Pelvic actinomycosis associated with bilateral hydronephrosis developed in a nulligravida woman / 대한산부인과학회지

Pelvic actinomycosis is well-known to be associated with the longstanding use of intrauterine devices, sometimes related with a pregnancy history and an obstetric and/or gynecologic surgery. It can extend to the retroperitoneum and may also be associated with ureteral obstruction. In this case, pelvic actinomycosis in the form of bilateral tubo-ovarian abscess extending to the retroperitoneum resulting in bilateral hydronephrosis occurred in a nulligravida woman who had only few prior sexual intercourses. Apparently, pelvic actinomycosis can occur without any specific history. Moreover, such could possibly give rise to hydronephrosis by direct extension to the retroperitoneum.

Analysis of residual tumor based on pathologic severity and site of positive margin after cold-knife conization of the uterine cervix / 대한산부인과학회지

OBJECTIVE: To evaluate correlation of sites of positive margin and residual tumor and to establish management after conization. METHODS: Of 599 cold-knife conizations [15 (2.6%) with cervical intraepithelial neoplasia (CIN) I, 37 (6.1%) with CIN II, 450 (75.1%) with CIN III, 97 (16.2%) with microinvasion] performed at our institution from January, 1993 to June, 2006, 144 patients (24.0%) had positive margins and 113 patients were included in the retrospective study excluding 31 cases that were not followed more than 12 months. Correlation of conization pathology and residual tumor according to sites of positive margin were evaluated. RESULTS: The prevalence rates of positive margins were 6.7% (1/15) in CIN I, 21.6% (8/37) in CIN II, 21.1% (95/450) in CIN III, and 41.2% (40/97) in microinvasion. The prevalence rate of positive margin increased with severity of conization pathology (P=0.0001). Of 113 patients followed more than 12 months, 27.4% (31/113) had residual tumor [0.0% (0/1) in CIN I, 12.5% (1/8) in CIN II, 18.9% (14/74) in CIN III, and 53.3% (16/30) in microinvasion]. The prevalence rate of residual tumor increased with severity of conization pathology (P=0.0028). Residual tumor was more common in patients in whom both endocervical and exocervical margins or in whom only the endocervical margin were involved than in those in whom only exocervical margin was involved [87.5% (7/8) or 35.3% (24/68) versus 0% (0/37), respectively]. CONCLUSIONS: Expectant management is reasonable for patients with positive margin after conization. However, careful follow-up of these patients is essential, particularly in endocervical involvement.

Expression of Survivin in extrapelvic endometriosis / 대한산부인과학회지

OBJECTIVE: To examine survivin expression in extrapelvic endometriosis. METHODS: The study group consisted of 14 cases with extrapelvic endometriosis which were confirmed histologically. The control group (total, n=47) was divided into 2 groups. Group I included normal endometrium (n=34) obtained from hysterectomy specimens with myoma and without endometriosis. Group II included ovarian endometrioma (n=13) obtained from laparoscopy. Expression of survivin was immunohistochemically confirmed. RESULTS: In extrapelvic endometriosis, the expression of nucleus in glandular epithelium and stromal cells were significantly stronger than normal endometrium. But cytoplasm expression of glandular epithelial cells and stromal cells in extrapelvic endometriosis showed statistically lower in comparison with normal endometrium. In ovarian endometrioma, the expression of nucleus in glandular epithelial cells and stromal cells was significantly stronger than normal endometrium. But the expression of nucleus in glandular epithelial cells with ovarian endometrioma was stronger than during proliferative phase but was not significant. Also cytoplasm expression of ovarian endometrioma was lower than normal endometrium. There was no difference in survivin expression between extrapelvic endometriosis and ovarian endometrioma. CONCLUSIONS: In extrapelvic endometriosis, survivin expression was stronger than normal endometrium except cytoplasm. Our findings suggest that increased survivin expression may contribute to survival of extrapelvic implants.

Chylous ascites, following radical hysterectomy with pelvic lymph node dissection in a patient with cervical cancer / 대한산부인과학회지

Chylous ascites is a disorder caused by various diseases and conditions that interfere with the abdominal or retroperitoneal lymphatics. There are several gynecologic reports on chylous ascites with radiation therapy and para-aortic lymph node dissection. However, the report of chylous ascites caused by performing only pelvic lymph node dissection was extremely rare. In most cases after surgical trauma, it is resolved after dietary managements but it may be associated with serious nutritional and immunologic consequences due to the constant loss of protein and lymphocytes. The authors experienced a 42-year-old woman with cervical cancer Ib1 who presented with chylous ascites after a radical hysterectomy and bilateral pelvic lymph node dissection. She was successfully managed by fasting and low fat diet. We report this case of chylous ascites following pelvic lymph node dissection with a brief review of literature.

LEEP conization: Risk factors of positive margin / 대한산부인과학회지

OBJECTIVE: Conization is the popular procedure to diagnose or treat in most cases of cervical intraepithelial neoplasia (CIN) and some cases of early cervical cancer. Many reports show the conservative management of positive margin is reasonable. Nevertheless, it is generally accepted the positive margin of conization is the major cause of being received additional operation such as hysterectomy. The aim of this study is to evaluate the risk factors of positive margin. PATIENTS AND METHODS: 283 CIN or early cervical cancer women who underwent conization were enrolled this study. We evaluated many possible risk factors for positive margin, including age, weight, height, body mass index (BMI), gravity, parity, abortion, severity of disease, glandular involvement, and human papillomavirus (HPV) infection. RESULTS: Of the 283 patients, 80 (28.2%) had positive margin in their conization specimens. Statistical significant risk factors of positive margin included older age (P(trend) < 0.001), higher BMI (P(trend) = 0.036), more severity of disease (P(trend) < 0.001), and involvement of endocervical gland (OR = 2.5, 95% CI 1.5-4.2). Parity (P(trend) = 0.054) showed statistically marginal significance. Weight (P(trend) = 0.154), height (P(trend) = 0.456), gravity (P(trend) = 0.194), abortion (P(trend) = 0.813), and HPV infection (OR = 1.2, 95% CI 0.5-2.5) were not statistically significant risk factors. CONCLUSIONS: The data of present study demonstrated that older age, high BMI, and higher pathologic diagnosis are statistical risk factors of positive margin we can know preoperatively.

Group B Streptococcal Colonization Rate in Korean Pregnant Women / 대한산부인과학회지

OBJECTIVE: To evaluate the colonization rate of the group B streptococcus (GBS) in Korean pregnant women and their neonates, and the antimicrobial susceptibility of isolated GBS. METHODS: From March 2005 to May 2005, pregnant women who visited 3 obstetric clinics in Goyang-si and Paju-si for antenatal care after 35 weeks of gestation were enrolled. According to Centers for Disease Control and Prevention (CDC) guideline for collecting and processing clinical specimens for group B streptococcal culture, specimens were obtained from the lower third of the vagina and perianal areas, and then inoculated on Todd-Hewitt broth. The test for antimicrobial susceptibility was performed by a disc diffusion method. RESULTS: Of the 273 pregnant women, 13 (4.8%) had a positive culture from at least 1 site (vaginal culture 6, perianal culture 3, both 4). No GBS colonization was found in their neonates. The antibiotic resistance rate was 53.9% (7/13) for erythromycin and 61.5% (8/13) for clindamycin. CONCLUSION: In this study, the colonization rate of group B streptococci in Korean pregnant women was found to be lower than those reported in USA, Western Europe, and other Asian countries. The antibiotic resistance rate for erythromycin and clindamycin was higher than those reported in other countries. Further evaluation was needed to establish the screening and chemoprophylaxis guideline for Korean pregnant women.

A case of solitary fibrous tumor arising from the vagina / 부인종양

Solitary fibrous tumor (SFT) arising from the vagina is a very rare benign stromal tumor, which has a well-demarcated margin and proliferation of spindle cells with the absence of any atypical features. Immunohistochemically, the cells are strongly positive for CD34. Surgical resection of the tumor is recommended as a definite treatment. Clinical courses of SFT are almost benign but long-term follow-up of SFT of the vagina have not been reported yet. We have experienced a case of solitary fibrous tumor arising from the vagina and report this case with a brief of literature.

Ovarian Pregnancy: Two Cases Report / 대한산부인과학회지

Ovarian pregnancy is an uncommon variant of ectopic pregnancy. Spiegelberg's criteria should be fulfilled for the diagnosis of ovarian pregnancy. The reported incidence is 0.5-3% of all ectopic pregnancies. The reported frequency of ovarian pregnancies remained stable. It seems that the frequency is underestimated because some of the suspected tubal pregnancies treated conservatively with methotrexate, without laparoscopic validation, are in fact early ovarian pregnancy. The improvements in ultrasonography, methods for hCG detection, and operative laparoscopy have led to earlier and more accurate diagnosis of ovarian pregnancies. The therapy of ovarian pregnancy is surgical in the first place, and medical treatment with systemic or local methotrexate injection can be applicable after confirming diagnosis of ovarian pregnancy by laparoscopy, in women in a stable condition. Two cases of histologically proven primary ovarian pregnancy are presented with brief review of literature.

Survivin and Bcl-2 expression in eutopic endometrium with and without endometriosis / 대한산부인과학회지

OBJECTIVE: To examine expression of survivin and Bcl-2 in eutopic endometrium with endometriosis and without endometriosis by immunohistochemical stain. METHODS: Expression of survivin and Bcl-2 was immunohistochemically investigated in eutopic endometrium with endometriosis (n=30, study group I; laparoscopy-proved endometriosis, study group II; adenomyosis) or without endometriosis (n=34, control group). The score of immunohistochemical staining was evaluated semi-quantitative method modified by Sinicrope and Lu. Statistical analyses was carried out using one-way ANOVA with Turkey test. RESULTS: Survivin expression was significantly higher in nucleus of glandular epithelium of eutopic endometrium with endomtriosis compared to that without endometriosis (p<0.05). Increased expression of Bcl-2 was found in glandular epithelium of eutopic endometrium with endometriosis than without endometriosis, but there was no significantly difference. CONCLUSION: Our findings suggest that increased survivin expression may contribute to survival of endometriosis. Moreover, survivin could play an important role in pathogenesis of endometriosis.

4 Cases of pelvic actinomycosis associated with intrauterine contraceptive device / 대한산부인과학회지

Pelvic actinomycosis is a rare chronic anaerobic infectious disease, which occurs most commonly in association with an IUD. It is difficult to diagnose the disease initially. In most cases, the diagnosis is made postoperatively because of its diverse clinical manifestations and courses. Besides it is frequently misdiagnosed as pelvic malignancy or endometriosis. If physician has a full understand to these characteristics of pelvic actinomycosis, the use of preoperative antibiotics can reduce the risk of pelvic structure injuries and then a patient can be saved from an extensive surgical procedure. We experienced four cases of pelvic actinomycosis complicated by tubo-ovarian abscess in women wearing IUD and report it with a brief review. In three cases, it was helpful that preoperative intravenous antibiotics therapy.

Increased Proliferating Activity of Endometrium in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: We investigated the expression of Ki-67, NF-kappa B, and COX-2 in endometrial tissue, and the incidence of polyps by hysteroscopic biopsy with or without endometriosis. METHODS: The study group was 92 patients with endometriosis and the control group was 90 patients without endometriosis. The subjects were 20 samples. The 10 samples consisted of eutopic endometrium with endometriosis. The control subjects were 10 samples of normal endometrium. Expression of Ki-67, NF-kappa B, and COX-2 was immunohistochemically investigated by polyclonal antibody. RESULTS: Endometrial polyps were found in 53 of 92 (57.6%) women with endometriosis but only in 15 of 90 (16.7%) women without endometriosis. High expression of Ki-67 was shown in eutopic endometrium with endometriosis. The expression of NF-kappa B and COX-2 was increased in eutopic endometrium with endometriosis, but normal endometrium showed lower expression. CONCLUSION: The increase of endometrial polyps and hyperexpression of NF-kappa B, COX-2, Ki-67 could explain that proliferation activity of eutopic endometrium with endometriosis is increased.

A case of mixed type large cell neuroendocrine carcinoma of the uterine cervix / 대한산부인과학회잡지

Neuroendocrine carcinomas of the uterine cervix are very rare cervical neoplasms. It has frequent distant metastasis at diagnosis and high recurrent rate against multimodality therapies such as surgery, chemotherapy and radiation therapy. In 1997, four categories of endocrine tumors of uterine cervix were recommended by the Cancer Committee of the College of American Pathologists and the National Cancer Institute. It has been suggested that infection of human papillomavirus and molecular biologic abnormalities in genomic level are causes of this disease. Although a lot of studies about this disease concerning therapies and prognostic factors have been reported, there is no standard therapeutic regimens because of low incidence and difficulties of histologic diagnosis, so further studies about this issues are required. We report a case of large cell neuroendocrine uterine cervical carcinoma treated with chemotherapy followed by surgery.

Effects of Coculture of Vero Cells on the Development of Frozen-thawed Two-cell Stage ICR Mouse Embryos / 대한산부인과학회잡지

OBJECTIVE: The rate of developmental progression of frozen-thawed embryos is lower than that of nonfrozen embryos in mice, cows, humans and other mammalians. This study was designed and performed to evaluate the beneficial effects of coculture of Vero cells on the development of frozen-thawed two-cell stage embryos of ICR strain mice. MATERIASL AND METHODS: The late two-cell stage mouse embryos were obtained from oviducts of 5~6 week old mated ICR mice superovulated with pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). Two-cell stage mouse embryos were frozen slowly with 1,2-propanediol and sucrose as cryoprotectants and thawed rapidly, followed by stepwise dilution. The frozen-thawed embryos were cultured in Ham's F-10+10% Fetal Bovine Serum (FBS) basal culture medium with and without Vero cells. The rates of development in both groups were compared every 24 hours for 5 days. RESULTS: Vero cells did not significantly stimulate the rate of embryonal development compared to controls at 24 hours after culture, 124 (69.3%) and 68 (61.3%), respectively (p=0.161). On day 4, however, 55 (30.7%) cocultured embryos had developed to expanded-hatching blastocysts, which was the significantly higher number than that of the embryos in controls: 16 (14.4%) (p=0.002). In addition, more embryos in coculture developed to hatching-hatched blastocysts (43[24.0%]) compared to the controls (10[9.0%]) (p=0.001). CONCLUSION: Coculture of cryopreserved embryos after thawing with Vero cells seems to be an useful tool to remove the postthaw deleterious effects of freezing and to obtain better quality embryos appropriate for transfer. These beneficial effects of Vero cell coculture appear to become more prominent as the embryonic development progresses over time.

Vero Cell Co-culture Counteracts the Detrimental Effects of Hydrosalpinx Fluid on the Development of Mouse Embryos in vitro

Recent studies have suggested that the hydrosalpinx has a negative effect on pregnancy outcome, with markedly diminished implantation and increased early pregnancy loss. Fluid from the hydrosalpinx may leak into and accumulate in the uterine cavity. It is not clear, however if this creates a hostile local environment in the uterus for embryo implantation or exerts a direct embryotoxic effect. This study was conducted to investigate the detrimental effects of hydrosalpinx fluid (HSF) on the development of mouse embryos in vitro and to demonstrate whether Vero cells overcome these adverse effects. HSF was collected from three women with bilateral hydrosalpinx at the time of laparoscopic surgery. Collected fluid was centrifuged and the supernatant was frozen at -20degrees C. For co-culture, Vero cells were commercially obtained in a frozen state and cultured using Ham's F10 medium. Single-cell mouse embryos (B6CBAF1) were cultured for 5 days in 0, 0.4, 0.8, and 1.2% of HSF in media with and without Vero cells and examined daily to record the number of embryos reaching expanded blastocyst and hatching stage. Co-culture of mouse embryos with Vero cells at 0.8% HSF concentration significantly enhanced embryo development, but not at 1.2% hydrosalpinx fluid concentration. These results suggest that HSF is highly embryotoxic and Vero cells are likely to overcome these detrimental effects to some degree.