Follow-up Study of 119 cases of Fetal Choroid Plexus Cysts in the Second Trimester: Associated with Trisomy 18? / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical significance of fetal choroid plexus cysts (CPCs) in the second trimester, especially an association with trisomy 18. METHODS: From March 1998 through June 1999, second trimester screening ultrasonography was performed on 4,948 unselected single-ton pregnancies. CPCs were noted in 132 fetuses. Among them, detailed ultrasonography and follow-up was possible in 119 cases and they were recruited into the study. There were 91 cases of isolated CPCs and 28 cases of CPCs in high-risk population. "Isolated CPCs" were defined as: mother did not have any risk factors requiring amniocentesis and there were no other sonographic abnormalities on detailed ultrasound. "CPCs in high-risk population" were defined as: mother had any risk factor requiring karyotyping or there were any other sonographic abnormalities although she was general population. Amniocentesis was performed in 39 cases. We compared gestational age at time of detection, size, bilaterally, multiplicity, and complexity of CPCs in the group of isolated CPCs and CPCs in high-risk population (t-test, chi-square test; P0.05). Mean size (6.4 vs 6.2 mm), bilaterality (60% vs 57%), multiplicity (66% vs 57%), and complexity (8% vs 14%) of CPCs were also similar. All CPCs were disappeared irrespective of size and mean time of disappearance was 25+/-3 and 26+/-3 week, respectively (p>0.05). All cases of isolated CPCs resulted in phenotypically-normal neonates. It was confirmed by either amniocentesis or postnatal examination by the pediatrician. Among fetuses having CPCs in high-risk population, two trisomy 18 and one trisomy 21 were detected. All of them had positive result of maternal serum marker test and/or sonographic abnormalities. Remaining cases were proved normal. CONCLUSION: The risk of chromosome abnormalities is very high when CPCs are associated with other abnormalities on detailed ultrasound, indicating a clear need to offering genetic amniocentesis. As contrast, the risk of chromosome abnormalities for a case of isolated CPCs is very low, and in this series there was no trisomy 18. Therefore isolated CPCs should be considered as the indication of detailed ultrasound examination, but not routine karyotyping.

A Case Report: Prenatal Ultrasonographic Diagnosis of Autosomal Dominant Polycystic Kidney Disease / 대한산부인과학회잡지

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disorder characterized by renal cyst formation, hypertension, and end-stage renal disease. For many years, ADPKD was considered an adult disease. In fact, it may occur at any time in life including in utero. We experienced a case of ADPKD at 34 weeks of gestation. On ultrasound, both kidnies were enlarged and echogenic. Amniotic fluid index was normal. We discovered a family history of paternal origin. Sonographic findings of bilaterally enlarged and echogenic kidnies without oligohydroamniosis may suggest ADPKD. Renal ultrasound examination of parents is useful in the diagnosis of ADPKD.

A Case of Benign Retroperitoneal Schwannoma of the Obturator Fossa / 대한산부인과학회잡지

The schwannoma is a benign neoplasm originating from Schwann cell. Solitary nerve sheath tumors such as benign schwannomas arising in the pelvic retroperitoneum are infrequently reported. Those tumors can indeed be misdiagnosed for other more common conditions both clinically and instrumentally. We report a very rare case of a benign retroperitoneal pelvic schwannoma of the obturator fossa, which was incidentally found and misdiagnosed as adnexal mass preoperatively in fifty one-years-old postmenopausal women.

A Case of Emergency Cerclage for Advanced Cervical Incompetence / 대한산부인과학회잡지

Emergency cerclage commonly known as that performed in the setting of advanced cervical dilatation with bulging membranes and associated with significantly increased failure rates. We experienced a successful emergency cerclage for advanced incompetent internal os of cervix ( IIOC ). Pregnancy was prolonged and we delivered viable fetus. Hereby we report this case with the brief review of literature.

4 Cases of Pelvic Actinomycoses / 대한산부인과학회잡지

Actinomycoces is a gram positive, anaerobic, branching and non-acid fast bacterium which is a normal habitant of the skin, oral cavity, tonsil and gastrointestinal tract and its human infection is rare. Pelvic actinomycoses is frequently caused by Actinomycoces israel-ii. It is chronic, progressive, and more suppurative than granulomatous disease, and the symptoms are usually persistent and gradual, therefore the misdiagnosis and improper trea-tment are not uncommon. Actinomycoses is generally classified as cervicofacial, abdominal and thoracic type ac- cording to the site of the primary infection. Many actinomycotic pelvic infections in women used intrauterine device with long du- ration were reported, in contrast, others suggest that actinomycoces developed opportunistic infection irrespective of intrauterine device presence. We have experienced 4 cases of pelvic actinomycoses, one case with IUD(Lippes' loop) in a 47 year old woman, the other case with abdominal wall ctinomycoses in a 34 year old woman, the third case without IUD in a 41 year old woman, the fourth case with IUD(Cu-7) in a 37 year old woman and reported them with a review of literature.