Tuberculous peritonitis in the first trimester of pregnancy

Tuberculous peritonitis in pregnancy is a rare form of extrapulmonary tuberculosis that is not easily diagnosed. The clinical presentations of tuberculous peritonitis are usually non-specific and mimic those of other diseases, such as ovarian malignancy or chronic liver disease, and this non-specificity can cause diagnostic delays and complications. The authors report the case of a 31-year-old primigravida woman who presented with uncontrolled fever, dyspnea, elevated liver enzymes, and mild abdominal distension at 13+2 weeks of gestation. At 14+2 weeks, a therapeutic abortion was conducted and tuberculous peritonitis was confirmed by laparoscopic excisional biopsy of peritoneal nodules and histopathologic examination. The patient recovered on antituberculosis therapy and abdomen and chest follow up radiographic findings have confirmed improvement.

Incidental diagnosis of vaginal schwannoma in a patient with thigh pain

Schwannoma commonly arises from Schwann cells of the neural sheath, and is rare in the groin region. Here, we describe a vaginal schwannoma incidentally detected by magnetic resonance imaging (MRI) in a patient with thigh pain. A 43-year-old woman presented with thigh pain with burning and tingling sensations in the medial aspect of her left thigh. MRI revealed a mass lesion of heterogeneous intensity 5.2 x 5.7 cm in the left vaginal wall. The mass was resected and histology revealed schwannoma.

Discrimination between Benign and Malignant Pelvic Masses Using the Risk of Malignancy Index 1 / 대한폐경학회지

OBJECTIVES: To assess the ability of risk of malignancy index (RMI) 1 to discriminate between benign and malignant pelvic masses. METHODS: Between January 2007 and December 2010, 547 women with pelvic masses were evaluated. Their medical records are reviewed here retrospectively. The sensitivity, specificity and positive and negative predictive values of the cancer antigen (CA) 125 level, ultrasound findings and menopausal status in the prediction of malignant pelvic masses were calculated and compared individually or combined using the RMI 1. RESULTS: The receiver operating characteristic (ROC) curves of CA 125, the ultrasound score and the RMI 1 were all found to be relevant predictors of malignancy. ROC analysis of the RMI 1, CA 125 serum levels, ultrasound score and menopausal status showed areas under the curves of 0.795, 0.782, 0.784 and 0.594, respectively. The RMI 1 was found to be statistically significantly correlated with menopausal status (P = 0.001), while not statistically significantly correlated with CA 125 (P = 0.628) or the ultrasound score (P = 0.541). The RMI 1 at a cut-off of 150 - with a sensitivity of 77.9%, specificity of 81.1%, positive predictive value of 51.7% and negative predictive value of 93.4% - showed the highest performance in determining the malignant tendency of pelvic masses. CONCLUSION: Accepting a RMI 1 cut-off value of 150 results in statistically more significant diagnostic criteria than menopausal status for the discrimination of benign and malignant pelvic masses.

Squamous cell carcinoma arising in an ovarian mature cystic teratoma complicating pregnancy

Mature cystic teratomas of the ovary (MCT) are usually observed in women of reproductive age with the most dreadful complication being malignant transformation which occurs in approximately 1% to 3% of MCTs. In this case report, we present a patient with squamous cell carcinoma which developed from a MCT during pregnancy. The patient was treated conservatively without adjuvant chemotherapy and was followed without evidence of disease for more than 60 months using conventional tools as well as positron emission tomography-computed tomography following the initial surgery. We report this case along with the review of literature.

Prognostic factors in early endometrial cancer: a single institution / 대한산부인과내시경학회지

OBJECTIVE: To assess the prognostic factors of early endometrial cancer. METHODS: Medical records of patients with endometrial cancer stage I and II were reviewed retrospectively between 1999 and 2005. Progress-free survival rates of each prognostic factor were obtained. RESULTS: The mean age of 45 patients was 49 (27-74). Thirty-nine patients had stage I, 6 patients had stage II of the disease. Most cases of histology were diagnosed with endometrioid adenocarcinoma (42 patients, 93.3%). Twenty-three patients had grade 1, 16 patients had grade 2, and 6 patients had grade 3 histology. Thirty patients had myometrial invasion of less than 50%, while 15 patients had myometrial invasion of more than 50%. Thirty-one patients showed no lympho-vascular space involvement (LVSI), and 14 patients were LVSI positive. All patients were primarily treated by surgery. Twenty-four patients received adjuvant radiotherapy, and 1 patient received concurrent chemotherapy and radiotherapy. In univariate analysis, FIGO stage (p=0.004), tumor grade (p=0.043), myometrial invasion (p=0.030), and LVSI (p=0.003) had statistical significance with PFSR. However, age, parity, menopause, lymphadenectomy, and histology did not. CONCLUSION: Stage, tumor grade, myometrial invasion, and LVSI seemed to be statistical prognostic factors in early endometrial cancer.

Clinical data of patients with endometrioid endometrial adenocarcinoma at a single institution / 대한산부인과학회지

OBJECTIVE: The incidence of endometrial cancer is increasing. We would like to report our institution's clinical data of endometrioid adenocarcinoma (EC) which is the most frequent type. METHODS: From 1998 to 2009, patients' clinical data were reviewed through medical records, retrospectively. RESULTS: For 11 years, there were 96 patients with EC. The average age was 51.1 years old and mean follow duration was 36.6 months. There were 73 patients with stage I, 10 patients with stage II, and 12 patients with stage III. 42 patients were treated by operation only and 46 patients were treated by operation and adjuvant radiotherapy. Among 95 patients who underwent operations, 32 patients did not get lymph node removal and 63 did, and 10 patients had malignant cells at the lymph nodes removed. 6 patients died of EC, 1 with stage I, 3 with stage II and 1 with stage III. CONCLUSION: This study had retrospective limitation but could show the profile of 96 patients with EC.

Ultrasound imaging guided high intensity focused ultrasound (HIFU) may be a safe tool to ablate uterine myoma / 대한산부인과학회지

OBJECTIVE: to test the safety of ultrasound imaging guided high intensity focused ultrasound (HIFU) to ablate uterine myoma. METHODS: From September 2008 to February 2009, patients with dysmenorrhea and/or menorrhagia for uterine myomas had been enrolled. HIFU ablation was performed at 1 MHz. 400 W/cm2 of pulses were delivered for 150 m second with 150 m second interval at the target point for 70 cycles. This process was repeated on a point by point basis. After one slice was treated, the target was shifted 4 mm laterally. If patient were complaining of pain, the procedures were stopped for a while. RESULTS: The distribution of age was 29~48 years old, and of longest diameter was 36.0~115.0 mm, and of target distance from skin was 55~100 mm, and of number of treatment was 2~6. Nobody gave up the procedure for pain or any other reason. The procedures took 40 to 60 minutes for a slice. One or three slices were treated in a day. All patients went home after HIFU without medication. Nobody reported any clinically severe complications. Everybody returned to normal activities 1 day after the procedure. Nobody complained of vaginal spotting after one cycle of menstruation. CONCLUSION: Ultrasound imaging-guided HIFU treatment appears to be safe to ablate the uterine myomas.

Evaluation of p53 and Bax Expression as Prognostic Markers in Invasive Cervical Carcinoma Stage IIB Patients Treated with Radiation Therapy / 대한방사선종양학회지

PURPOSE: The objective of our study was to evaluate the immunohistochemical expression of p53 and bax proteins as prognostic markers in FIGO stage IIb invasive squamous cell carcinoma of the uterine cervix. MATERIALS AND METHODS: Sixty-five cases of squamous cell carcinoma of the cervix (stage IIb) that were diagnosed from October 1996 to December 2003 were analyzed retrospectively for the bax and p53 expression. These expressions were determined immunohistochemically and they were correlated to the patients' overall survival and disease-free survival. RESULTS: The overall 5-year survival (OS) rate and the disease-free survival (DFS) rate were 65.1% and 62.9%, respectively. p53 and bax immunoreactivity was seen in 26.2% and 52.3% of cases, respectively, with variable levels of expression. On the univariate analysis, only p53 positivity correlated with poor survival in DFS (log-rank test p=0.027), but this significance was not maintained on multivariated analysis by Cox's regression. The nine cases with the immunophenotype p53+/bax- had the poorest survival. CONCLUSION: Neither p53 nor bax expression are independent predictors of the prognosis for stage IIb cervical squamous cancers. Evaluation of p53 and bax co-expression may affect the clinical outcome and further investigation is needed.