Endometrial carcinoma arising in a bicornuate uterus

Endometrial carcinomas arising in a bicornuate uterus are rare, only five case of which have been previously reported. We present a case of endometrial cancer arising in a bicornuate uterus, occurring in a 65-year-old woman. Unlike previously reported cases, our case showed mixed endometrial adenocarcinoma and undifferentiated carcinoma in one horn and focal adenocarcinoma in the other. Adequate tissue sampling of both horns is necessary for accurate diagnosis of malignancy in patients with a bicornuate uterus. Physicians should be aware of the possibility of this abnormality in cases when endometrial cancer is suspected but histology fails to confirm.

Ectopic adrenal tissue in right uterine adnexa: A case report / 대한산부인과학회지

Ectopic adrenal tissue is observed in about 50% of neonates, but observed in about 1% of adults as it atrophies and disappears over time. In most cases, ectopic adrenal tissue is found in organs below the diaphragm such as liver, pancreas, kidney, transverse colon and male and female genital tract. However, ectopic adrenal tissue found in the uterine adnexa is a very rare case through the world. Ectopic adrenal tissue was incidentally found in the right uterine adnexa after total hysterectomy and bilateral salpingooophorectomy, so we report this case with a brief review of literatures.

A case of huge sclerosing stromal tumor of the ovary weighing 10 kg in a 71-year-old postmenopausal woman / 부인종양

Sclerosing stromal tumor (SST) is a rare benign neoplasm of ovarian stromal origin and predominantly affects young women in the second and third decades. This tumor characteristically differentiates itself histologically and clinically from both thecomas and fibromas. We present a case of huge SST of the ovary weighing 10 kg in a 71-year-old postmenopausal woman with a brief review of the literature.

A case of huge sclerosing stromal tumor of the ovary weighing 10 kg in a 71-year-old postmenopausal woman / 부인종양

Sclerosing stromal tumor (SST) is a rare benign neoplasm of ovarian stromal origin and predominantly affects young women in the second and third decades. This tumor characteristically differentiates itself histologically and clinically from both thecomas and fibromas. We present a case of huge SST of the ovary weighing 10 kg in a 71-year-old postmenopausal woman with a brief review of the literature.

Uterine abscess after radiofrequency myolysis of uterine myoma: A case report / 대한산부인과학회지

Radiofrequency myolysis is a method for preserving uterus and fecundity, and due to its more non-invasive and simpler operation, it is now frequently carried out to cure the uterine myomas. However, not long time has passed since this operation started, and little studies were conducted on its complications and side effects. Therefore, since the authors experienced the formation of an abscess in uterus after radiofrequency myolysis of uterine myoma, we hereby report the case.

A case of parovarian tumor of borderline malignancy / 부인종양

Parovarian cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. Due to the rarity of this lesion, there are controversies concerning the origin, clinical behavior, treatment and prognosis of these tumors. Parovarian borderline malignancy mostly occur in young women, main complaints are abdominal enlargement and pelvic pain. we experienced one case of parovarian borderline malignancy and report this case with a brief review of literature.

A Case of Retroperitoneal Leiomyoma developing after total abdominal hysterectomy / 대한산부인과학회지

Leiomyomas are very common tumors in the uterus and related adjacent structures but rare in the retroperitoneal space. Retroperitoneal leiomyomas are extremely rare and have a good prognosis. Long-term follow-up reveals no metastasis but small potential for local recurrences cannot be ruled out. We report a 44-years-old woman with retroperitoneal leiomyomas who had undergone total abdominal hysterectomy and left salpingooophorectomy 8 years ago due to uterine leiomyomas. Laparotomy was performed, and mass excision was successful.

A Case of Pelvic Actinomycosis with Right Ureter Obstruction and Hydronephrosis / 대한산부인과학회지

Pelvic actinomycosis is a rare infectious disease in female genital organ, which occurs most commonly with intrauterine device. Because of it's diverse clinical manifestation and progress, the diagnosis is made postoperatively by pathologic confirm in most cases and adequate medical treatment is required. Ureter obstruction is one of the common complication of pelvic actinomycosis, but it's management has been very variable by cases. If physician operate this after adequate management of ureter and preoperative antibiotics therapy, the risk of pelvic structure injury is reduced and then a patient can be saved from an extensive surgical procedure. We experienced a case of pelvic actinomycosis complicated by tubo-ovarian abscess with ureter obstruction and hydronephrosis, improving by Double J catheter insertion and preoperative antibiotics therapy and report it with brief review of literatures.

A Case of Primary Signet Ring Cell Adenocarcinoma of the Uterine Cervix / 대한산부인과학회지

Signet ring cell adenocarcinoma of the cervix is most commonly considered to be metastatic in origin. We describe one case of primary signet ring cell adenocarcinoma of the cervix occuring in 49-year-old patient. The lesion was located at the posterior lip of the cervix and about 3 cm in size. This case was parametrium thickening in pelvic examination and positive for HPV type 18. CCRT (concurrent chemoradiotherapy) was done for clinical FIGO stage II B adenocarcinoma of the cervix. The patient is alive for 6month since diagnosis and disappear lesion of the cervix. A upper gastroenteroscopy, colonoscopy, cystoscopy, intravenous pyelogram, abdominal pelvic CT, PET CT, mammogram were reported negative. Therefore we concluded this case for a primary cervical origin of signet ring cell adenocarcinoma of the uterine cervix.

Clinical analysis of 19 cases of uterine sarcoma / 대한산부인과학회지

OBJECTIVE: The aim is to evaluate the clinical findings of uterine sarcoma we had experienced. METHODS: This study was retrospectively reviewed 19 patients with uterine sarcoma who were managed at Wonju Christian Hospital between September 1982 and May 2003. We analyzed clinical features, type of surgery, adjuvant therapy, three year-survival rate, prognostic factors of uterine sarcoma, and the effects of postoperative chemotherapy and radiotherapy on death. RESULTS: Our study included four histologic types: 8 patients with leiomyosarcoma (42.1%), 5 patients with endometrial stromal sarcoma (26.3%), 4 patients with malignant mixed Mullerian tumor (21.0%), 1 patient with angiosarcoma (5.3%) and 1 patient with both leiomyosarcoma and endometrial stromal sarcoma (5.3%) (Table 1). The cases were classified according to the FIGO staging system. 13 patients (63.2%) had stage I, 2 patients (10.5%) stage II, 2 patients (10.5%) stage III, 3 patients (15.8%) stage IV (Table 1). The three-year survival rate of uterine sarcoma was 53.8%, the most common symptom was abnormal vaginal bleeding. CONCLUSION: Uerine sarcomas are aggressive tumors with poor prognosis, except when the diagnosis is low grade endometrial stromal sarcoma. The effects of postoperative chemotherapy and radiotherapy on death were not statistically significant. This is a retrospective review with small numbers and short periods. Prospective multicentric trials including a statistically evaluable number of patients are necessary.

A Case of Pseudo-Meigs' Syndrome with Elevated Serum CA 125 levels / 대한산부인과학회지

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with an ovarian fibroma, which spontaneously resolve soon after the removal of the tumor. Pseudo-Meigs' syndrome refers to the same clinical features associated with other ovarian tumors; thecoma, granulosa cell tumor, Brenner tumor, struma ovarii, etc. Elevated serum CA 125 levels have a strong correlation with ovarian malignancy, but several benign ovarian tumors have been found to cause a rise in CA 125 levels. We present a case of Pseudo-Meigs' syndrome with an elevated CA 125 resulting from thecoma with a brief review of the literatures.

Patterns of Normal Change in Fetal Cerebral Artery Doppler by Fetal Gender / 대한산부인과학회지

OBJECTIVE: To establish the normal range of the fetal cerebral artery pulsatility index (PI) throughout pregnancy and to determine if there are any gender differences. METHODS: Doppler ultrasonographic examination was performed to measure the fetal middle cerebral artery (MCA) and anterior cerebral artery (ACA) PI in 71 normal pregnancies between 25 and 39 weeks gestation. Gender determination was possible in 44 fetuses by either a postnatal examination or genetic amniocentesis. The gestational weeks were grouped into 4-week sections. Group I ranged from 28 to 31 gestational weeks. Group II and III ranged from 32 to 35 and from 36 to 39 weeks, respectively. RESULTS: The ACA PI of the male fetuses decreased with increasing gestational time (group I, II and III: 1.79+/-0.35, 1.57+/-0.67 and 1.30+/-0.35; P<0.05). The ACA PI of the female fetuses also decreased significantly (group I, II and III: 1.97+/-0.59, 1.68+/-0.41 and 1.33+/-0.21; P<0.05). The MCA PI of the male fetuses decreased (group I, II and III: 2.02+/-0.58, 1.88+/-0.43 and 1.53+/-0.47; P<0.05). However, there was no significant decrease in the MCA PI of female fetuses (group I, II and III: 2.14+/-0.60, 1.87+/-0.56 and 1.88+/-0.40; P=0.83). CONCLUSION: These data demonstrate that female fetuses show a relatively constant middle cerebral artery PI regardless of the gestational time.

A Case of Primary Uterine Angiosarcoma / 대한산부인과학회잡지

Angiosarcoma is defined as a malignant tumor of the endothelial cells present in blood vessels and represents less than 1% of all soft tissue sarcomas. Primary uterine angiosarcomas are particularly rare, and tend to have poor prognosis mostly related to the aggressive nature and the metastatic potential of these tumors. They present most commonly with vaginal bleeding or with weight loss and a pelvic mass. Although postoperative radiation and combination chemotherapy are options being utilized, the results have only shown limited success. We report a case of primary uterine angiosarcoma with a brief review of literature.

Expression of TRAIL (Apo-2L)/TRAIL Receptor System Related to Apoptosis at the Human Extraembryonic Tissues and Gestational Trophoblastic Disease / 대한산부인과학회잡지

Human uterus has been known as a immune privileged site for the product of conception. At the feto-maternal interface, Fas system is a underlying main mechanism of maternal immune acceptance. To date, the TRAIL (TNF-related apoptosis-inducing ligand) system is known to be another pivotal mechanism. OBJECTIVE: To clarify the protein expression of TRAIL ligand and receptors in the normal and pathologic (preeclampsia, hydatidiform mole) placenta, chorioamnion, decidua. METHODS: we investigated the expression of TRAIL system in the above-mentioned tissues by using Western Hybridization. RESULTS: All tissues expressed TRAIL ligand and only a DcR2 among TRAIL receptors (DR4, DR5, DcR1, DcR2). CONCLUSION: we demonstrated the expression of TRAIL ligand and DcR2 protein at the feto-maternal interface of the normal and pathologic pregnancies. Further study regarding the expression of other receptors and quantitative analysis between normal and pathologic pregnancies should be followed.

The Efficacy of Computed Tomography in the Staging of Carcinoma of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: The authors have aimed to compare the efficacy of the computed tomography with other study methods, and to investigate if replacement by computed tomography is possible METHODS: From January 1998 to December 2002, 203 cervical cancer patients underwent pre-staging studies including computed tomography. The positive predictive values, negative predictive values, sensitivity, specificity of each method of study were compared. RESULTS: 1. Compared computed tomography with intravenous pyelonephrography. Each values of computed tomography for hydronephrosis or non visualization of kidney were sensitivity 91.7%, specificity 97.8%, positive predictive values 84.6%, negative predictive values 98.9%. 2. Compared computed tomography with cystoscopy. Each values of computed tomography for bladder invasion were sensitivity 90%, specificity 95.8%, positive predictive values 52.9%, negative predictive values 99.4%. 3. Compared computed tomography with sigmoidoscopy. Each values of computed tomography for rectal invasion were sensitivity 80%, specificity 94.4%, positive predictive values 26.6%, negative predictive values 99.4%. CONCLUSION: Rather than routine examination for staging of invasive cervical cancer in all patients, it is more ideal to first take a non invasive technique. then perform on intravenous pyelonephrography, cystoscopy and sigmoidoscopy only in patient showing positive findings of hydronephrosis or non visualization of kidney, bladder or rectal invasion on computed tomography.

Clinical Analysis of 896 Cases of Midtrimester Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: We report our experience with midtrimester amniocentesis. METHODS: This study was retrospectively reviewed 896 cases of midtrimester genetic amniocentesis from January 1997 to October 2003 in Yonsei university, Wonju Colleage of medicine. We analyzed the indications, distributions of gestational age, cytogenetic results, and the safety. RESULTS: The most common Indications for amniocentesis were abnormal maternal serum marker (52.7%) and advanced maternal age (36.6%). Most amniocentesis has been performed during second trimester from 16 to 20 weeks. The incidence of chromosomal abnormality was 3.9% (35 cases). There were 26 cases of numerical aberration, 6 cases of structural aberration and 3 cases of mosaicism. In chromosomal aberration, there was 9.0% (2/22) of chromosomal abnormalities in abnormal ultrasonographic finding group and 6.9% (2/29) in previous chromosomal anomaly. There were 3 cases of fetal loss (0.3%) after amniocentesis. CONCLUSION: Midtrimester amniocentesis is a useful and safe technique for the prenatal detection of genetic disorder.

Clinical Evaluation of Ovarian Tumors in Pregnancy / 대한산부인과학회잡지

OBJECTIVE: We performed this study to evaluate the clinical appearance of ovarian timor in pregnancy. MATERIALS AND METHODS: From January 1995 to December 2000, a review was performed 51 cases of ovarian tumors in pregnancy. The diagnosis of ovarian tumor was confirmed by pathologist after operation. RESULTS: 1. The incidence of ovarian tumors in pregnancy was 51 in 11,056 deliveries (1:217). Five cases of borderline malignancy and one case of granulosal cell tumor were reported. 2. The ovarian tumors were the most common between 30 and 34 years of age pregnant women (35.5%) and more common in multiparous women than in nulliparous women. 3. As to the initial chief complaints, no symptoms and sign were in 36 cases (70.6%) low abdominal pain and discomfort were in 6 cases (11.8%) palpable mass were found in 2 cases (3.9%). 4. 53% of patients was diagnoses in the third trimester, 33.3% of patients in the first trimester, 13.7% of patients in the second trimester. 5. Excluding the 27 cases of incidental operation during cesarean section, operation was performed at first trimester in 4 cases (16.7%), at second trimester in 9 cases (37.5%), after conservative management operation during cesarean section was performed at third trimester in 11 cases (45.8%). 6. Complication resulting ovarian tumors occurred in one case of torsion. 7. According to histologic type, there were 15 cases (29.4%) of benign cystic teratoma, 13 cases (23.5%) of mucinous cystadenoma, 8 cases (15.7%) of serous cystadenoma, 4 cases (7.7%) of corpus luteal cyst, 5 cases (9.8%) of mucinous cystic tumor borderline malignancy, 1 case (2%) of granulosal cell tumor. 8. According to effects on pregnancy, among 13 cases in which the ovarian tumor was removed, vaginal delivery occurred at term in 6 cases (46.1%), cesarean section at term in 4 case (30.8%), missed abortion in 1 case (7.7%), preterm delivery in 2 cases (15.4%). 11 cases in which was performed conservative management were done cesarean section at term. CONCLUSION: The incidence of benign and malignant ovarian tumor in pregnancy and is being increased. Considering effects on pregnancy and pregnant women of treatment method, appropriate timing and treatment method should be chosen.

A Case of Juvenile Granulosa Cell Tumor of the Ovary / 대한산부인과학회잡지

Juvenile granulosa cell tumor is a well-known sex-cord stromal ovarian neoplasm different in appearance and behavior from the adult granulosa cell tumor and occurs most (80%) frequently in the first two decades. The prognosis of juvenile granulosa cell tumor in children is good in most cases, but correlated with stage, size, the presence of ruptures, the grade of nuclear atypia, the degree of mitotic activity. The surgery remains the principal line of treatment for low stage juvenile granulosa cell tumor in children, but for those patient with high stage juvenile granulosa cell tumor or recurrence, the best treatment has yet to be determined and tumor sensitivity to radiation therapy and chemotherapy is not clearly. We present a case of juvenile granulosa cell tumor with brief review of literatures.

Clinical Response of Uterine Embolization for the management of Leiomyomas / 대한산부인과학회잡지

OBJECTIVE: To determine of the effectiveness of uterine arterial embolization as a primary therapy in the management of symptomatic leiomyomas. MATERIALS AND METHODS: Uterine arterial embolization was performed in 23 patients (age range, 27-50 years) who complaint menorrhagia, bulk-related symptoms(frequency of urination, sensation of pressure, sensation of mass), or both, with leiomyomas. The effectiveness of the therapy was evaluated in the view of symptomatic relief and the patients' acceptance with ultrasonography, 3 months later. RESULTS: Sixteen (89%) of 18 patients reported marked improvement in their abnormal bleeding. Ten (90%) of 11 patients with bulk-related symptoms reported marked improvement in these symptoms. Follow-up ultrasonographic examination showed a mean 21% reduction in uterine size and mean 39% reduction in leiomyoma size. CONCLUSION: Utrine arterial embolization is an effective therapy in the management of symptomatic leiomyomas and may prove to be a valuable alternative to myomectomy, hysterectomy, or other surgical procedures.

Chorioamnionitis and Fetal Death with Intact Membranes Involving Staphylococcus aureus at term / 대한산부인과학회잡지

It has been believed that the intact placental membranes are a good barrier to ascending infection, but this may be only partly true.` Neonatal infection without premature rupture of the amniotic membranes occurs in 1-2% of births. The prevalence of membranes inflammation among births at term is approximately 10%.2-4 Chorioamnionitis is a frequent cause of fetal death mostly as a silent chorioamnionitis without maternal signs of infection.4 Below we present a case of subclinical acute chorioamnionitis in a woman admitted because of labor pain at 39weeks with intact membranes and subsequent sudden intrauterine fetal death. Culture specimens from the endometrium and uterine cervix showed growth of Staphylococcus aureus.