Study for the clinical efficacy of laparoscopic myomectomy / 대한산부인과학회지

OBJECTIVE: The objective of this study is to evaluate the safety and the clinical efficacy of the laparoscopic myomectomy through analyzing several operation factors. METHODS: There were 185 cases of laparoscopic myomectomy between January 2004 and December 2008 at the department of obstetrics and gynecology in Hanyang University Guri Hospital. Retrospectively many factors of the operation were analyzed. The factors include the size, number and type of the myoma, BMI (body mass index), operation method, operation time, and complication and the prognosis of the operation. RESULTS: For the type of myomas, 115 (62.2%) cases were intramural myomas, 38 (20.5%) cases were subserosal types and 32 (17.3%) cases were mixed types. The average diameter of the biggest myoma was 6.67+/-0.16 cm (range, 2.5~15 cm) and the average number of the myoma was 2.07+/-0.15 (range, 1~15). Previous operation history and pelvic adhesion did not show correlation with the operation time. The size, type and number of myoma and the operation methods showed correlation with the operation time. According to myoma size and number, we divided the cases into two groups, low risk group (122 cases) and high risk group (63 cases). The analysis showed that post-operation hemoglobin drop (2.89+/-0.10 g/dL vs. 4.03+/-0.23 g/dL) and blood transfusion amount (2.89+/-0.10 pints vs. 4.03+/-0.23 pints) as well as the operation time (137.58+/-4.37 min vs. 193.73+/-9.88 min) showed noticeable increase in the high risk group. CONCLUSION: This statistics show that laparoscopic myomectomy is now being applied to patients with larger and more myomas. Factors affecting operation time were the weight of myomas, number of myomas, type of myomas, number of trocars and methods of resected myomas removal. Also, operation time and post-operative hemoglobin drop increased in the high risk group.

A Case of Mature cystic teratoma in Omentum / 대한산부인과학회지

The mature cystic teratoma of the omentum is a very rare tumor. It is generally believed that autoamputation and reimplantation of an ovarian tumor is the most common etiology of omental teratoma. Abdominal pain is the main presenting symptom of these tumors. A 41-year-old woman was admitted for pelvic mass. At laparotomy, a 8.5 x 7.0 x 7.5 cm mass was found in the pelvic cavity, attached to the omentum with adhesion to bladder. The histopathologic diagnosis was mature cystic teratoma in conjunction with the cyst wall is diffusely necrotic and calcified with hairs. The absence of the left ovary suggested that the tumor underwent autoamputation and reimplantation on the omentum. We report the case with a brief review of literature.

A case of ruptured omental pregnancy / 대한산부인과학회지

Abdominal pregnancy is a rare form of ectopic pregnancy, which has been classified as early and advanced abdominal pregnancies. In case of early abdominal pregnancy, we may miss the diagnosis because the symptoms and clinical characteristics are non-specific. However, recently, the early diagnosis is made because of the development of quantitative beta-hCG measurement, transvaginal ultrasonography and the development of laparoscopy. Omental pregnancy is a very rare form of abdominal pregnancy, which is hard to detect early. When ruptured, it accompanies with massive hemorrhage. So, early diagnosis and treatment is essential to prevent high morbidity, mortality and serious complications. Definite diagnosis is made by cytopathologic examination of tissue specimen after surgery. We have experienced a case of ruptured early omental pregnancy and reviewed it briefly.

Two Cases of Granulosa Cell Tumor of the Ovary / 대한산부인과학회지

Granulosa cell tumors are relatively low-grade malignancies accounting for about 1 to 2% of all primary ovarian neoplasms and have an indolent growth pattern. There are two types of tumors, adult type granulosa cell tumor (AGCT) and juvenile type granulosa cell tumor (JGCT), and each tumor reveals different clinical or histopathological features. The clinical manifestations are mostly associated with estrogen produced by tumor, which are vaginal bleeding or menstrual irregularity in AGCT and precocious puberty in JGCT. Although most patients are diagnosed in early stage with favorable prognosis, some recur after several years. So, continuous follow up is required. Recently, we experienced two cases of adult type granulosa cell tumor and report with a brief review of literatures.

A Case of Variants of Turner syndrome Showing 46,X,inv(Y)/45,X Karyotype with Y Chromosome microdeletion / 대한산부인과학회지

46,X,inv(Y)/45,X mosaicism is a extremely rare sex chromosomal disorder. We experienced an unusual mosaic Turner syndrome case in a 29-years old Korean woman with a phenotypic female, primary amenorrhea and immature secondary sexual characteristics. Cytogenetic analysis including GTG banding revealed 46,X,inv(Y)(q11.2q12?)[15]/45,X[35] mosaicism, and X/Y chromosome Fluorescence in situ hybridization (FISH) analysis result was ish (SRY-,DYZ3-)[16]/ ish der(Y)del(Y)(q12)inv(Y)(p11.3q12)(SRY sp, DYZ3-)[4] and its meaning was coexistence of microdeletion and inversion of Y chromosome. To our knowledge, this karyotype may be a very rare variant of Turner syndrome, and we report this case with brief review of related literature.

A case of primary ovarian pregnancy / 대한산부인과학회지

Ovarian pregnancy is comparatively rare form of ectopic pregnancy. Although earlier diagnosis is now possible due to the availability of quantitative beta-hCG measurement and the development of transvaginal ultrasonograghy, it is mostly difficult to diagnosis before surgery, and frequently misdiagnosed as a ruptured corpus luteum accompanied with massive hemoperitoneum. Definite diagnosis is made only by cytopathologic examination of tissue specimen. The treatment of ovarian pregnancy has been operative management including oophorectomy, salpingo-oophorectomy and ovarian wedge resection. But recently conservative management using laparoscopic technique has become the preferred treatment. We have experienced a case of primary ovarian pregnancy and reviewed it briefly.