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.

Uterine prolapse in a primigravid woman

Uterine prolapse during pregnancy is an uncommon condition. It can cause preterm labor, spontaneous abortion, fetal demise, maternal urinary complication, maternal sepsis and death. We report the case of uterine prolapse in a 32-year-old healthy primigravid woman. She had no risk factors associated with uterine prolapse. She was conservatively treated, resulting in a successful vaginal delivery. This report is a very rare case of uterine prolapse in a young healthy primigravid woman, resulting in a successful vaginal delivery.

A live birth after spontaneous complete chorioamniotic membrane separation associated with uterine scar

Spontaneous complete chorioamniotic membrane separation (CMS) without invasive fetal procedure is extremely rare and associated with adverse perinatal outcomes. A woman with complete CMS which was detected at the 21 weeks' gestation. She did not take any fetal invasive procedures before the diagnosis. At 27 weeks' gestation, an emergency Caesarean section was performed because of fetal distress. The defect of the uterine muscle was detected on the fundus. The baby has grown well without any morbidity. This is the first reported case of complete CMS relative to uterine scar. And we suggest that the pregnancy can be maintained successfully if there is no fetal abnormality when complete CMS is detected on ultrasound.

Abdominal Wall Metastasis of Uterine Papillary Serous Carcinoma in a Post-Menopausal Woman: A Case Report

Uterine papillary serous carcinoma (UPSC) is an aggressive form of endometrial cancer characterized by a high recurrence rate and poor prognosis. We report a case of a 58-year-old post-menopausal woman with an abdominal wall metastasis in stage IA UPSC. After surgical staging, she did not receive additional adjuvant therapy. An egg sized palpable mass developed in the right lower abdomen after 8 months. Both Abdominopelvic computed tomography (CT) and positron emission tomography (PET)-CT revealed a metastatic lesion in the abdominal wall. Hence, surgical excision was performed. The pathological findings showed metastatic UPSC with clear resection margin. After the diagnosis of UPSC metastasis in the abdominal wall, she received chemotherapy utilizing paclitaxel and carboplatin. After 3 years, no evidence of recurrence was found. Therefore, we suggest that even when UPSC is confined to the endometrium without lymph node metastasis and without lymphovascular invasion, chemotherapy should be considered as a postoperative adjuvant therapy.

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.

Transactivation of bad by vorinostat-induced acetylated p53 enhances doxorubicin-induced cytotoxicity in cervical cancer cells

Vorinostat (VOR) has been reported to enhance the cytotoxic effects of doxorubicin (DOX) with fewer side effects because of the lower DOX dosage in breast cancer cells. In this study, we investigated the novel mechanism underlying the synergistic cytotoxic effects of VOR and DOX co-treatment in cervical cancer cells HeLa, CaSki and SiHa cells. Co-treatment with VOR and DOX at marginal doses led to the induction of apoptosis through caspase-3 activation, poly (ADP-ribose) polymerase cleavage and DNA micronuclei. Notably, the synergistic growth inhibition induced by the co-treatment was attributed to the upregulation of the pro-apoptotic protein Bad, as the silencing of Bad expression using small interfering RNA (siRNA) abolished the phenomenon. As siRNA against p53 did not result in an increase in acetylated p53 and the consequent upregulation of Bad, the observed Bad upregulation was mediated by acetylated p53. Moreover, a chromatin immunoprecipitation analysis showed that the co-treatment of HeLa cells with VOR and DOX increased the recruitment of acetylated p53 to the bad promoter, with consequent bad transactivation. Conversely, C33A cervical cancer cells containing mutant p53 co-treated with VOR and DOX did not exhibit Bad upregulation, acetylated p53 induction or consequent synergistic growth inhibition. Together, the synergistic growth inhibition of cervical cancer cell lines induced by co-treatment with VOR and DOX can be attributed to the upregulation of Bad, which is induced by acetylated p53. These results show for the first time that the acetylation of p53, rather than histones, is a mechanism for the synergistic growth inhibition induced by VOR and DOX co-treatments.

Liver recurrence in early endometrial cancer with focal myometrial invasion

Endometrial cancer is the most common malignancy of the female genital tract. The cancer spreads by direct extension, transtubal dissemination, lymphatic dissemination, and/or by hematogenous spread, usually results in lung metastasis, but may less commonly involve liver, brain, and bone. Here, we describe a patient with stage IA endometrial cancer who developed liver recurrence 17 months after surgery.

H1 Magnetic Resonance Spectroscopy of Cystic Ovarian Lesions

On H1 MRS (magnetic resonance spectroscopy), malignant tumors show higher concentration of metabolite than benign lesions. Lactate double peak was detected in malignant tumor and endometriosis, and more prominent high concentration was demonstrated in endometriosis. Tuboovarian abscesses and salpingitis do not show prominent peak. Dermoid cysts show high levels of lipid peak. Paratubal cyst and follicular cyst can be showed the lipid peak, however, the concentration of lipid is lower than that of dermoid cyst. H1 MRS of ovarian cystic lesions can give valuable information about the presence of metabolites of ovarian cystic lesions.

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.

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.

E-cadherin expression and mutation in endometrial carcinomas and endometrial hyperplasias / 대한산부인과학회지

OBJECTIVE: Reduced tumor cell adhesion is associated with invasive growth and unfavorable prognosis. In endometrial carcinoma, the prognostic impact of adhesion marker such as E-cadherin is partly known. The purpose of this study is to investigate the correlation of the expression and the mutation of E-cadherin in endometrioid endometrial adenocarcinomas and endometrial hyperplasias and to correlate their results with various clinicopathological factors. METHODS: The expression of E-cadherin by using immunohistochemical staining (IHC) and the mutation of E-cadherin gene by using polymerase chain reaction-single stranded conformational polymorphism (PCR-SSCP) and sequencing were performed in tissues of 20 endometrial adenocarcinomas and 30 endometrial hyperplasias. The results were compared with previously known prognostic factors such as the stage, tumor grade and lymph node metastasis. RESULTS: Decreased expression of E-cadherin was detected in 13 of 30 (43.3%) endometrial carcinomas and in 1 of 20 (5%) endometrial hyperplasias (P=0.009). There was no statistical significance of the mutation of E-cadherin gene in between the endometrial carcinomas and endometrial hyperplasias (6.7%: 0%) (P=0.06). The incidence of the expression loss of E-cadherin in endometrial carcinomas also showed significantly higher with tumor grade 3, tumor stage above Ic or lymph nodal metastasis (P=0.01, P=0.02, P=0.03). CONCLUSION: Decreased expression of E-cadherin was detected significantly higher in endometrial carcinomas than endometrial hyperplasias. And the incidence of decreased expression of E-cadherin was more frequent in advanced stage, high histopathologic grade, and lymph nodal metasis. The mutation of E-cadherin gene was detected in only 2 cases. These results suggests that the expression of E-cadherin seems to be important in endometrial carcinomas and associated with aggressive subgroups. But the mutation of E-cadherin gene would not be related to endometrial carcinomas.

The analysis of the clinical results of total laparoscopic hysterectomy according to body mass index / 대한산부인과학회지

OBJECTIVE: To know impacts of BMI on clinical results of total laparoscopic hysterectomy (TLH). METHODS: We reviewed medical records of patients with myoma uteri who undergone TLH between March 2003 and February 2007, retrospectively. We classified group 1 when BMI was or =28. We reviewed age, parity, body weight and height, operation time, amount of blood loss, change of hemoglobin change and days of hospital stay, and analyze these. RESULTS: There were 83 patients (Group 1; 30, Group 2; 40, Group 3; 13). The body weight distributions of Group 1, 2, and 3 were 52.2, 60.9, and 72.0 kg and there were significant differences. But there was no difference of height distributions. The age distributions were 44.3, 47.0, 43.8 year old, and there were differences. But there was no difference of parity distribution. The weight distribution of removed uterus were 250.5, 257.4, 242.7 gm and there was no difference. The operation time distributions were 155.0, 168.2, 160.8 minutes, and there was no difference. The amount distributions of bleeding were 342.7, 356.5, 396.2 ml, and there was no difference. The change distributions of hemoglobin were 2.1, 1.8, 2.2 g/dL, and there was no difference. The day distributions of hospital stay were 5.2, 5.5, 4.8, and there was no difference. CONCLUSION: We could not find any trend between operation time, amount of bleeding, change of hemoglobin, and days of postoperative hospital stay after TLH with BMI.

A case of right rudimentary uterus with ipsilateral renal agenesis misdiagnosed as an ovarian tumor / 대한산부인과학회지

Rudimentary uterus with ipsilateral renal agenesis is a very rare Mullerian duct malformation. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An appropriate and prompt diagnosis and treatment will prevent unnecessary procedures and offer relief of symptoms. We report one case of rudimentary uterine horn with ipsilateral renal agenesis with a brief review of concerned literatures.

A case of perivascular epithelioid cell tumor (PEComa) at the uterus / 대한산부인과학회지

Perivascular epithelioid cell tumors (PEComas) at the uterus are very rare tumors and about 30 cases have been reported as far as we know. As a case was experienced at our hospital, we would like to report it with a brief review of literature.

Identification of CYP2C8 gene polymorphisms in Korean patients with epithelial ovarian cancer and their association with effect and toxicity of anticancer drug / 대한산부인과학회지

OBJECTIVE: The frequency of CYP2C8 gene polymorphisms in Korean patients with epithelial ovarian cancer was identified and their association with toxicity and effect of the anticancer drug according to haplotypes was analyzed. METHODS: DNA was extracted from 57 epithelial ovarian cancer patients between January 2004 and March 2005. Genetic variations that are three common SNPs (CYP2C8*1D; -411T>C, CYP2C8*1C; -370T>G and CYP2C8*1B; -271C>A) by direct sequence analysis from 57 Korean women with epithelial ovarian cancer were observed. 33 patients who received debulking surgery, were diagnosed over FIGO state III, serous ovarian cancer were enrolled and received paclitaxel based chemotherapy. Among 33 patients 21 chemo-sensitive patients and 12 resistant patients were analyzed. Using these SNPs, We constructed haplotypes and haplotype pairs. CYP2C8 genotypes according to the clinical characteristics were analyzed and evaluated. RESULTS: Genetic analysis revealed the common SNPs' allele frequencies of -411T>C, -370T>G, and -271C>A were 0.3, 0.44, and 0.1. Two common SNPs allele frequency was similar to the data in Korean population substantially, but CYP2C8*1C frequency was more frequent in epithelial ovarian cancer patients and especially in FIGO stage III. Disease free interval in CYP2C8*1C homologous group was longer than others. CONCLUSION: CYP2C8*1C SNPs were detected more frequently in epithelial ovarian cancer patients and especially in FIGO stage III patients. CYP2C8*1C homologous patients had more longer disease free interval than others.

Three Cases of Primary Ovarian Transitional Cell Carcinoma / 대한산부인과학회지

Primary ovarian transitional cell carcinoma (TCC) is extremely rare tumor and recently it has been recognized as one of histologic subtype of ovarian epithelial carcinoma. We experienced three cases at Inha University Hospital and report our experiences with a brief review of literature.

Clinical and histopathological studies on ovarian tumors / 대한산부인과학회지

OBJECTIVE: To know the clinical and histopathologic profiles of ovarian tumors. METHODS: 822 women undergone operations for their ovarian tumors were enrolled in this study from July of 1996 to June of 2004 at Inha University Hospital in S. Korea. Incidence, age, laterality and size were analyzed according to their histopathologic results. RESULTS: Among 822 women, there were 2.1% of non-neoplastic ovarian cysts, 81.0% of benign tumors, 4.4% of borderline tumors, and 12.5% of malignant tumors. Among benign tumors, 48.2 were cystic teratomas, 22.5% were mucinous, and 19.4% were serous tumors. Among borderline tumors, 52.8% were mucinous and 42.2% were serous. Among malignant tumors, 25.2% were serous and metastatic, respectively, and 18.4% were mucinous. The average and median age of non-neoplastic cysts were 39.1 +/- 12.7, 41 years old, those of benign tumors were 38.2 +/- 18.4, those of borderline tumors were 33.4 +/- 16.7, 28, and those of malignant tumors were 47.8 +/- 15.4, 49. The bilaterality of benign tumors was 10.7%, that of borderline were 16.7%, and that of malignant were 24.2%. The average and median diameter of non-neoplastic cysts were 3.2 +/- 1.4 cm, 3 cm, those of benign tumors were 8.1 +/- 4.3 cm, 7 cm, those of borderline tumors were 13.5 +/- 7.8 cm, 12 cm, and those of malignant tumors were 10.2 +/- 6.1 cm, 9.3 cm. CONCLUSION: We analyzed clinical and histopathologic data of 822 ovarian tumors.

The clinical analysis of hyperglycemic controls with four times daily administration of insulin on diabetes in pregnancy / 대한산부인과학회지

OBJECTIVE: To determine whether administrating insulin four times daily, compared to 1-3 times daily, improves maternal and perinatal outcomes of diabetes. METHODS: From August 1998 to April 2004, the 14 pregnant diabetic women were treated with four times daily administration of NPH and insulin-lispro and 15 pregnant diabetic women were treated with 1-3 times daily administration of Mixtard (30% RI, 70% NPH) or NPH. We compared the maternal and fetal complications between two groups. The goals for therapy are to achieve and maintain normoglycemia (premeal whole blood capillary glucose levels of less than 90 mg/dL and 1-hour after-meal levels of less than 120 mg/dL). RESULTS: The pregnant diabetic women who were treated with four times daily administration of NPH and Insulin lispro, instead of 1-3 times daily administration of Mixtard or NPH, resulted in better maternal and fetal outcome. But there was no significant difference between two groups statistically. CONCLUSION: This study reveals that this four times daily administration of NPH and insulin-lispro protocol achieved the glucose target level without maternal hypoglycemic events and helped to reduce the perinatal complications in pregnant diabetic women.

5 Cases of Granulosa Cell Tumors of the Ovary / 대한산부인과학회잡지

Sex cord stromal tumors (GCT) of the ovary compose just 5% of ovarian tumors. Most of them are granulosa cell tumors (GCT). There are two types of tumors, juvenile (JGCT) and adult type (AGCT), which have different clinical and histopathological features. JGCT represents only 5% of GCT. GCT is characterized by secretion of estrogen. Patients may present with vaginal bleeding in adult type, and sexual pseudoprecocity in juvenile type, as results of prolonged exposure to tumor-derived estrogen. Surgery is a principle of treatment and required for definite tissue diagnosis, staging, and tumor debulking. Survival of patients with GCT is generally excellent because most patients present with early stage disease. Because of the propensity of GCT to recur years after initial diagnosis, prolonged surveillance such as physical examination and serum tumor markers such as estradiol and inhibin is reasonable. We present 5 cases GCT, 4 AGCT and 1 JGCT, with brief review of literature.