Ovarian nongestational choriocarcinoma and associated adenocarcinoma with the same germ cell origin determined by a molecular genetic approach: A case report.

Ovarian non-gestational choriocarcinomas co-existing with adenocarcinoma are extremely rare and have been reported as epithelial ovarian carcinomas of a "non-germ cell origin" with "choriocarcinomatous differentiation". Although the cellular origin of non-gestational choriocarcinoma may be post-meiotic ovarian germ cells or the dedifferentiation of epithelial ovarian carcinoma, detailed genetic evidence has not yet been obtained to support this. We herein present a case of ovarian non-gestational choriocarcinoma co-existing with adenocarcinoma in a 29-year-old woman. The tumor rapidly increased in size and lung metastases appeared soon after parturition. We genetically demonstrated that the cellular origin of ovarian non-gestational choriocarcinoma was a post-meiotic germ cell derivation using a short tandem repeat analysis. The co-existing adenocarcinoma component was also shown to be of the same germ cell origin. These tumors showed the same homozygous pattern. A molecular genetic approach may be important for understanding the clinicopathological features of such tumors.

Meningeal dissemination from an ovarian carcinoma with effective response to intrathecal chemotherapy.

Meningeal dissemination is rare in the clinical course of ovarian carcinoma, and its prognosis is poor. Although it is treated by the intrathecal administration of methotrexate (MTX) and/or total brain irradiation, these treatments are usually ineffective. We report a 58-year-old woman with stage IIIc ovarian cancer who had received nine courses of adjuvant chemotherapy after surgery. But her carbohydrate antigen (CA) 125 serum level had increased further (38.9 U/ml) after five courses of biweekly paclitaxel (Taxol; Bristol-Myers Squibb, Tokyo, Japan; BT) maintenance therapy. Fainting occurred, with a few seconds of unconsciousness, as did severe headaches. However, results of head computed tomography (CT), head magnetic resonance imaging, and electroencephalogram were normal. Lumbar puncture (LP) was performed. The opening pressure was 30 cmH2O or greater. Meningeal dissemination of the ovarian cancer was diagnosed, as adenocarcinoma cells were found by cerebrospinal fluid (CSF) cytology. We started chemotherapy with intrathecal injections of MTX and hydrocortisone acetate. Establishing a diagnosis of carcinomatous meningitis may be difficult. Clinical signs and biological data are not conclusive. In this patient, CSF cytology was very effective in establishing the diagnosis, and the intrathecal administration of MTX and hydrocortisone was very effective.

Open fan sign: An ultrasound finding suggesting postpartum intrauterine forgotten gauze.

Gauze counting is regarded as the most essential way to prevent forgotten gauze inside the body during any surgery. However, incident may still occur due to artificial mistake. An open fan sign on ultrasonography may indicate a gauze left in the intrauterine cavity.

A trio of risk factors for the onset of preeclampsia in the second and early third trimesters.

OBJECTIVE: We evaluated the biological interaction among mean blood pressure (MBP), uterine artery Doppler (UAD), and the soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio for preeclampsia (PE) risk. STUDY DESIGN: A prospective cohort study. MAIN OUTCOME MEASURES: In 1239 pregnant women, MBP and UAD were measured at 16-23weeks of gestation, and plasma levels of the sFlt-1/PlGF ratio at 19-25weeks and 26-31weeks. A Cox proportional hazard model was used. Women with a low sFlt-1/PlGF ratio and either low BP or normal UAD were set as controls. The relative excess risk due to biological interaction (RERI) was calculated using the following equation: RERI=hazard ratio (HR) in women with high sFlt-1/PlGF and both high BP and abnormal UAD (group 3) - HR in women with both high BP and abnormal UAD alone (group 1) - HR in women with high sFlt-1/PlGF alone (group 2)+1. RERI⩾10 was considered to be strong. RESULTS: At 19-25weeks, the HR and 95% confidence intervals (CI) in group 1, group 2, and group 3 were 7.4 (3.1-17.4), 15.3 (4.5-52.2), and 107.0 (41.0-279), respectively, and the RERI for PE was 85.3. At 26-31weeks, the HR and 95% CI in each group were 8.3 (2.9-23.2), 7.5 (0.97-57.8), and 69.0 (18.5-256), respectively; the RERI for PE was 54.2. CONCLUSIONS: We found a trio of risk factors for the onset of PE in the second and early third trimesters: high BP, abnormal UAD, and high sFlt-1/PlGF ratio.

Gestational hypertension as a subclinical preeclampsia in view of serum levels of angiogenesis-related factors.

It is controversial whether gestational hypertension (GH) and preeclampsia (PE) have the same pathophysiology. Our aim was to clarify whether the serum soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and levels of soluble endoglin (sEng) are different in women with GH and with PE. In women with GH (15 cases), hypertension preceding PE (h-PE, 10 cases) and PE in which hypertension and proteinuria occurred simultaneously (si-PE, 36 cases), blood samples were collected after disease onset. The levels of log(10)(sFlt-1/PlGF) in women with GH were significantly lower than in women with h-PE and si-PE (1.65±0.39 vs. 2.22±0.35 and 2.15±0.46). The levels of log(10)sEng in women with GH were also significantly lower than in women with h-PE and si-PE (1.51±0.43 vs. 1.87±0.21 and 1.85±0.32). The incidence rates of the sFlt-1/PlGF ratio 95th percentile of the reference value were 73, 100 and 92%, respectively, (P=0.080), and those of sEng 95th percentile were 67, 100 and 89%, respectively, (P=0.053). In conclusion, the levels of sFlt-1/PlGF ratio and sEng in women with GH were lower than in those with h-PE and with si-PE; however, the majority of women with GH showed abnormal increases of both sFlt-1/PlGF ratio and sEng, suggesting that GH may be a subclinical PE in view of serum levels of angiogenesis-related factors.