Adenomatoid tumors of female genital tracts: An analysis of 195 cases / 대한산부인과학회지

OBJECTIVE: Adenomatoid tumors of female genital tracts are benign lesions derived from mesothelium, occurring most commonly during the reproductive years. The aim of this study was to evaluate the overall incidence of adenomatoid tumors in Korean women and to analyze the clinical characteristics. METHODS: One hundred and ninety five patients with adenomatoid tumors were found in a retrospective medical records review of pathologic reports for 44,984 benign uterine diseases at Cheil General Hospital, from January 1995 to April 2009. RESULTS: The overall incidence rate was 0.42% of all benign uterine disease. Among them, 149 patients received hysterectomy, and 46 patients received uterine conservative surgery. Main symptoms of the patients were pain (25.1%), bleeding (30.2%), and palpable mass (18.5%). Most common associated pathologies were leiomyoma (46.6%), adenomyosis (25.1%) and endometriosis (13.1%). Most of the diagnosis was made postoperatively. Among 46 patients with conservative treatment, 13 patients showed successful pregnancy outcome. No recurrence occurred during the follow up period. CONCLUSION: Adenomatoid tumors are associated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. The recurrence is rare even after conservative operation. Our data about this benign neoplasm may be helpful for counseling patients after operations.

Clinicopathological observation on ovarian masses in childhood and adolescence / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to describe the clinical presentation and histopathologic findings that help in decisions about management of ovarian mass in childhood and adolescence. METHODS:We retrospectively analyzed the data on 307 patients with surgically treated ovarian mass under 20 years of age at the Cheil General Hospital, between January 1995 and December 2005. RESULTS: Of the 307 cases, 40 cases (13%) were ovarian malignancy. The incidence of malignant ovarian tumor increased to 16.9% in 237 neoplastic tumors. Epithelial, germ cell, and sex-cord stromal malignancies accounted for 57.5%, 30% and 12.5%, respectively, of the 40 ovarian malignancies. The stage of the 35 cases (87.5%) with the ovarian malignancy was the FIGO stage I. The incidence of ovarian malignancies increased with larger size, higher CA125 level. Solid ovarian masses on ultrasound were more likely ovarian malignancy. But age and menarchal status was not correlated with ovarian malignancy. Mature cystic teratoma seen in 132 patients (55.7%), was the most common neoplasm of ovary in this age group, and the incidence of bilaterality was 12.1%. On follow up, 4.9% (13/267) of previously diagnosed benign ovarian tumor were reoperated due to recurred or newly developed ovarian tumor. After cystectomy, the recurrence rate of ipsilateral ovarian tumor was 2.8% (4/142). CONCLUSION: If there is no evidence of malignancy, conservative surgical treatment should be employed to preserve future endocrine function and fertility in this age group.

Clinicopathological observation on ovarian masses in childhood and adolescence / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to describe the clinical presentation and histopathologic findings that help in decisions about management of ovarian mass in childhood and adolescence. METHODS:We retrospectively analyzed the data on 307 patients with surgically treated ovarian mass under 20 years of age at the Cheil General Hospital, between January 1995 and December 2005. RESULTS: Of the 307 cases, 40 cases (13%) were ovarian malignancy. The incidence of malignant ovarian tumor increased to 16.9% in 237 neoplastic tumors. Epithelial, germ cell, and sex-cord stromal malignancies accounted for 57.5%, 30% and 12.5%, respectively, of the 40 ovarian malignancies. The stage of the 35 cases (87.5%) with the ovarian malignancy was the FIGO stage I. The incidence of ovarian malignancies increased with larger size, higher CA125 level. Solid ovarian masses on ultrasound were more likely ovarian malignancy. But age and menarchal status was not correlated with ovarian malignancy. Mature cystic teratoma seen in 132 patients (55.7%), was the most common neoplasm of ovary in this age group, and the incidence of bilaterality was 12.1%. On follow up, 4.9% (13/267) of previously diagnosed benign ovarian tumor were reoperated due to recurred or newly developed ovarian tumor. After cystectomy, the recurrence rate of ipsilateral ovarian tumor was 2.8% (4/142). CONCLUSION: If there is no evidence of malignancy, conservative surgical treatment should be employed to preserve future endocrine function and fertility in this age group.

Submucosal adenomyotic cyst successfully treated with hysteroscopic surgery: Two case reports / 대한산부인과학회지

Two women presented with history of vaginal bleeding and abnormal transvaginal ultrasound findings. Saline infusion sonohysterography was done for preoperative evaluation and this imaging study revealed centrally located uterine mass with internal cystic portion. Our initial impression was submucosal myoma with cystic degeneration and hysteroscopic removal of the mass was performed. During the procedure, dark brownish cystic fluid was drained. The excised submucosal mass was pathologically diagnosed as adenomyosis and clinically as submucosal adenomyotic cyst. Submucosal adenomyotic cyst should be part of the differential diagnosis of submucosal uterine masses with cystic portion. We report two cases of submucosal adenomyotic cyst successfully treated with hysteroscopic resection and brief review on this topic.

Pregnancy outcomes of heterotopic pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.

Pregnancy outcomes of heterotopic pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.

Uterine myoma: Treatment modalities and patient preference / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to describe the clinical features of myoma, treatment options, patient preference and to identify the clinical features which affect the management of myoma. METHODS: We retrospectively analyzed medical records of 577 patients who were diagnosed as uterine myoma on ultrasound exam between January 2006 and December 2006. Patients' characteristics, treatment methods and questionnaires for patient preference were evaluated. RESULTS: The mean age was 42.3 years and 90.8% of the patients were premenopausal status. Common symptoms were pain (58.6%), bleeding (51.3%) and compression symptom (30.2%). In our study, 183 of 577 patients (31.7%) planned to have regular follow-up without treatment. Non-hormonal medical treatment was used in 27.1% and hormonal treatment was used in 41.9% of the patients. One hundred eighty-two patients underwent surgical treatment, including myomectomy (57.1%), subtotal hysterectomy (19.8%) and total hysterectomy (23.1%). Among the patients who underwent surgery, 50.6% of patients (88/174) had surgery due to compression symptom, 42.6% (126/296) due to bleeding, and 34.6% (117/338) due to pain. According to the 100 patients who answered the questionnaires, 78 patients preferred medical therapy initially, but 22 patients chose surgical treatment. When the patient was asked to choose between myomectomy and hysterectomy, 94 patients wanted myomectomy, but only 6 patients chose hysterectomy. CONCLUSIONS: Many patients diagnosed as myoma prefer medical treatment initially. Medical treatment for myoma may be considered as the first line treatment for pain and bleeding symptoms before proceeding to surgical treatment.

Ovarian hemangioma: A case report / 대한산부인과학회지

Hemangiomas of ovary are extremely rare tumors, although ovaries have a very rich vasculature. There are only approximately 50 cases of ovarian hemangioma reported in the literature. The most of ovarian hemangiomas are the cavernous type and may present either as isolated unilateral ovarian masses, which are discovered incidentally, or together with diffuse abdominopelvic hemangiomatosis. We report a case of a ovarian hemangioma discovered incidentally in a 35-year-old woman with brief review on this topic.

A case of telangiectasis of the uterus: uncontrolled massive uterine bleeding after gnrh agonist therapy / 대한산부인과학회지

Telangiectasis of the uterus is an extremely rare but life-threatening disease because of massive uterine bleeding. The usage of GnRH agonist can cause regression and atrophy of the endometrium through induction of hypoestrogenism by pituitary down-regulation. But there is no clear explanation or report in the literature showing the relationship between uterine telangiectasis and GnRH agonist usage. We have experienced a patient with uncontrolled massive uterine bleeding after GnRH agonist treatment, who needed emergency hysterectomy. Pathologic tissue examination showed telangiectasis of the endometrium and myometrium. This is the first case report of telagiectasis of the uterus without other organ involvement. We report this case with a brief review of the literatures.

Impact of vaginal hysterectomy on total vaginal length / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the impact of vaginal hysterectomy on total vaginal length (TVL). METHODS: Retrospective analysis of 155 medical records of patients underwent vaginal hysterectomy by one surgeon with benign uterine pathology in the absence of prolapse between January 2004 and February 2007. After hysterectomy, uterosacral vaginal vault resuspension (anchoring to vaginal vault about 1.0~1.5 cm proximal at the ligament) was performed for prevention of vault prolapse. Patients' characteristics and TVL before and after surgery were evaluated. RESULTS: Preoperative mean TVL was 7.32+/-0.84cm. At two months after the surgery, mean TVL was 7.42+/-0.77 cm. The change of vaginal length was statistical significance (P=0.045). Eighty-one patients were reevaluated at five to twelve months after surgery, mean TVL was longer than the preoperative results (7.3+/-0.82 cm vs 7.48+/-0.78 cm, P=0.011). We evaluated 30 patients who were followed at least 12 months after the surgery, the length was longer than the preoperative results, also (7.17+/-0.81 cm vs 7.46+/-0.66 cm, P=0.006). CONCLUSION: Although that appears to be statistically significant elongation of the total vaginal length after vaginal hysterectomy, the impact is unlikely to be clinically significant.

Comparison of efficacy of GnRH agonist and intravenous iron therapy for preoperative correction of anemia in gynecologic patients / 대한산부인과학회지

OBJECTIVE: This study is aimed to compare the efficacy of GnRH agonist and intravenous iron therapy in women who need correction of anemia prior to hysterectomy for uterine myoma and adenomyosis. METHODS: We reviewed retrospectively the data of 105 patients with initial hemoglobin level under 10g/dl, who had undergone total abdominal hysterectomy after correction of anemia with GnRH agonist (Group 1) or intravenous iron therapy (Group 2) from January 2004 to April 2006. RESULTS: Initial hemogloblin level was not different between the two groups. After administration, hemoglobin level increased by 3.9+/-2.3 g/dl and 2.6+/-1.7 g/dl, respectively. Therefore, group 1 was superior in anemia correction (p<0.01). On postoperative 1st day, hemoglobin level was 10.3+/-1.6 g/dl and 9.0+/-1.0 g/dl. Correction duration was 7.8+/-4.7weeks (1-18weeks) in group 1 and 4.0+/-4.8weeks (1-30 weeks) in group 2. Shorter duration was needed for correction in group 2 (p<0.01). Surgically removed uterine weight was 391.4+/-195.1 gm and 630.6+/-648.9 gm, respectively. Uterine weight was heavier in Group 2 (p<0.01). CONCLUSION: In comparison of efficacy of GnRH agonist with intravenous iron therapy for the correction of preoperative anemia, corrected hemoglobin level was higher and removed uterine weight was smaller in group 1. But duration of therapy for the correction of anemia was shorter and cost-effectiveness was superior in group 2. Clinicians should consider the patients' condition prior to the selection of drug for preoperative anemia correction.

The rate of malignant endometrial polyps and it's associated factors / 대한산부인과학회지

OBJECTIVE: To determine the incidence of benign, hyperplastic, and malignant endometrial polyps and whether particular clinical parameters are associated with malignancy in the polyps. METHODS: Four hundred and forty nine patients who were suspected as endometrial polyps by hysteroscopy underwent hysteroscopic guided removal over 12 months period were retrieved. The medical records and histopathological findings were reviewed. Statistical analysis was performed. RESULTS: Histologically, among 360 (80.1%) polypoid lesions, 353 polyps (75.1%) were benign; 16 polyps (3.5%) had simple or complex hyperplasia, only 1 polyp (0.2%) had hyperplasia with atypia (considered as premalignant lesions), and 6 polyps (1.3%) were cancerous. Non polypoid lesions were found in 89 (19.9%) cases. Older age, postmenopausal status were associated with pre-malignant or malignant changes significantly, but presence of abnormal uterine bleeding, multiplicity, larger sizes (>1.5cm) were not a predictor of malignancy in the polyp. CONCLUSIONS: Age and menopausal status may increase the risk of premalignant and malignant polyps. Although the risk of malignancy is low, we should pay attention to postmenopausal women with endometrial polyps regardless of the symptoms, and we prefer hysteroscopic resection for the exact diagnosis.

Clinical Usefulness of Transvaginal sonography and sonohysterography in evaluation of endometrial abnormalities / 대한산부인과학회지

OBJECTIVE: The aim of our study is to evaluate the clinical usefulness of transvaginal sonography (TVS) and saline infusion sonohysterography (SHG) in the evaluation of endometrial abnormality. METHODS: We retrospectively reviewed 370 patients with abnormal uterine bleeding or uterine cavity abnormalities confirmed by TVS. SHG was carried out by experienced gynecologist, on the same setting in an outpatient clinic after the performance of TVS. Two hundred nineteen patients aged between 23 and 69 years (mean age 41+/-8.2) had operative hysteroscopy (88.2%), hysterectomy (9.1%) and dilatation/curettage (2.7%) within 3 months which provided a detailed description of uterine cavity. Surgical-pathologic findings were compared with the results obtained from TVS and SHG. RESULTS: The sensitivity and specificity were 71.7% and 31.4% for TVS, and 98.4% and 67.6% for SHG respectively. The positive and negative predictive values were 84.6% and 17.5% for TVS, and 94.3% and 92.3% for SHG, respectively. Twenty one cases showed a discrepancy between the TVS and SHG, and 16 cases showed a discrepancy between SHG and the pathologic diagnosis. Fifty five cases (25%) in TVS were unconfirmed, but SHG showed 51 pathologic confirmed intracavitary lesion. CONCLUSION: SHG is a sensitive tool and is superior to TVS used alone for evaluation of endometrial abnormalities. SHG definitely enhances the diagnostic potential of TVS in assessment of endometrium and intracavitary pathologies.

Hysterectomy; Is it essential for the correction of uterine prolapse? / 대한산부인과학회지

OBJECTIVE: The aim of this study was to compare the efficacy of sacrospinous colpopexy without hysterectomy and with hysterectomy for symptomatic uterine prolapse. METHODS: A retrospective chart review was performed in the women who underwent sacrospinous ligament suspension between March 1998 and March 2002. A hundred fifty five women with a symptomatic uterine prolapse were treated with either sacrospinous colpopexy without hysterectomy and/or anterior-posterior repair (83 cases=Group A) or sacrospinous colpopexy with hysterectomy and/or anterior-posterior repair (72 cases=Group B). RESULTS: The mean duration of surgery, hemoglobin change, catheter days and inpatient days were shorter in group A compared with group B. (Group A 102.5+/-33.4 min, 2.4+/-0.7 mg/dL, 5.2+/-1.4 days, 7.6+/-2.2 days vs. Group B 135.3+/-33.9 min, 2.9+/-0.8 mg/dL, 6.1+/-2.1 days, 9.4+/-3.7 days, p<0.05 respectively) Recurrent pelvic organ prolapse developed in 14.5% in group A and 12.5% in group B. Six patients (7.2%) in group A and 5 patients (6.9%) in group B required repeat operation for recurrent pelvic organ prolapse. CONCLUSIONS: Sacrospinous colpopexy without hysterectomy and with hysterectomy are equally effective surgical operation for uterine prolapse. This study shows that hysterectomy is not essential for the correction of uterine prolapse.

Safety and Efficacy of Transvaginal Sacrospinous Colpopexy / 대한산부인과학회지

OBJECTIVE: To determine the success rate and complications of transvaginal sacrospinous colpopexy for symptomatic uterine/vault prolapse when performed by one surgeon. METHODS: Between march 1996 and march 2002, 105 women with a symptomatic uterine/vault prolapse were treated with transvaginal sacrospinous ligament colpopexy at samsung cheil hospital. Primary outcome measures were complications (acute and long term) and success rate, with failure defined as any degree of uterine/vault prolapse requiring repeat operation, any degree of symptomatic isolated uterine/vault prolapse, any pelvic organ prolapse at or beyond the introitus. Statistical analysis was performed using simple descriptive technique. RESULTS: During the study period, 105 transvaginal sacrospinous ligament colpopexy were performed: 41 with vaginal hysterectomy, 38 without hysterectomy, 25 for post-hysterectomy vault prolapse and 1 cervical amputation. The mean duration of follow-up was 17.7 months (0-66) There were no acute hemorrhage and no deaths. There were four intraoperative complications - three rectal wall injury and one bladder wall injury. There was a complaints of postoperative right buttock pain in 8 of the 105 procedure (7.6%), with this persisting on a chronic basis in 2 patients (1.9%). Postoperatively, there were 11 patients with uterine/valut prolapse, 4 with a cystocele and 1 with a rectocele. Of these 105, there were 6 failures (5.7%). CONCLUSION: Transvaginal sacrospinous colpopexy for the correction of uterine/vault prolapse, when performed by a surgeon experienced in the procedure, is safe and effective surgical procedure and rare major complications.

A Case of Marked Hydroureter, Misdiagnosed as a Hydrosalpinx by Ultrasound / 대한산부인과학회잡지

The retroperitoneal space of the posterior abdomen and the pelvic retroperitoneum contain the major neural, vascular and lymphatic supply to the pelvic viscera, the urinary system and colorectal system. A pain or mass in the pelvis may arise primarily from the reproductive organs, but it may just as easily arise from the retroperitoneal space, include the urinary tract and the gastrointestinal tract. Therefore, the gynecologic surgeon should be aware of the various conditions associated with retroperitoneal mass and the correct management of these disorders. Hydroureter may misdiagnose as a pelvic mass or retroperitoneal mass. The cause of hydroureter is mainly secondary obstruction such as malignancy, idiopathic retroperitoneal fibrosis and pelvic disease but primary obstructive megaureter should be considered. This report describes a case of marked hydroureter, misdiagnosed as a hydrosalpinx by ultrasound.

A Case of Marked Hydroureter, Misdiagnosed as a Hydrosalpinx by Ultrasound / 대한산부인과학회잡지

The retroperitoneal space of the posterior abdomen and the pelvic retroperitoneum contain the major neural, vascular and lymphatic supply to the pelvic viscera, the urinary system and colorectal system. A pain or mass in the pelvis may arise primarily from the reproductive organs, but it may just as easily arise from the retroperitoneal space, include the urinary tract and the gastrointestinal tract. Therefore, the gynecologic surgeon should be aware of the various conditions associated with retroperitoneal mass and the correct management of these disorders. Hydroureter may misdiagnose as a pelvic mass or retroperitoneal mass. The cause of hydroureter is mainly secondary obstruction such as malignancy, idiopathic retroperitoneal fibrosis and pelvic disease but primary obstructive megaureter should be considered. This report describes a case of marked hydroureter, misdiagnosed as a hydrosalpinx by ultrasound.

Uterine Prolapse-Need for Hysterectomy? / 대한산부인과학회잡지

OBJECTIVE: To compare the efficacy of transvaginal sacrospinous colpopexy with hysterectomy and without hysterectomy for symptomtic uterine prolapse when performed by one surgeon. METHODS: Between march 1996 and march 2002, 59 women with a symptomatic uterine prolapse were treated with either transvaginal sacrospinous ligament colpopexy with hysterectomy (30 cases=Group A) or transvaginal sacrospinous cervicocolpopexy without hysterectomy (29 cases=Group B). Patients were reviewed at least 12 months after operation. RESULTS: The mean age, parity, prolapse grade, menopausal status, body weight and length of follow-up for two groups were no difference. There were two intraoperative complications-Rectal wall injury one patient in group A and one in group B. The mean duration of surgery, hemoglobin change, inpatient days and catheter days were shorter in group B compared with group A. Recurrent asymptomatic cystocele developed in 2 patients in group A and 2 in group B. One patient in group A and one patient in group B required repeat operation for recurrent pelvic organ prolapse. There was no significant difference between the two groups in postoperative satisfactory result (96.7% vs 98.6%, respectively p=0.51). CONCLUSION: Sacrospinous cervicocolpopexy without hysterectomy and sacrospinous colpopexy with hysterectomy are equally effective surgical operation for uterine prolapse. Sacrospinous cervicocolpopexy without hysterectomy avoids the potential morbidity of vaginal hysterectomy and decreases the operation time, blood loss, inpatient days and catheter days. Vaginal hysterectomy may not be necessary in the correction of uterine prolapse.

A Case of Omental Herniation after Operative Laparoscopy / 대한산부인과학회잡지

The increasing use of the laparoscopic surgery in the management of gynecologic disease resulted in an increasing incidence of complication and the development of new complications. Incisional hernia through laparoscopic trocar site is an unusual complication of laparoscopy. A rare form of port-associated complication is omental herniation. This report describes a case of omental herniation through a 10-mm subumbilical incision following uneventful laparoscopic surgery.

A Case of Mature cystic teratoma of the Douglas pouch Associated with an Pregnancy / 대한산부인과학회잡지

The mature cystic teratoma is most common in the ovary, and several authors have reported mature cystic teratoma in female genitalia such as fallopian tube, uterus and pouch of douglas. The mature cystic teratoma in the douglas pouch is very rare, which was reported only twice in the world. The pathogenesis of the mature cystic teratoma in the douglas pouch is not established. We experienced a case of mature cystic teratoma in the douglas pouch associated with pregnancy, which was diagnosed by the ultrasonography at the first trimester of pregnancy and remained at the third trimester of pregnancy without change of size. We report the case with a brief review of literature.