Chylous vaginal discharge in a patient with lymphangioleiomyomatosis.

We present the case of a patient having chylous vaginal discharge, which may be a symptom of the secondary to an established diagnosis of the systemic disorder, lymphangioleiomyomatosis, a disease predominantly affecting women during their reproductive years. Lymphangioleiomyomatosis causes dyspnea, pneumothorax, chylous pleural effusions, and eventually respiratory failure.

Perforated colon volvulus coiling around the uterus in a pregnant woman with a history of severe constipation.

A case of intestinal volvulus in both the sigmoid colon and cecum in a pregnant woman suffering from severe constipation is reported herein. The fetus was dead and the mother developed acute shock. The twisted sigmoid colon coiled twice around the uterus and was perforated. The mother died 10 h after the onset of severe abdominal pain. Volvulus should be considered when examining severe abdominal pain in a pregnant woman with a history of severe constipation. Early suspicion together with prompt intervention will minimize maternal and fetal morbidity and mortality of this rare complication of pregnancy.

Mechanical ileus in a pregnant woman at term pregnancy accompanied by labor pains.

Intestinal obstruction in pregnancy is a rare, but serious complication of pregnancy with significant maternal and fetal mortality. We herein report a case of intestinal strangulation in a pregnant woman with a history of pelvic surgery due to an ectopic pregnancy. Epigastric pain occurred at term pregnancy with concomitant onset of labor pains. The epigastric pain disappeared transiently, and she gave a birth to a healthy child. However, the pain appeared again after the vaginal delivery. She immediately underwent ileo-ileostomy with a diagnosis of mechanical ileus, and the postoperative course was uneventful. Mechanical ileus should be considered when examining epigastric pain in a pregnant woman with a history of abdominal or pelvic surgery even after the onset of labor pains.

Preoperative plasma osteopontin level as a biomarker complementary to carbohydrate antigen 125 in predicting ovarian cancer.

AIM: New biomarkers other than carbohydrate antigen (CA) 125 are needed for the detection of ovarian cancer. Osteopontin (OPN) is one of the candidates identified by high-throughput complementary DNA microarray techniques. We evaluated the preoperative plasma OPN level as a diagnostic biomarker for ovarian cancer in comparison with CA125. METHODS: Preoperative plasma OPN and CA125 levels were measured and compared in 32 patients with ovarian cancer, 34 patients with benign ovarian tumor, 30 patients with other gynecologic cancers and 31 healthy women. Preoperative plasma OPN levels were also assessed according to tumor stage, the volume of ascites and histological types. The sensitivity and specificity for predicting ovarian cancer was compared between OPN and CA125. RESULTS: Preoperative plasma OPN levels were significantly higher in patients with ovarian cancer than in those with benign ovarian tumor, in other gynecologic patients or in healthy women. Stage IV ovarian cancer patients and ovarian cancer patients with ascites had higher plasma OPN levels than those without ascites and in a lower stage. There was no relation between OPN and the histological type. The sensitivity of preoperative plasma OPN in detecting ovarian cancer was 81.3% and almost reached that of CA125. The specificity was moderate. Sensitivity increased to 93.8% with the combination of CA125, compared to 84.4% with CA125 alone. CONCLUSION: Preoperative OPN is a useful biomarker for predicting ovarian cancer. It is especially useful when used complementary to CA125. Larger studies of patients with ovarian cancer showing a low CA125 level or in early stages of ovarian cancer are needed.

Metastasis of uterine leiomyosarcoma to the pancreas.

BACKGROUND: Metastasis of uterine leiomyosarcoma to the pancreas is extremely rare. CASE: A 46-year-old woman presented with hypermenorrhea and dysmenorrhea and underwent surgery. The histologic and immunohistochemical diagnosis was uterine leiomyosarcoma stage I with no metastasis to the ovaries or the pelvic lymph nodes. The mitotic count was very high. Thereafter, recurrences in the lung and subsequently in the pancreas were detected. The lesions in the lung and pancreas were resected and diagnosed as metastases of uterine leiomyosarcoma based on histology and immunohistochemistry. CONCLUSION: We report an extraordinarily rare case of uterine leiomyosarcoma with metastasis to the pancreas following initial metastasis to the lung, both of which were diagnosed using histology and immunohistochemistry of the specimens obtained at surgery.

Leydig cell tumor in an elderly patient with complete androgen insensitivity syndrome.

BACKGROUND: Androgen insensitivity syndrome (AIS) is usually diagnosed in phenotypically female patients at puberty with primary amenorrhea. Testicular tumors often develop in patients with AIS, Sertoli cell tumor and seminoma being the most common types. Leydig cell tumor in AIS is extremely rare. CASE: A large abdominal tumor developed in a 73-year-old female patient. Physical examination and cytogenetic analysis revealed that the patient was with complete AIS. The patient underwent the extirpation of bilateral gonads including the tumor, pelvic lymph nodes, omentum and appendix vermiformis. The pathological diagnosis was malignant Leydig cell tumor of the left testis. There was no invasion or dissemination grossly and histologically. There was no adjuvant radiation or chemotherapy performed. The post-operative course was uneventful. The patient showed no evidence of disease at the post-operative 1 month checkup. CONCLUSION: We reported an extremely rare case of malignant Leydig cell tumor developing in an elderly AIS patient.

Verrucous carcinoma of the vulva in Turner syndrome.

BACKGROUND: Verrucous carcinoma of the vulva in a patient with Turner syndrome is extremely rare. CASE REPORT: A 7.5 x 4 cm exophytic tumor of the vulva with a palpable ipsilateral groin lymph node developed in a 41-year-old single nulligravid Japanese woman with short stature and a history of primary amenorrhea. Analysis of karyotype demonstrated mosaic Turner syndrome. She underwent total deep vulvectomy with en-block inguinal femoral lymphadenectomy. Histopathological finding of the extirpated specimen demonstrated verrucous carcinoma with clear margins and the absence of metastasis to the lymph nodes. There was no sign of HPV genome detected in the carcinoma tissue. CONCLUSION: This seems to be the first case of vulvar verrucous carcinoma in a patient with Turner syndrome.

Association of estrogen receptor alpha and beta3-adrenergic receptor polymorphisms with endometrial cancer.

OBJECTIVE: To investigate the association of estrogen receptor alpha and beta3-adrenergic receptor polymorphisms with endometrial cancer risk in Kagoshima, Japan. METHODS: Ninety-two patients with endometrial cancer and 65 healthy women were enrolled in this study. Blood samples were collected, and deoxyribonucleic acid (DNA) was extracted. Estrogen receptor alpha and beta3-adrenergic receptor gene variants were analyzed by restriction fragment length polymorphisms using the restriction enzymes, Pvu II, Xba I for estrogen receptor alpha, and Mva I for beta3-adrenergic receptor. Multivariable logistic regression analysis was performed, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: The Pvu II PP genotype was associated with a decreased risk of endometrial cancer (multivariable OR 0.23; 95% CI 0.07, 0.82) compared with the pp genotype. The Xba I XX genotype was associated with a decreased risk for endometrial cancer (multivariable OR 0.26; 95% CI 0.09, 0.79) compared with the xx genotype. The Mva I variants were not associated with endometrial cancer risk (multivariable OR 0.55; 95% CI 0.20, 1.51). CONCLUSION: Estrogen receptor alpha polymorphisms, but not beta3-adrenergic receptor gene, may be associated with a risk of endometrial cancer.

Effects of vitamin K(2) on bone of ovariectomized rats and on a rat osteoblastic cell line.

The effects of vitamin K(2) on bone mineral density (BMD) and bone metabolic markers of ovariectomized rats, and those on mRNA expression of osteocalcin and IL-6 on a rat osteoblastic cell line, were investigated. BMD and bone metabolic markers were examined in ovariectomized rats after 2 months' treatment with vitamin K(2), and mRNA expression of osteocalcin and IL-6 were measured in the cell line after 24-hour treatment with vitamin K(2). Vitamin K(2) attenuated the decline in BMD after ovariectomy in the rats, and suppressed serum deoxypyridinoline levels of the ovariectomized rats. No effect on osteocalcin and IL-6 mRNA expression on the cell line was observed. In conclusion, vitamin K(2) has a bone-protective effect on ovariectomized rats.