complications.

The usefulness of combined treatment of GnRH agonist and levonorgestrel-releasing intrauterine system (Mirena(R)) for chronic pelvic pain of endometriosis / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the effects of levonorgestrel-releasing intrauterine system (Mirena(R)) combination to GnRH (gonadotropin releasing hormone) agonist treatment on chronic pelvic pain of endometriosis, hypoestrogenic symptoms. METHODS: One hundred twenty eight patients who were diagnosed as endometriosis, were divided into endometriosis without adenomyosis group (n=88) and endometriosis with adenomyosis group (n=40). In 57 of 88 patients who had only endometriosis without adenomyosis, only GnRH agonist for 6 months was injected monthly (Group A). In the other 31 of 88 patients, Mirena(R) was inserted and GnRH agonist for 6 months was injected monthly (Group B). In 12 of 40 patients who had endometriosis and adenomyosis, only GnRH agonist for 6 months was injected monthly (Group C). In the other 28 of 40 patients, Mirena(R) was inserted and GnRH agonist for 6 months was injected monthly (Group D). The degree of pelvic pain, dysmenorrhe, and hypoestrogenic symptoms of each groups were observed and compared. RESULTS: The decreased pain rates of Group B and D were significantly higher than Group A and C (p<0.01), and decreased pain rates of Group D were significantly higher than Group B (p<0.05). The incidence of hot flush, depression and insomnia of 4 groups were not significantly different. CONCLUSIONS: Although Mirena(R) combination to GnRH agonist treatment cannot prevent the hypoestrogeic symptoms, Mirena(R) combination increases the treatment effect for pain of endometriosis. Especially, this effect is the more if adenomyosis is combined to endometriosis.

Diagnostic efficacy of saline infusion sonohysterography and hysteroscopy for intrauterine lesion / 대한산부인과학회지

OBJECTIVE: To compare the diagnostic accuracy and acceptability of saline infusion sonohysterography (SIS), and hysteroscopy for detecting intracavitary abnormalities in women with abnormal uterine bleeding. METHODS: Seventy-eight patients with abnormal uterine bleeding were selected from the Department of Obstetrics and Gynecology in Chonnam University Hospital. The findings at SIS were compared with the hysteroscopic and histologic findings. The agreement of diagnosis between SIS and hysteroscopy was calculated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: SIS had a sensitivity of 84% and a specificity of 85% for a diagnosis of endometrial polyp. Hysteroscopy had a sensitivity of 86% and a specificity of 96% for diagnosis of endometrial polyp. SIS had a sensitivity of 75% and a specificity of 86% for a diagnosis of submucosal myoma. Hysteroscopy had a sensitivity of 100% and a specificity 99% for a diagnosis of submucosal myoma. SIS had a sensitivity of 91% and a specificity of 96% for a diagnosis of submucosal myoma. Hysteroscopy had a sensitivity of 100% and a specificity 91% for a diagnosis of endometrial hyperplasia. CONCLUSIONS: The diagnostic accuracy of SIS was significant to that of hysteroscopy in diagnosing intracavitary abnormalities, Moreover, SIS in a safe, convenient, cost effective, easily accessible and acceptable investigative modality.

The usefulness of laparoscopic myomectomy after Hormone Replacement Therapy in postmenopausal women with uterine myoma / 대한산부인과학회지

OBJECTIVE: This study was undertaken to evaluate the usefulness of laparoscopic myomectomy after hormone replacement therapy in postmenopausal women with uterine myoma. METHODS: The total number of patients with uterine myoma in a postmenopausal women from March 1999 to December 2002 in Department of Obstetrics and Gynecology in Chonnam University Hospital was 137. Patients underwent laparoscopic myomectomy are 12 (Group B) and only hormone replacement therapy without operation are 83 (Group A). The others are not undertaken any treatment (Group C). The number and size of myoma and the development of estrogen-dependent tumor periodically followed up. RESULTS: There were significant differences among three groups with respect to myoma dimension, number. And the risk of developing of estrogen dependent tumor is not increased with Hormone replacement therapy in postmenopausal women. So, laparoscopic myomectomy in a postmenopausal patients would be performed carefully. CONCLUSION: We are not sure whether HRT increases the number and size of the myoma and malignant change when compared with untreated with postmenopausal women. So, laparoscopic myomectomy in a postmenopausal patients would be performed carefully. Further prospective studies with larger groups and a long-term would be helpful in deciding which treatment modality would be appropriate in a postmenopausal patient with myoma.

Treatment strategy for postoperative persistent pain of endometriosis / 대한산부인과학회지

OBJECTIVE: This study was designed to establish the treatment strategy on postoperative persistent pain of endometriosis. METHODS: During a 12-month period from March 2000 to February 2001, 62 patients had postoperative persistent pelvic pain. 62 patients of them were treated with GnRH analogue for 6 months. If they were not responsive to those treatment, It were recommended high dose progesterone treatment for 6 months after trigger point injection to differentiate from trigger point pain. and then for remained pain, Nonsteroidal antiinflammatory drugs (NSAIDs) and tricyclic antidepressants (TCAs) were supplied for 6 months. Finally, contineously remained pelvic pain was treated by mistletoe extract. RESULTS: 62 patients had a postoperative persistent pelvic pain. GnRH analogue were supplied to 62 patients, and then 23 patients had persistent pain. These 23 patients undertook lidocaine injection on trigger point to differentiate from trigger point pain. Two patients were responsive to injection. Remained 21 patients were treated with high dose progesterone for 6 months. Thereafter unresponded 14 patients were supplied with NSAIDs and TCAs. Finally, remained 5 patients that were uncontrolled with previous treatments were injected with mistletoe extract. Three patients were controlled with mistletoe extract. CONCLUSION: Most of persistent pain after laparoscopic operation of endometriosis were successfully controlled by sequential treatment of GnRH analogue, trigger point injection, high dose progesterone, NSAIDs and TCAs, and mistletoe extract injection.

Estrogen Receptor Dinucleotide Polymorphism in Patients with Endometriosis / 대한산부인과학회잡지

OBJECTIVE: To explore the association of the estrogen receptor dinucleotide repeat polymorphism with the risk of endometriosis. DESIGN: Case-control study. METHODS: One hundred fifty-one women with surgically or histologically diagnosed endometriosis of stages I-IV (ASRM, 1997) were recruited, and 137 patients with no evidence of endometriosis by laparoscopy or laparotomy served as control. Dinucleotide repeat polymorphism of the estrogen receptor gene was assessed by fluorescent PCR with gene scan analysis. Allele frequencies of dinucleotide repeat polymorphism of the estrogen receptor gene were evaluated. RESULTS: Fifteen alleles of the estrogen receptor dinucleotide repeat polymorphism were found in subjects: from 12 repeats to 27 repeats except 26 repeats. There was no statistically significant difference in the allele distribution of dinucleotide repeat polymorphism between patients with endometriosis and controls. However, patients with stage I or II endometriosis (n=51) showed a higher incidence of alleles with fewer (TA)n repeats (12-15 repeats) compared with controls (67.6% vs 52.9%, p=0.010, odds ratio=1.860). CONCLUSION: These results suggest that dinucleotide repeat polymorphism of the estrogen receptor gene is associated with the risk of minimal or mild endometriosis in the Korean population.

The Efficacy of GnRH Analogue on Pain Treatment after Laparoscopic Cystectomy of Endometrioma / 대한산부인과학회잡지

OBJECTIVE: To estimate the efficacy of GnRH analogue on pain treatment after laparoscopic cystectomy of endometrioma. METHODS: During a 12-month period from March 2000 to February 2001 in Chonnam National University Hospital, Sixty five patients with ovarian cysts were diagnosed as endometrioma by clinical examination, ultrasonogram and serum CA 125 level. The laparoscopic cystectomy was performed and 65 consecutive women were biopsy-proved endometrioma. They were treated with GnRH analogue intramuscular injection every 4 weeks over a period of 6 months after operation. 10-point linear visual analogue scales for pelvic pain were completed pre- and post- treatment at 6 months and 12 months. RESULTS: A total of 96 endometriotic cysts (21 cysts were bilateral) were found in the 65 patients. 65 patients had a pain associated with endometriosis. 40 patients of them complained of a dysmenorrhea, 14 patients for dyspareunia, and 24 patients for non-menstrual pain. At preoperative, the mean pain score was 5.85 +/- 2.28 (mean +/- SD) for dysmenorrhea; for dyspareunia, 5.29 +/- 1.49; for non-menstrual pain, 5.33 +/- 2.10. At 6 months and 12 months, the mean pain score was 3.20 +/- 1.68 and 2.42 +/- 1.9 for dysmenorrhea; for dyspareunia, 3.71 +/- 1.73 and 3.57 +/- 1.79; for non-menstrual pain, 3.63 +/- 2.26 and 3.29 +/- 1.97. The mean pain score for pelvic pain decreased after combined treatment. CONCLUSION: The laparoscopic cystectomy of ovarian endometrioma is an effective treatment for pelvic pain and the combination therapy with GnRH analogue is more useful to relieving pelvic pain after operation.

Three Cases of Parenchymal Pulmonary Endometriosis / 대한산부인과학회잡지

Parencymal pulmonary endometriosis is a rare gynecologic problem, characterized by cyclic hemoptysis. Lung is the origin of hemoptysis. The diagnosis is based upon the clinical history and exclusion of other causes of recurrent hemoptysis, changes in the radiologic findings of chest lesion associated with menstrual cycle. We describe three women with recurrent hemoptysis during menstruation and localized lesion on computerized tomography (CT) scanning. The patients were treated with gonadotropin releasing hormone (GnRH) agonist or surgery. We represent three cases with a brief review of literature.

Simplified Submucosal Myomectomy by Operating Hysteroscopy on OPD Basis / 대한산부인과학회잡지

OBJECTIVE: To evaluate possibility of simplified hysteroscopic operation instead of resectoscopic operation on OPD basis for sumucosal myoma with small pedicle. MATERIALS AND METHODS: On twenty five patients, who diagnosed submucosal myoma with small pedicle by sonohysterogram and diagnostic hysteroscopy, simplified hyteroscopic operations were performed on OPD. Used expanding media was normal saline. At first, pedicle was incised by hysteroscopic scissors and myoma mass was dissected by pushing of scope. After dissection of myoma mass, remained pedicle was cut by hysteroscopic scissors. The bleeding from cut pedicle site was controlled by bipolar coagulation. Cut myoma mass was removed to outside of uterus by ring forceps. However if removal of myoma mass is failed, let it in uterine cavity and it is removed at second-look hysteroscopy 1 month later after degeneration. RESULTS: On 1 of 25 patients, cutting of pedicle was failed due to fundal invisible pedicle on hysteroscopic view. On 20 of 24 patients, pedicles were completely cut. On 12 of these 20 patients, myoma masses were completely removed to outside of uterus by grasping forceps. However on remained 8 of 20 patients, myoma mass was removed easily on second-look hysteroscopy 1 month later due to shrinkage of mass. On 4 of 24 patients, pedicles were not cut completely due to large submucosal myoma. They were removed also easily on second-look hysteroscopy. Postoperative bleeding from cutting pedicle was surprisingly minimal in most cases and moderate bleeding was only in 3 cases. Severe bleeding case was not observed. Preoperative GnRH agonist therapy had not so big benefit due to these minimal to moderate postoperative bleeding. CONCLUSION: Therefore simplified hysteroscopic operation on OPD basis for submucosal myoma with small pedicle should be considered before resectoscopic operation, because this simplified hysteroscopic operation has many benefit economically and psychologically to patients on submucosal myoma with small pedicle. It is better that resectoscopic operation is performed in failed case of this simplified operation.

Comparsion of Laparoscopic with minilaparotomic myomectomy in uterine myoma / 대한산부인과학회잡지

OBJECTIVE: This study investigates the safety and effectiveness of laparoscopic myomectomy by comparing with minilaparotomic myomectomy in terms of the operation time, hemorrhage, pain, complications and pregnancy rates after operation. METHOD: Total 56 patients who underwent myomectomy in Chonnam National University Hospital from January 1996 to December 2000 were included. 26 subjects underwent minilaparotomy and 30 subjects laparoscopic myomectomy respectively. The number, size and place of uterine myoma, the operation time required, hemoglobin reduction, and operation indication were compared. The frequency of analgesics application, the period without analgesics injection, complications, and pregnancy rates after operation were investigated. RESULTS: 1. The amount of hemorrhage and hemoglobin markedly decreased in laparoscopic myomectomy in comparison with minilaparotomy (P<0.01). 2. Analgesics were much less frequently used in laparoscopic myomectomy than minilaparotomy (P<0.01). Also Analgesics were injected for a significantly shorter period after laparoscopic myomectomy (P<0.01). 3. There was no significant difference in operation time, hospital period and complications rates between two groups. 4. Total 24 patients conceived after myomectomy. 12 of them belonged to minilaparotomy patients group and 13 patients to laparoscopic myomectomy group. 10 patients of the former and 11 of the latter were delivered of a baby through elective cesarean section and there was no significant difference. One to each group tried vaginal delivery, and there was no complication such as uterine rupture. CONCLUSION: Laparoscopic myomectomy is a safe and effective to treat uterine myoma and better than minilaparotomy in terms of post operative pain and hemoglobin.

The Prognosis of Resectoscopic Myomectomy of Submucosal Myomas / 대한산부인과학회잡지

OBJECTIVES: To examine the outcome after operative resectoscopic resection of submucosal myomas in symptomatic women. METHODS: Forty eight symptomatic women with submucosal myomas underwent operative resectoscopy for resection of the submucosal myomas. A few months after the myomectomy, I compared postoperaive status of the patients to preoperative status of the patients. RESULTS: No operative or postoperative complications occurred and all patients were discharged within 4 days. The follow-up period was 11.12+/-6.44 months(mean+/-SD). The age of the patients was 37.69+/-9.22 years(mean+/-SD) at the time of the operation. Twelve women out of 16 conceived(pregnancy rate of 75%)and all of them subsequently delivered at term. Thirty two women(menorrhagia of 28 and backache of 4) had been rid of their chief complaints that they had suffered from preoperatively. CONCLUSION: The results of this study indicate that operative resectoscopy achieved a pregnancy rate 75%. These results suggest that operative resectoscopy is an effective procedure to resect submucosal myomas in infertile symptomatic women.

The Effect of Vascular Endothelial Growth Factor and basic Fibroblast Growth Factor on the Growth of Endometrial Stromal Sarcoma / 대한산부인과학회잡지

OBJECTIVE: In order to investigate the role of VEGF and bFGF in endometrial stromal sarcoma(ESS). METHODS: We studied the effect of VEGF and bFGF on proliferation of endometrial stromal sarcoma cell after adding VEGF and bFGF into a culture system by autoradiography. The incorporation of [H3]-thymidine into cellular DNA was used as an index of cellular proliferation. RESULTS: VEGF and bFGF significantly stimulated the proliferation of endometrial stromal sarcoma cells. The comparison of the effects of VEGF and bFGF showed that there was slightly more potent growth effects on endometrial stromal sarcoma cells with bFGF however, there was no stastistical significance. CONCLUSION: Taken together, these results suggest that VEGF and bFGF play an essential role in endometrial stromal sarcoma growth and our data adds new insights in the pathogenesis of ESS. This suggests that the involvement of growth factors may not only angiogenesis, but also play a critical role in controlling ESS cell growth.

The Effect of Vascular Endothelial Growth Factor and basic Fibroblast Growth Factor on the Growth of Endometrial Stromal Sarcoma / 대한산부인과학회잡지

OBJECTIVE: In order to investigate the role of VEGF and bFGF in endometrial stromal sarcoma(ESS). METHODS: We studied the effect of VEGF and bFGF on proliferation of endometrial stromal sarcoma cell after adding VEGF and bFGF into a culture system by autoradiography. The incorporation of [H3]-thymidine into cellular DNA was used as an index of cellular proliferation. RESULTS: VEGF and bFGF significantly stimulated the proliferation of endometrial stromal sarcoma cells. The comparison of the effects of VEGF and bFGF showed that there was slightly more potent growth effects on endometrial stromal sarcoma cells with bFGF however, there was no stastistical significance. CONCLUSION: Taken together, these results suggest that VEGF and bFGF play an essential role in endometrial stromal sarcoma growth and our data adds new insights in the pathogenesis of ESS. This suggests that the involvement of growth factors may not only angiogenesis, but also play a critical role in controlling ESS cell growth.

Hysteroscopic evaluation of the efficacy of sonohysterography for diagnosis of submucosal myoma / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of sonohysterography on exact submucosal myoma. methods: Transvaginal sonohysterography was performed on 45 patients who diagnosed as submucosal myoma and 29 patients who diagnosed as endometrial polyp by classic abdominal or vaginal sonogram, and then they received the diagnostic hysteroscopy at all. RESULTS: In 24 of 45 patients on sonohysterogram, submucosal myoma was diagnosed that was protruded to uterine cavity more than 2/3 of mass. Nine patients had intramural myoma and 12 patients had myoma that protruded only lesser than 1/3 of mass on sonohysterogram. These 21 patients revealed the same finding on hysteroscopy. On hysteroscopy, submucosal myomas were in 20 of 24 patients and polyps were in 3 patients and synechia was in one patients. In 8 of 29 patients on sonohysterogram, endometrial hyperplasia was found and confirmed by hysteroscopy. In 16 of 21 patients whose finding was polyp on sonohsyterogram, polyp was confirmed by hysteroscopy. However hysteroscopic findings were myomas in 3 of 21 patients and synechia in one patients. Therefore in 29 of 74 patients (39.2%), further hysteroscopy was not needed by sonohysterogram. In 65 of 74 patients (87.8%), sonohysterographic findings were same as hysteroscopic findings. CONCLUSION: Sonohysterogram for diagnosis of submucosal myoma and polyp is essential procedure in order to avoid unnecessary hysteroscopy. However differentiation between polyp and submucosal myoma has still some difficulty.

Safety and Usefulness of Laparoscopic Myomectomy for Intramural Myoma in Reproductive Woman / 대한산부인과학회잡지

PURPOSE: This study was undertaken to evaluate the safety and usefulness of laparoscopic myomectomy compare to abdominal myomectomy in pregnancy outcome through estimating the uterine wall thickness in second, third trimester pregnancy and delivery. MATERIALS AND METHODS: Total number of patients underwent operations for intramural myomectomy in Department of Obstetrics and Gynecology in Chonnam University Hospital was 95. Patients underwent laparoscopic myomectomy(Group A) patients are 42 and abdominal myomectomy (Group B) are 53 patients. Age, parity, size of fibroid, number of fibroid, indications of myomectomy, pregnancy loss, delivery methods and complications during delivery were evaluated. Uterine wall thickness in second and third trimester pregnancy was measured by Aloka SSD-2000 sonography. RESULTS: Mean age of patients was 32.84.6 years in Group A and 32.45.1 years in Group B. Operation time, admission period and postoperative complications were not sinificantly different but operative blood loss was significantly small amount in Group A(p=0.001). Pregnancy rates was 47.6%(20/42) in Group A and 49.1%(26/53) in Group B after surgery(p=0.182). Successful delivery was 80%(16/20) in Group A and 76.9%(20/26) in Group B(p=0.182). Early pregnancy loss was 20%(4/20) in Group A and 19.2%(5/26) in Group B. Therefore pregnancy rates and successful delivery was not significantly different in Group A and B. Complications of pregnancy were premature rupture of membrane, preterm labor, pregnancy induced hypertension. There were no difference between Group A and B. In delivery methods, elective cesarean section was done 15 in Group A and 16 in Group B. Vaginal delivery was done 1 in Group A and 4 in Group B. Early pregnancy loss was 4 in Group A and 6 in Group B. Mean gestational weeks was 38.02.2 in Group A and 38.21.9 in Group B. In operative findings, adhesion was 5 in Group A and 7 in Group B at previous myomectomy site. Only one case was uterine wall thinning in Group B but maternal and fetal conditions were good. Mean uterine wall thickness was 4.2 2.5mm in Group A and 4.0 2.8mm in Group B at 2nd trimester, 4.0 2.7mm in Group A and 3.8 2.5mm in Group B at 3rd trimester, 4.0 2.5mm in Group A and 3.9 2.7mm in Group B at delivery. CONCLUSION: We conclude that pregnancy after laparoscopic myomectomy is safe, useful method comparable to abdominal myomectomy without increased risk of pregnancy loss and complications.

A Case of laparoscopic cystectomy for large adenomyotic cyst within myometrium with bilateral endometriomas / 대한산부인과학회잡지

Adenomyotic cysts are not uncommon disease, but their sizes are mostly lesser 5 mm. Reports of large adenomyotic cyst ( >5 mm ) are vere rary. These large sized hemorrhagic cysts arise from small sized cyst and may be caused by progressive expansion of cyst due to progressive menstrual bleeding. And the active secreting of cystic wall may play a part in making the large cyst. Authors observed a case of large adenomyotic cyst within myometrium occuring in o 39-year-old woman, and she was accompanied with both ovarian endometriomas. The cyst was 3 *3 cm sized, and had chocolate-colored thick viscous contents. Histologically, cystic wall was lined with endometrial type epithelium. Epithelium were composed of single layer columnar, partly ciliated cells. Stroma under glandular epithelium were thin throughout the cyst and resembled morphologically endometrial stroma in endometriosis and had red cells and hemosiderin-laden macrophages in places. We experienced one case of large adenomyotic cyst, so we report the case with a brief review of the concerned literatures.

Fertility after conservative operation for ectopic pregnancy / 대한산부인과학회잡지

No abstract available.