Cavernous Hemangioma of the Uterus in a Postmenopausal Woman: A Case Report

Cavernous hemangioma of the uterus is an uncommon mesenchymal tumor. Most cases have been reported in young, pregnant women and the condition is very rare in a postmenopausal patient. An 81-year-old woman presented with a huge pelvic mass. Abdominal computed tomography and magnetic resonance imaging results suggested a leiomyoma with degenerative change and hemorrhage. Microscopically, large, thick-walled and variable-sized vascular channels were evident in the majority part of myometrium; the lining cells were immunohistochemically reactive for CD31. Vascular tumors of the female genital tract should be cautiously excised due to the profuse intra-operative bleeding. The pathological examination of a hysterectomy specimen is the only method to confirm the diagnosis of this tumor.

Sexual behavior of Korean young women: preliminary study for the introducing of HPV prophylactic vaccine / 부인종양

OBJECTIVE: The decision of optimal age for administration of recently approved prophylactic human papillomavirus (HPV) vaccines in the world depend on the basis of the sexual behavior of each countries. The aim of the study was to survey the age-specific sexual behavior including the sexual debut time and sexual experience in the Korean young women to design the tailored HPV vaccination. METHODS: This study was conducted by the Synovate Healthcare in the 6 city of Korea e.g. Seoul, Pusan, Daegu, Incheon, Kwangju and Daejon. By a stratified sampling methods 2,400 women aged 12-29 years old were included. The measures of sexual behavior presented in this report were collected by a Computer-Assisted Self-Interviewing (ACASI), in which the respondent enters her own answers into a computer without telling them to an interviewer. RESULTS: Among women 12-29 years of age, 39 percent of women (934 persons in 2,400 women) and 33 percent of single women (724 persons in 2,190 women) have had vaginal intercourse; 8 percent of women under 19 years old single women (79 persons in 1,045) and 56 percent of single women with 20-29 years old (645 persons in 1,145). Number of sexual partner was 2.8 person and 54 percent of women had more than 2 partners. Age of the first sexual activity (sexual debut) was 21 years old. The age of partner at the sexual debut was 23.2 years old. Sexual experience before 15 years old was only 2%. About the condom, 41% did not use or rarely use. CONCLUSION: Our data demonstrate that the sexual debut time of young Korean women differ from other countries in which the prophylactic HPV vaccine had already used. We conclude that the optimal age for HPV vaccination in Korea would be determined at 15-17 years old by this situation.

Recommendation guideline of Korean Society of Gynecologic Oncology and Colposcopy for quadrivalent human papillomavirus vaccine / 부인종양

Genital HPV infection is the most common sexually transmitted infection, but the majority of infections are self-limited. However, persistent infection with high-risk types can cause cervical cancer in women, which is the most common female genital cancer in Korea. In addition, HPV infection is the cause of genital warts and is associated with other anogenital cancers. The HPV vaccine is composed of the HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein in yeast using recombinant DNA technology produces noninfectious virus-like particles (VLP) that resemble HPV virions. The quadrivalent HPV vaccine is a mixture of four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18 combined with an aluminum adjuvant. Clinical trials indicate that the vaccine has high efficacy in preventing persistent HPV infection, cervical cancer precursor lesions, vaginal and vulvar cancer precursor lesions, and genital warts caused by HPV types 6, 11, 16, or 18 among females who have not already been infected with the respective HPV type. The recommended age for primary vaccination of Korean females is 15-17 years, considering sexual debut and duration of protection of the vaccine. Vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 18-26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended.

Maternal serum soluble Fas/Fas ligand level and expression of Fas/Fas ligand in placenta in preeclampsia / 대한산부인과학회지

OBJECTIVE: The aims of this study were designed to determine that serum soluble Fas and Fas ligand levels are altered in women with preeclampsia and HELLP syndrome, and to assess the expression of placental Fas and Fas ligand in women with preeclampsia and HELLP syndrome. METHODS: Blood samples were obtained from 31 women with normal pregnancy, 27 women with preeclampsia and five women with HELLP syndrome. Serum Fas/Fas ligand levels were measured by enzyme linked immunoassay. Immunohistochemical stain with polyclonal antibodies of Fas/Fas ligand were used to identify apoptosis. Mann-Whitney test, x2 test, Pearson correlation coefficients and multiple regression test were used for statistical analysis. RESULTS: Both soluble Fas ligand and Fas were detected in the sera of normal pregnancy, preeclampsia and HELLP syndrome. The mean serum level of soluble Fas was 5.83+/-0.37 U/mL in women with normal pregnancy, 10.84+/-0.93 U/mL in women with preeclampsia, and 10.79+/-00.69 U/mL in women with LELLP syndrome. The mean serum level of soluble Fas ligand was 0.59+/-0.03 U/mL in women with normal pregnancy, 0.51+/-0.21 U/mL in women with preeclampsia, and 0.60+/-0.01 U/mL in women with LELLP syndrome. The mean serum levels of soluble Fas were significantly higher in women with preeclampsia and HELLP syndrome than in women with normal pregnancy, but those of Fas ligand were no significant difference in each group. Apoptosis was conclusively demonstrated within placental tissue. The immunohistochemical analysis of Fas revealed diffuse immunoreactive stains were increased in women with preeclampsia than in women with normal pregnancy. But the immunohistochemical analysis of Fas ligand revealed diffuse immunoreactive stains were decreased in women with preeclampsia than in women with normal pregnancy. CONCLUSION: Placental apoptosis and altered expression of Fas and Fas ligand in trophoblast might influence the pathogenesis or pathophysiologic mechanism of preeclamsia. Elevated serum soluble Fas levels is associated with preeclampsia and HELLP syndrome. The source of elevated serum soluble Fas in preeclampsia and HELLP snydrome remains to be determined.

A Successful Live Birth Through in vitro Fertilization Program After Conservative Treatment of FIGO Grade I Endometrial Cancer

Infertile women with chronic anovulation are prone to be exposed to unopposed estrogen stimulation and have the high risk of being suffering from endometrial hyperplasia or even endometrial carcinoma. A few reports have suggested that nulliparous young women (under 40 yr of age) with endometrial carcinoma could be treated conservatively to preserve fertility and succeed the live birth. We report on a 36-yr-old woman who received conservative treatment of endometrial carcinoma (stage I, grade 1) by curettage and progestin. After megestrol medication of total 71,680 mg during 24 weeks, we found the regression of endometrial lesion by curettage and hysteroscopic examination. Then we decided to perform in vitro fertilization program. Two embryos were transferred and heterotypic pregnancy was diagnosed 27 days after embryo transfer. After right salpingectomy, she received routine obstetrical care and delivered by cesarean section at 38 weeks in gestational periods. Two years after delivery, she is healthy without any evidence of recurrent disease. The fertility preserving treatment is an option in endometrial cancer patients if carefully selected, and assisted reproductive technologies would be helpful.

Gene Expression Analysis between Uterine Leiomyoma and Normal Myometrial Tissues by DNA Chip / 대한산부인과학회잡지

OBJECTIVE: To investigate the difference of gene expressions between leiomyoma and normal myometrial tissue was analzed by DNA Chip. METHODS: cDNAs retro-transcribed from equal quantities of mRNA derived from leiomyoma and corresponding normal myometrial tissue were labeled with Cy5 and Cy3 fluorescein as probes. The mixed probe was hybridized with two pieces of 3,066 double dot from a human dermal papilla cell cDNA library and scanned with a laser scanner. The acquired image was analyzed by ImaGene 3.0 software. Validation of gene expression was performed by reverse transcription-Polymerase chain reaction (RT-PCR) in 5 leiomyomas and corresponding normal myometrial tissues. RESULTS: Among many differentially expressed genes, genes with expression levels more than 3 times were found by comparing leiomyoma with corresponding normal myometrial tissue. One gene with expression levels lesser than 3 times in leiomyoma tissue compared to normal myometrial tissue was also detected. Although alterations of several genes, such as osteoblast specific factor 2, PAI-1 mRNA-binding protein, hydroxyacyl-Coenzyme A dehydrogenase/3-ketoacyl-Coenzyme A thiolase/enoyl-Coenzyme A hydratase alpha subunit (HADHA), p311, DEAD/H (Asp-Glu-Ala-Asp/His) box polypeptide 1 (DDX1), Hexokinase 1, 2 were identified in a significant high fraction of uterine leiomyoma compared to normal myometrial tissue. Cyr61 gene was shown to be markedly down-regulated in leiomyoma compared with the matched uterine myometrial control. I validated differential expression of genes by RT-PCR and demonstrated overexpression of OSF-2, HADHA, p311, DDX1, Hexokinase 1, 2. CONCLUSION: DNA chip techniques are effective in screening differential gene expression between leiomyoma tissue and normal myometrial tissue. These genes may be related to the genesis and development of uterine leiomyoma. Analysis of the human leiomyoma gene expression profile by DNA chip may be helpful gene diagnosis, treatment and prevention of this disease.

Gene Expression Analysis between Uterine Leiomyoma and Normal Myometrial Tissues by DNA Chip / 대한산부인과학회잡지

OBJECTIVE: To investigate the difference of gene expressions between leiomyoma and normal myometrial tissue was analzed by DNA Chip. METHODS: cDNAs retro-transcribed from equal quantities of mRNA derived from leiomyoma and corresponding normal myometrial tissue were labeled with Cy5 and Cy3 fluorescein as probes. The mixed probe was hybridized with two pieces of 3,066 double dot from a human dermal papilla cell cDNA library and scanned with a laser scanner. The acquired image was analyzed by ImaGene 3.0 software. Validation of gene expression was performed by reverse transcription-Polymerase chain reaction (RT-PCR) in 5 leiomyomas and corresponding normal myometrial tissues. RESULTS: Among many differentially expressed genes, genes with expression levels more than 3 times were found by comparing leiomyoma with corresponding normal myometrial tissue. One gene with expression levels lesser than 3 times in leiomyoma tissue compared to normal myometrial tissue was also detected. Although alterations of several genes, such as osteoblast specific factor 2, PAI-1 mRNA-binding protein, hydroxyacyl-Coenzyme A dehydrogenase/3-ketoacyl-Coenzyme A thiolase/enoyl-Coenzyme A hydratase alpha subunit (HADHA), p311, DEAD/H (Asp-Glu-Ala-Asp/His) box polypeptide 1 (DDX1), Hexokinase 1, 2 were identified in a significant high fraction of uterine leiomyoma compared to normal myometrial tissue. Cyr61 gene was shown to be markedly down-regulated in leiomyoma compared with the matched uterine myometrial control. I validated differential expression of genes by RT-PCR and demonstrated overexpression of OSF-2, HADHA, p311, DDX1, Hexokinase 1, 2. CONCLUSION: DNA chip techniques are effective in screening differential gene expression between leiomyoma tissue and normal myometrial tissue. These genes may be related to the genesis and development of uterine leiomyoma. Analysis of the human leiomyoma gene expression profile by DNA chip may be helpful gene diagnosis, treatment and prevention of this disease.