Clinicopathological features of premature ovarian insufficiency associated with chromosome abnormalities

PURPOSE: The aim of this study was to investigate the clinicopathological features of premature ovarian insufficiency (POI) associated with chromosomal abnormalities. MATERIALS AND METHODS: This was a retrospective study of POI patients with chromosomal abnormalities diagnosed between January 2009 and December 2017. The definition of POI is based on hypergonadotropinism of 40 or greater in follicle stimulating hormone (FSH) measurements at age 40 years or less. FSH was measured twice at least 4 weeks apart. Karyotyping using peripheral blood for chromosomal testing was conducted in all patients diagnosed with POI. We analyzed the clinical characteristics and genetic causes of patients who were diagnosed with POI. RESULTS: Forty patients were diagnosed with POI including 9 (22.5%) with identified chromosomal abnormalities. The mean age at diagnosis was 23.1±7.8 years (ranging between 14 and 39). Three patients did not experience menarche. The presenting complaints were short stature in one case, one case of amenorrhea with ambiguous external genitals, one case of infertility, and six related to menstruation such as oligomenorrhea or irregular rhythm. Turner syndrome was diagnosed in four cases, Xq deletion in one case, trisomy X in two cases, and 46,XY disorder of sexual development in two other patients. CONCLUSION: Patients diagnosed with POI carrying the same type of chromosomal abnormality manifest different phenotypes. The management protocol also needs to be changed depending on the diagnosis. A karyotype is indicated for accurate diagnosis and proper management of POI in patients, with or without stigmata of chromosomal abnormalities.

Triploidy that escaped diagnosis using chromosomal microarray testing in early pregnancy loss: Two cases and a literature review

About 15% to 20% of all clinically recognized pregnancies result in spontaneous abortion or miscarriage, and chromosomal anomalies can be identified in up to 50% of first trimester miscarriages. Chromosomal microarray analysis (CMA) is currently considered first-tier testing for detecting fetal chromosomal abnormalities and is supported by the absence of cell culture failure or erroneous results due to cell contamination in pregnancy loss. Triploidy is a lethal chromosome number abnormality characterized by an extra haploid set of chromosomes. Triploidy is one of the most common chromosomal aberrations in first trimester spontaneous abortions. Here, we report two cases of triploidy abortion that were not detected using array comparative genomic hybridization-based CMA. The aim of this report was to remind clinicians of the limitations of chromosomal testing and the misdiagnosis that can result from biased test selection.

Partial molar pregnancy and coexisting fetus with Turner syndrome: Case report and literature review

Partial hydatidiform mole and coexisting fetus is a rare entity with antecedent high risk of maternal and fetal complications, and risk of persistent trophoblastic disease in later life. Here, we report a case of twin pregnancy with live fetus identified as 45,X and normal placenta and another partial mole. Ultrasound scan at 10 weeks showed a hydrops fetus with a focal area of multicystic placenta. The patient underwent chorionic villus sampling and amniocentesis for chromosomal analysis, and the result was 45,X. Based on these finding, the patient then underwent induced abortion. Pathological examination (immunohistochemical staining) of the placenta confirmed the partial mole. This report suggests that careful prenatal ultrasonography and appropriate karyotyping in a molar pregnancy and coexisting fetus enable early diagnosis and may be beneficial for prognosis.

Torsion of a parasitic myoma that developed after abdominal myomectomy

Iatrogenic parasitic myomas are rare. The condition is defined by the presence of multiple smooth-muscle tumorous nodules in the peritoneal cavity. This may be attributable to seeding of myoma particles during uterine surgery. The clinical course is usually indolent. The disease is often asymptomatic and is usually discovered only incidentally. A 38-year-old woman who had undergone abdominal myomectomy 7 months prior presented with acute abdominal pain and a huge pelvic mass. We performed exploratory laparotomy. A parasitic mass 17 cm in diameter with a twisted omental pedicle was identified. En bloc excision of the mass and omentum was performed, followed by total abdominal hysterectomy. Histopathological examination of multiple sections revealed features compatible with an infarcted leiomyoma. Thus, we present a very rare case of an iatrogenic, rapidly growing parasitic myoma complicated by omental torsion (which caused the acute abdominal pain). We also offer a literature review.

Immunologic properties of differentiated and undifferentiated mesenchymal stem cells derived from umbilical cord blood

The expression of immunogenic markers after differentiation of umbilical cord blood (UCB)-derived mesenchymal stem cells (MSC) has been poorly investigated and requires extensive in vitro and in vivo testing for clinical application. The expression of human leukocyte antigen (HLA) classes on UCB-derived MSC was tested by Fluorescence-activated cell sorting analysis and immunocytochemical staining. The undifferentiated MSC were moderately positive for HLA-ABC, but almost completely negative for HLA-DR. The MSC differentiated to chondrocytes expressed neither HLA-ABC nor HLA-DR. The proliferation of MSC was not significantly affected by the allogeneic lymphocytes stimulated with concanavalin A. The responder lymphocytes showed no significant decrease in proliferation in the presence of the MSC, but the apoptosis rate of the lymphocytes was increased in the presence of MSC. Taken together, these findings indicate that UCB-derived MSC differentiated to chondrocytes expressed less HLA class I and no class II antigens. The MSC showed an immunomodulatory effect on the proliferation and apoptosis of allogeneic lymphocytes. These data suggest that the differentiated and undifferentiated allogeneic MSC derived from umbilical cord blood can be a useful candidate for allogeneic cell therapy and transplantation without a major risk of rejection.

Split hand/foot malformation with long-bone deficiency and BHLHA9 duplication: A prenatal diagnosis report

Distal limb deformities are congenital malformations with phenotypic variability and high genetic heterogeneity. Split hand/foot malformation, also known as ectrodactyly, is a congenital limb malformation characterized by a defect of the central rays of the hands and/or feet. Split hand/foot malformation with long-bone deficiency (SHFLD) is a rare condition related to a 17p13.3 duplication. Recently, genomic duplications encompassing BHLHA9 have been associated with SHFLD. We report a case of SHFLD presenting with campomelia of the right femur, bilateral agenesis of fibulae, bilateral club feet, and oligosyndactyly of the hands and feet, that was associated with a 17p13.3 duplication, as determined prenatally using array comparative genomic hybridization.

Cryopreservation of Human Wharton's Jelly-derived Mesenchymal Stem Cells Following Controlled Rate Freezing Protocol Using Different Cryoprotectants; A Comparative Study

OBJECTIVES: To compare the effect of three different cryoprotectants on basic stem cell characteristics for the possibility of using well defined, dimethyl sulfoxide (DMSO) and serum free freezing solutions to cryopreserve human Wharton's jelly-derived mesenchymal stem cells (WJMSCs) following controlled rate freezing protocol. METHODS: The mesenchymal stem cells isolated from human Wharton's jelly were cryopreserved using 10% DMSO, 10% polyvinylpyrrolidone (PVP) and a cocktail solution comprising of 0.05 M glucose, 0.05 M sucrose and 1.5 M ethylene glycol following controlled rate freezing protocol. We investigated the post-thaw cell viability, morphology, proliferation capacity, basic stem cell characteristics, in vitro differentiation potential and apoptosis-related gene expression profile before and after cryopreservation. RESULTS: The cryoprotectant 10% DMSO has shown higher post-thaw cell viability of 81.2+/-0.58% whereas 10% PVP and cocktail solution have shown 62.87+/-0.35% and 72.2+/-0.23%, respectively at 0 h immediately thawing. The cell viability was further reduced in all the cryopreserved groups at 24 h later post-thaw culture. Further, the complete elimination of FBS in cryoprotectants has resulted in drastic reduction in cell viability. Cryopreservation did not alter the basic stem cell characteristics, plasticity and multipotency except proliferation rate. The expression of pro-apoptotic BAX and p53 genes were higher whilst p21 was lower in all the cryopreserved groups when compare to the control group of WJMSCs. CONCLUSION: Although 10% DMSO has shown higher post-thaw cell viability compare to 10% PVP and cocktail solution, the present study indicates the feasibility of developing a well-defined DMSO free cryosolution which can improve storage and future broad range applications of WJMSCs in regenerative medicine without losing their basic stem cell characteristics.

Expression of angiogenic factors in cryopreserved mouse ovaries after heterotopic autotransplantation

OBJECTIVE: Revascularization is critical for successful ovarian tissue transplantation. Vascular endothelial growth factor (VEGF) and angiopoietin-2 (angpt-2) are the principal mediators of neovascularization. This study was designed to assess VEGF and angpt-2 levels in cryopreserved ovarian tissue after heterotopic autotransplantation. METHODS: Ovarian tissues harvested from ICR mice at 5 to 6 weeks of age were stratified as follows: no cryopreservation (controls, group I); vitrification in VFS-40 (vitrification, group II); and gradual freezing in dimethyl sulfoxide (slow-freezing, group III). Frozen specimens were thawed at room temperature, assaying VEGF and angpt-2 levels 1 week after cryopreservation and 2 weeks after autotransplantation. RESULTS: VEGF and angpt-2 protein levels were significantly lower in cryopreserved ovaries of groups II and III than in controls (group I, P<0.05), whereas groups II and III did not differ significantly in this regard. After autotransplantation of cryopreserved ovarian tissue, VEGF and angpt-2 protein levels did not differ significantly by technique but tended to be lower than corresponding levels in controls. CONCLUSION: Expression of angiogenic factors in ovarian tissue is thought to vary by method of cryopreservation. Our findings indicate that levels of angiogenic factors expressed in cryopreserved ovarian tissue after autotransplantation do not differ appreciably from control levels, regardless of cryopreservation technique.

Analysis of increased nuchal translucency: Chorionic villi sampling and second-trimester level II sonography

PURPOSE: To assess the outcomes of increased fetal nuchal translucency (NT), to aid in prenatal counseling and management in our practice. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who underwent first trimester fetal karyotyping using chorionic villi sampling (CVS) and second trimester level II sonography for a fetal NT thickness > or =3.0 mm between 11 weeks and 13 weeks 6 days' gestation, at Gyeongsang National University Hospital. Pediatric medical records and a telephone interview were used to follow-up live-born children. Exclusion criteria included incomplete data and CVS for other indications. RESULTS: Seventy cases met the inclusion criteria (median NT thickness, 4.7 mm; range, 3.0-16.1 mm). Twenty-nine cases (41.4%) were aneuploid. The prevalence of chromosomal defects increased with NT thickness: NT 3.0-3.4 mm, 16.7%; NT 3.5-4.4 mm, 27.3%; NT 4.5-5.4 mm, 66.7%; NT 5.5-6.4 mm, 37.5%; NT > or =6.5 mm, 62.5%. The most common karyotype abnormality was trisomy 18 (n=12), followed by trisomy 21 (n=9). In chromosomally normal fetuses (n=41), fetal death occurred in 2 cases (4.9%), and structural malformations were found in 11 cases (26.8%). In chromosomally and anatomically normal fetuses (n=28), one child had neurodevelopmental delay (3.6%). Twenty-eight infants who had a prenatal increased NT were alive and well at follow-up (40%). CONCLUSION: Outcomes of increased fetal NT might help inform prenatal counseling and management. The high prevalence of chromosomal defects associated with increased fetal NT implies that CVS should be performed in the first trimester, particularly considering the stress associated with an uncertain diagnosis.

Influence of the vitrification solution on the angiogenic factors in vitrificated mouse ovarian tissue

OBJECTIVE: To investigate the effect of the dimethyl sulfoxide (DMSO) and EFS-40 during vitrification on the expression of angiogenic factors in vitrified mouse ovarian tissue. METHODS: The ovarian tissues were obtained from 5 or 6 weeks aged ICR mouse. Ovarian tissues were divided into four groups: ovarian tissue without cryopreservation (control, group I), ovarian tissue vitrified with 15% DMSO (group II), ovarian tissue vitrified with EFS-40 (group III), and ovarian tissue slowly frozen with 10% DMSO (group IV). Thawing was carried out at room temperature. Levels of messenger RNA (mRNA) and protein for vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (Angpt-2) were checked in ovarian tissues of four groups recovered on day 7 after cryopreservation. Reverse transcription-polymerase chain reaction and Western blot analysis were used to identify the levels of angiogenic factors in mouse ovarian tissues. RESULTS: Levels of mRNA and protein for VEGF-A and Angpt-2 were significantly decreased in cryopreserved group (group II, III and IV) than control group (group I) (P< 0.05). The significant differences of levels of mRNA and protein for VEGF-A and Angpt-2 between cryopreservation methods were observed (P< 0.05). Group III showed highest expression of mRNA and protein for VEFG-A and Angpt-2 than other cryopreservation groups (P< 0.05). CONCLUSION: These findings suggest that EFS-40 is more efficient vitrification solution for preservation of angiogenic factors than 15% DMSO during vitrification of mouse ovarian tissue. Future studies should investigate to improve the vitrification solution for ovarian tissue vitrification.

Three cases of primary non-Hodgkin's lymphoma of the pelvis / 대한산부인과학회지

Primary pelvic non-Hodgkin's lymphoma is a rare malignancy that has been reported in the retroperitoneum, ovary, uterine corpus, uterine cervix, vagina and vulva. Although primary pelvic lymphoma is rare, this may be encountered more frequently as the incidence of extranodal non-Hodgkin's lymphoma increases. We experienced three cases of primary non-Hodgkin's lymphoma of the pelvis. Two cases are primary non-Hodgkin's lymphoma of the ovary and one is primary non-Hodgkin's lymphoma of the retroperitoneum. We report these cases with a brief review of literature.

A Case of Placenta Increta Successfully Treated with Methotrexate and Misoprostol / 대한주산의학회잡지

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality. Although the incidence of placenta accreta was rare in the past, it is sharply rising as a result of the dramatic increases in the cesarean section rate. Hysterectomy is the most effective way to manage the placenta accreta in the majority of cases. While in many situations hysterectomy will remain appropriate, there are other management options available involving conservative approaches. In this article, we report our experience of a successful conservative treatment using methotrexate and misoprostol to a patient in whom the whole placenta was not detachable from the uterus due to placenta increta.

DHA and EPA Down-regulate COX-2 Expression through Suppression of NF-kappa B Activity in LPS-treated Human Umbilical Vein Endothelial Cells

Inflammatory processes of vascular endothelial cells play a key role in the development ofatherosclerosis. We determined the anti-inflammatory effects and mechanisms of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on LPS-treated human umbilical vein endothelial cells (HUVECs) to evaluate their cardioprotective potential. Cells were pretreated with DHA, EPA, or troglitazone prior to activation with LPS. Expression of COX-2, prostaglandin E2 (PGE2) and IL-6 production, and NF-kappaB activity were measured by Western blot, ELISA, and luciferase activity, respectively. Results showed that EPA, DHA, or troglitazone significantly reduced COX-2 expression, NF-kappaB luciferase activity, and PGE2 and IL-6 production in a dose-dependent fashion. Interestingly, low doses (10 micrometer) of DHA and EPA, but not troglitozone, significantly increased the activity of NF-kappaB in resting HUVECs. Our study suggests that while DHA, EPA, and troglitazone may be protective on HUVECs under inflammatory conditions in a dose-dependent manner. However there may be some negative effects when the concentrations are abnormally low, even in normal endothelium.

A case of primary amelanotic melanoma of the vagina / 대한산부인과학회지

Primary malignant melanoma of the vagina is extremely rare, accounting for 3% of all primary malignant tumor of the vagina and 0.3~1% of all malignant melanomas in the female. The amelanotic melanoma of the vagina showing no melanin granules on histological examination is exceedingly rare, accounting for only about 10% of all melanoma of the vagina. The amelanotic melanoma of the vagina is often difficult to differentiate from non-epithelial malignant tumor because of the minimal number of melanin granules. We describe a case of primary amelanotic melanoma of the vagina, which was initially suspected to be a non-epithelial malignant tumor, especially malignant peripheral nerve sheath tumor (MPNST), but was correctly diagnosed by HMB-45 antibody and S-100 protein immunohistochemical staining. So we present this case with a brief review of literature.

Synchronous primary endometrial and ovarian cancers / 대한산부인과학회지

The coexistence of carcinoma of the endometrium and ovary of female genital tract are an uncommon event, and it occurred in 5% of the patients with endometrial cancer and 10% of the patients with ovarian cancer. However, most of them are metastatic lesion from one organ and synchronous primary cancers from both organs are rare. In the present case, we experienced a case with simultaneous primary cancers from endometrium and ovary, occurring in 37-year-old woman presented with abnormal vaginal bleeding. Preoperative endometrial biopsy revealed endometrial carcinoma, and magnetic resonance imaging showed both ovarian lesion, which is suspicious of malignancy. Intraoperative and histological finding showed stage Ib endometrioid endometrial carcinoma and stage IIIc mucinous adenocarcinoma of both ovary, and we present this case with a brief review of reference.

Two cases of arachnoid cyst of prenatal diagnosis / 대한산부인과학회지

Intracranial arachnoid cysts are collections of clear fluid within the arachnoid membrane because of nondisjunction or duplication of the structure. They are rare, represent only 1% of intracranial masses in newborns. Etiologically, they are thought to be due to maldevelopment of the arachnoid or secondary to trauma or infection. The arachnoid cyst by ultrasonogram shows characteristic well capsulated homogeneous hypoechoic cyst. Many arachnoid cysts remain asymptomatic, however, and become symptomatic later in life to cyst growth-resulting in a compression, displacement and irritation of the surrounding structures. So, early diagnosis and treatment of these cysts are important. We present two cases of arachnoid cysts diagnosed in utero by ultrasonogram. In one case, postnatal MRI was checked and confirmed arachnoid cyst with choroid plexus cyst. And other case, postnatal brain USG was checked and diagnosed arachnoid cyst. Both children are asymptomatic, and presents normal development until now. But latter children underwent surgical treatment due to persistent huge cyst and hydrocephalus.

Expression of 14-3-3 proteins and Bax in the placenta of preeclampsia / 대한산부인과학회지

OBJECTIVE: Purpose of our study was to examine the expression level of 14-3-3 proteins and Bcl-2 family and to estimate the interaction between 14-3-3 proteins and Bcl-2 family in normal and preeclamptic placenta. METHODS: Placental tissues were sampled from preeclampsia with caesarean delivery (n=5) and normal pregnant women with caesarean delivery (n=5). Western blot and immunoprecipitation related Western blotting were performed on all placental samples. Unpaired Student t-test was used to determine the statistical significance. RESULTS: Western blot analysis revealed that the expression of Bax and 14-3-3 zeta was significantly greater in the preeclamptic placenta than in the normal placenta. Immunoprecipitation related Western blotting revealed that the interaction between 14-3-3 zeta and Bax was significantly less in the preeclamptic placenta than in the normal placenta. CONCLUSION: Increased expression of Bax and reduced interaction (between) 14-3-3 zeta and Bax in preeclamptic placenta might influence pathogenesis or sequelae of preeclampsia. Further study is needed to identify the trigger that induces dissociation of Bax from 14-3-3 proteins.

Prenatal diagnosis of partial trisomy 3q with omphalocele in the first trimester of pregnancy / 대한산부인과학회지

Abnormal offsprings from balanced translocation carriers usually inherit only one of the translocated products and are therefore partially trisomic for one chromosome and partially monosomic for another. Partial trisomy 3q usually demonstrates characteristic facial appearance, developmental delay, brain and ocular anomalies, severe growth retardation, congenital heart disease, renal and genitourinary malformations, omphalocele, and skeletal and limb anomalies with a wide range of characteristics and severities. It has been reported in a few individuals in the world and this is the first report of partial trisomy 3q in Korea. We present the case of partial trisomy 3q with omphalocele from maternal balanced translocation, which was prenatally diagnosed by chorionic villi sampling based on abnormal ultrasonographic findings.

Clinical Study for Fetal Death in Utero / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the incidence, causes and maternal complications in cases of fetal death in utero (FDIU). METHODS: This is a clinical study of 224 cases of FDIU among 10,582 deliveries at 00 University Hospital during January 1990 to December 2004. All the clinical informations were obtained by reviewing medical records retrospectively. RESULTS: The average incidence of FDIU was 2.1%. The mean age of mothers with FDIU was 28.5 years old. The mean gestational age was 30.4 weeks and mean weight of dead fetus was 1442 gm. The causes of FDIU were placenta abuptio (14.3%), severe preeclampsia (13.4%), congenital anomalies (9.4%), severe intrauterine growth restriction (IUGR, 9.4%), nuchal cord (6.7%), chrioamnionitis (5.8%). However the causes of FDIU were largely unknown (18.8%). The modes of delivery were induced labor (65.2%), laparotomy (26.8%), spontaneous labor (8.0%). The most common indication of laparotomy was placenta abuptio (36.7%). There were 66 cases (29.5%) with maternal complications and common complications were hemorrhage (11.2%), fever (8.5%), DIC (5.8%). The incidence of hypofibrinogenemia (<150 mg/dL) was 14.3%. CONCLUSION: The most common suspected causes of FDIU were placenta abruptio, severe preeclampsia and the causes could not be determined in 42 cases (18.8%). The proper prenatal care should be taken of fetuses on the basis of risk factors of antepartum and intrapartum so that unnecessary intrauterine fetal death might be able to be prevented.

Primary Mixed Carcinoid Tumor and Mucinous Tumor of Borderline Malignancy of the Ovary / 대한산부인과학회지

Primary mixed carcinoid with mucinous tumor of borderline malignancy of the ovary is very rare ovarian tumor. Most of them arose in dermoid cyst or in mature solid teratoma. Its diagnosis was based on histological and immunohistochemical findings. We experienced a case of primary mixed carcinoid postoperatively and present with a brief review of literatures.