Single-port laparoscopic debulking surgery of variant benign metastatic leiomyomatosis with simultaneous lymphatic spreading and intraperitoneal seeding

Benign metastatic leiomyomatosis (BML) is a rare disease characterized by smooth muscle cell proliferation in extrauterine sites including the lung, abdomen, pelvis, and retroperitoneum. Depending on location, BML is classified as intravenous leiomyomatosis and diffuse peritoneal leiomyomatosis. Pathogenesis of BML can be iatrogenic after previous myomectomy or hysterectomy, hormonal, or coelomic metaplasia. Treatment options are observation, hormonal suppression, and/or surgical debulking via laparotomy or laparoscopy. Laparoscopic surgery is gaining in popularity in the gynecologic field compared to laparotomic surgery and single-port laparoscopy has the benefits of cosmesis and early tissue extraction by transumbilical morcellation. We report a 39-year-old woman with BML who underwent single-port laparoscopy debulking surgery.

Two cases of immature teratoma / 대한산부인과학회지

About 20~30% of benign or malignant tumors of ovarian origin arise from embryonic cells, and only 3% represent malignancy. But under age of 20, 70% of ovarian tumors arise from embryonic cells, and over 1/3 of them are malignant tumors. Over all the ovarian tumors arising from embryonic cells, immature teratoma is germ cell tumor, components include immature tissues and cells derived from ectoderm, mesoderm, and endomermal origins. Most of the immature tissues are from neuroectodermal origins. The immature teratoma of the ovary is a rare tumor, representing less than 1% of all ovarian neoplasm. These tumors typically present in young age woman (mean age 10~20 years) with pelvic and abdominal pain. Nowadays newly developed combination chemotherapeutic agents such as bleomycin, etoposide, cisplatin give us great survival and disease free prognosis than before. We have experienced two cases of immature teratoma so we report them with a brief review of concerned literatures.

Follicular stimulating hormone enhances Notch 1 expression in SK-OV-3 ovarian cancer cells / 부인종양

OBJECTIVE: Notch is known as a transmembranous receptor family with four homologous forms - Notch 1, Notch 2, Notch 3, and Notch 4 and related to cell fate regulation and angiogenesis. The purpose is to investigate the effect of follicular stimulating hormone (FSH) on the Notch 1 expression and proliferation in ovarian cancer cells. METHODS: Human ovarian cancer cell line, SK-OV-3 and FSH were used. XTT cell proliferation and cell migration assay were carried out with FSH 100 mIU/mL and Notch 1 siRNA. Western blots and reverse transcriptase-polymerase chain reactions (RT-PCR) were carried out to determine the expression level of the Notch 1 protein and mRNA with FSH treatment in 0, 1, 5, 10, 100, 200, 300 mIU/mL concentrations. Immunofluorescent (IF) stains were performed in SK-OV-3 cell cultures with FSH 100 mIU/mL. Student-t tests were used in statistical analyses. RESULTS: The SK-OV-3 have Notch 1 receptors in their natural status. FSH stimulated SK-OV-3 cells in XTT cell proliferation and cell migration assays and notch 1 siRNA inhibited. The expression level of Notch 1 protein and mRNA were increased in a dose dependent pattern according to FSH concentrations compared to untreated cells. IF stains also showed brighter Notch1 expressions in the FSH treated cells compared to the control cells. CONCLUSION: FSH enhances proliferation & migration and Notch 1 signaling in SK-OV-3 cells. The Notch signaling probably supports one of the cell proliferating mechanisms of FSH in ovarian cancer cells.

A case of pelvic actinomyosis presenting as an advanced ovarian malignancy / 대한산부인과학회지

Pelvic actinomycosis is an infrequent chronic suppurative granulomatous disease, caused by a gram-positive bands Actinomyces israelii. It is often reported as a complicated case of an intrauterine device (IUD). Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. Sometimes pelvic actinomyosis is simulating ovarian malignancy. We report a case combined with hydronephrosis, multiple pelvic lymph nodes enlargements and elevated CA 125 as complications of pelvic actinomycosis.

A case of pelvic actinomyosis presenting as an advanced ovarian malignancy / 대한산부인과학회지

Pelvic actinomycosis is an infrequent chronic suppurative granulomatous disease, caused by a gram-positive bands Actinomyces israelii. It is often reported as a complicated case of an intrauterine device (IUD). Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. Sometimes pelvic actinomyosis is simulating ovarian malignancy. We report a case combined with hydronephrosis, multiple pelvic lymph nodes enlargements and elevated CA 125 as complications of pelvic actinomycosis.

A case of lymphangioleiomyomatosis originated in the pelvic cavity / 부인종양

Lymphangioleiomyomatosis is a rare disease that is characterized by proliferation of abnormal smooth muscle-like cells, especially that which occurs in the pulmonary parenchyme. It primarily affects women of child-bearing age. The majority of primary lymphangioleiomyomatosis occurs in the lung, but there are a few reports of extrapulmonary cases. We experienced a rare case of lymphangioleiomyomatosis which originated in the pelvic cavity (in the posterior portion of the uterus), and report with brief review of literatures.

Solitary mesenteric recurrence of ovarian cancer / 대한산부인과학회지

In epithelial ovarian cancer, solitary metastasis to mesentary is rare in the absence of apparent disease in other sites. We experienced one patient who developed isolated, solitary mesenteric metastasis of epithelial ovarian adenocarcinoma and underwent segmental resection of small bowel including mesentary to remove the recurrent disease. Rising CA125 heralded the recurrence and the patient was subsequently documented by computed tomography (CT) and PET-CT of the abdomen and pelvis with a high signal density noted only in the mesentery. There was no major postoperative complicathion. Solitary recurrence of epithelial ovarian cancer can occur in the absence of other demomstrable metastasis, so we report with brief review of literature.

The value of sentinel node HPV status for prediction of lymphnode metastasis and recurrence in cervical cancer patients / 부인종양

OBJECTIVE: The "sentinel node" is defined as the first lymph node encountered by lymphatic vessels draining a tumor. We tried to examine whether pathologic status of sentinel nodes of cervical cancer patients represent metastatic status of pelvic and paraaortic lymph nodes and to investigate the correlation between sentinel node HPV status and lymph node metastasis and recurrence of cervical cancer patients. METHODS: From August 2001 to December 2003, 57 patients affected by stage IB-IIA cervical cancer had sentinel node biopsies performed during radical hysterectomy and pelvic and paraaortic lymphadenectomy. We performed sentinel lymph node pathologic examination by frozen section and HPV typing by oligonucleotide microarray. After two years of follow up, we analyzed the prognosis of patients. RESULTS: Sentinel nodes were identified in all of our patients. A total of 79 nodes were detected as sentinel nodes. Metastasis in the sentinel nodes were found in 10 patients by frozen section and 11 patients by permanent pathologic examination. The results of sentinel lymph node frozen biopsy were statistically significant for predicting the metastatic status of the pelvic lymph nodes (p<0.05), but showed one false negative case. HPV DNA was detected in the cervices of 55 patients (96.5%), 44 (80.0%) of whom were found to have HPV DNA in the sentinel nodes. HPV DNA was detected in sentinel nodes of 10 patients among 11 patients with lymph node metastases. After mean follow up of 31.7 months (range; 1-48), disease recurred in five patients and all of these patients showed HPV in sentinel nodes. Combination of sentinel node frozen biopsy and HPV typing showed negative predictive value of 100% in predicting lymph node metastasis and recurrence. CONCLUSION: Our result suggests the possibility that sentinel node HPV typing would play a supportive role to reduce false negative rate of sentinel node biopsy. Additional study will be needed to confirm the clinical application of sentinel lymph procedure and to reveal correlation between HPV status of sentinel nodes and lymph node metastasis and recurrence of cervical cancer patients.

A Case of maternal metastatic Brain Tumor was detected in Midtrimester / 대한산부인과학회지

Hyperemesis gravidarum is a complication defined as nausea and vomiting during early pregnancy. Atypical hyperemesis syndrome is caused any other problems. Specially, brain tumors is confused hyperemetic symptom in pregnancy. In this case vomiting and mild headache were the only signs. Atypical hyperemesis syndrome is recommand MRI image study for detection of neurologic problem. Following the diagnosis of a brain tumor during pregnancy and management should be tailored to the individual patient. It must be considered to maternal state and fetal maturation. To minimize cerebral herniation in neurologically unstable patient, a consideration should be made for cesarean section delivery with patient under general anesthesia.

A Case of Synchronous Existence of Endometrial cancer and Cervical cancer / 대한산부인과학회지

The synchronous existence of endometrial cancer and cervical cancer is very rare. The reported frequency of concurrent gynecologic neoplasms has ranged from 0.7% to 4.3%, synchronous primary tumors of the female genital tract are relatively rare, comprising only 0.49% to 1.7% of all genital neoplasms. The majority of synchronous multiple primary neoplasm of female reproductive tract are of endometrial and ovarian origin. Multiple primary neoplams involving uterine cervix and endometrium were regarded as rare entity. We experienced a rare case of multiple primary neoplasm involving uterine cervix and endometrium and report with brief review of literatures.

A Case of Vaginal Bleeding after Cesarean Section due to Arteriovenous Malformation (AVM) of Uterus / 대한주산의학회잡지

Uterine arteriovenous malformations are very rare but potentially life threatening lesions. These lesions may be congenital or acquired, but especially occur in patients with a history of curettage, abortion or pregnancy. Color doppler ultrasonography is the preferred method of diagnosing of arteriovenous malformations. In many cases, hysterectomies are performed. But if patients want pregnancies, embolization therapy and conservative treatment are effective therapy. We have experienced a clinical case of uterine arteriovenous malformation, which is presented with a brief review of literature.

A case of retroperitoneal huge smooth muscle tumor misleading to ovarian cancer / 부인종양

Smooth muscle tumors are very common tumors in the uterus and related adjacent structures but occur rarely in the retroperitoneum. Traditionally, most retroperitoneal smooth muscle tumor are believed to be malignant. But well-differentiated smooth muscle tumors with lack of atypia, necrosis, and significant mitotic activity appear to have a benign behaviors. Laparotomy revealed a huge solid tumor in the retroperitoneal space, about 50 cm in diameter, and histologically diagnosed as a smooth muscle tumor of uncertain malignant potential (STUMP). We report a case of primary retroperitoneal smooth muscle tumor with a brief review of literatures.

The Effect of V-Y Advancement Flap after Vulvectomy in Patients with Vulvar Cancer / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the clinical effect of V-Y advancement flap after vulvectomy in patients with vulvar cancer. Local and systemic morbidity, the degree of satisfaction after operation, length of hospital stay were evaluated. PATIENTS AND METHODS: From March 2001 to september 2002, five patients with invasive vulvar cancer were eligible for this study. All the patients underwent radical vulvectomy with groin lymph nodes dissection. All of them were reconstructed by the same surgeon using ischial fasciocutaneous V-Y flaps based on perforators from the inferior border of the gluteous maximus muscle. RESULTS: Flap survival was 100%. There were no major complication including wound infection, wound disruption, urinary tract infection, and seroma in the femoral triangle. Functional outcome was excellent in all patients. CONCLUSION: The V-Y advancement flap provides a straight-forward and simple safe reliable method as a common approach in radical vulvectomy.

Two Cases of Vulvar Malignant Melanoma / 대한산부인과학회잡지

Malignant melanoma may show a predisposition for vulvar skin. Although 37% of all melanomas in women affect the vulva, the skin in this area accounts for only 12% of the total surface area of body. Malignant melanoma of the vulva presented as polypoid tumours in 35% of patients. The most common sites of disease were the clitoral area and the labia majora, which accounted for more than 60% of all lesions. Only 15% of tumours were located primarily in hair-bearing areas. Two women who were diagnosed vulvar melanoma in Uijongbu St. Mary's Hospital were evaluated. We reviewed their medical records. One woman underwent the radical vulvectomy with bilateral inguinal and femoral lymph node dissection, and the other underwent wide local excision with both inguinal lymph nodes dissection. We experienced 2 cases of vulvar melanoma, so we report it with a brief review of literature.

Anaphylactic Reaction after an Intracervical Injection of Isosulfan Blue Dye: A case report / 대한마취과학회지

Isosulfan blue dye can be used to mark the sentinel lymph node during various surgeries. The dye was known to have minimal side effects, but recently a few cases of an anaphylactic reaction were reported in melanoma and breast surgery. We experienced an anaphylactic reaction during peritumoral injection of this dye in a patient with cervical cancer. Immediately after dye injection, the patient showed an anaphylactic reaction with cardiovascular collapse and oxygen desaturation. We resuscitated the patient and she recovered without complications.

A Case of Anaphylactic Reactions to Isosulfan Blue Dye in A Cervical Cancer Patient / 대한산부인과학회잡지

The sentinel lymph node is defined as the first node of a regional lymphatic basin that receives the lymphatic drainage from a tumor, thus representing an elective site of lymph node metastasis. According to the sentinel lymph node hypothesis, histologically negative sentinel lymph nodes can guarantee the histological negativity of the remaining regional lymph nodes. These assumptions suggest that the sentinel node can be a suitable marker of regional lymph node status. Thus sentinel node biopsy may be a reasonable alternative to unnecessary pelvic lymph nodes dissection and a suitable method for limited control of early stage cervical cancer. To improve the sentinel node detection in surgical procedures, we investigated lymphatic mapping of sentinel lymph nodes with isosulfan blue dye (lymphazur 1%) and technetium-99m colloid albumin. We have made it a rule to inject 5 ml of isosulfan blue dye in the peritumoral area of cervix. It is reported that isosulfan blue dye has been safe and easily used in the detection of sentinel lymph node in melanoma, breast cancer and vulvar cancer. We experienced a case of anaphylactic reactions to isosulfan blue dye in cervical cancer patient, so we report it with a brief review of literature.

Sentinel Node Biopsy as an Indicator for Pelvic Nodes Dissection in Early Stage Cervical Cancer

The purpose of this study was to investigate the feasibility of sentinel node frozen biopsy to minimize the extensive pelvic lymph nodes dissection in early stage cervical cancer patients on the basis that the risk of skip metastasis to the paraaortic area is negligible. Twenty-six patients with early stage cervical cancer were enrolled in this study. Technetium-99m colloid albumin (Tc(99m)) was injected intradermally around the tumor for allowing preoperative lymphoscintigraphy and intraoperative hand-held gama probe detection of seninel nodes. For visual detection, isosulfan blue dye was injected into the peritumoral sites before peritoneal opening. Postoperative morbidity and negative predictive value were the endpoints of this study. The 26 patients, ranging in age from 32 to 71 yr, underwent intraoperative sentinel nodes mapping. All the patients underwent complete pelvic lymph nodes dissection including para-aortic nodes. There was one case with positive non-sentinel nodes despite the negative sentinel node by frozen biopsy (negative predictive value, 95.2%). This new technique of sentinel node mapping is safe and simple to perform. Further clinical trials using the combination of Tc(99m) and isosulfan blue dye are warranted and this technique will make a true advance for less aggressive management of patients with early stage cervical cancer.

Clinical Study of Tuberculous Peritonitis / 대한산부인과학회잡지

OBJECTIVE: The aim of this study is to evaluate the clinicopathologic characteristics of tuberculous peritontitis from calcinomatosis peritonei. METHODS: From July 1994 to May 2002, fifteen women who were diagnosed tuberculous peritonitis in Kangnam St. Mary's Hospital were analyzed. We reviewed their medical records. RESULTS: A total of 15 patients eventually diagnosed by pathological or bacteriological method were reveiwed. Five patients were taken explorative lapartomy and biopsy. Eight patiets were taken laparoscopy and biopsy. One patient shows M. tubcerculous only cutured in ascites. One patient with cervical lyhphadenopathy shows chronic granuloma on cervical lymph node. CONCLUSION: Tuberculous peritonitis needs differential diagnosis with ovarian cancer because of its vague symptoms as ascites, abdominal pain and fever. Since there is no specific and sensitive method, at present, an explorative laparotomy or pelviscopic surgery can be alternatives for differetial diagnosis between tuberculous peritonitis and ovarian cancer.

Treatment of Low Grade Endometrial Stromal Sarcoma / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to obtain information on the prognosis and treatment of the low grade endometrial stromal sarcoma. PATIENTS AND METHODS: Three patients with low grade endometrial stromal sarcoma treated in kangnam St. Mary's hospital between 1993 and 2002 were evaluated. The clinical stage, management and outcome were analyzed. RESULTS: Those patients with low grade endometrial stromal sarcoma had a long overall survival in the presence of receiving hormonal therapy after initial surgery. Two are alive with disease-free status, one has shown a partial response to hormonal treatment. CONCLUSION: Surgery is the primary treatment for low grade endometrial stromal sarcoma. High dose hormonal replacement as adjuvant therapy will be associated with a lengthened overall survival in patients with low grade endometrial stromal sarcoma.

A case of minimal deviation adenocarcinoma originated from uterine endocervix / 대한산부인과학회잡지

Minimal deviation adenocarcinoma (adenoma malignum) is a variant of adenocarcinoma and is expressed from uterine endocervix. As a result of ever reported cases in the world, it is rare enough to occur in 1 to 2% of invasive cervical adenocarcinoma. Minimal deviation adenocarcinoma is well-differentiated form of adenocarcinoma in which the cytoplasmic mucin is rich and the glandular pattern simulates that of normal endocervical glands. Because of this, the tumor may not be recognized as malignant in small specimens, thereby causing delay in diagnosis. But recent studies have found a favorable prognosis if the disease is detected early. We experienced a case of minimal deviation adenocarcinoma, rare disease in the world, so we report with a brief review of literature.