Metastatic hepatic actinomycosis masquerading as distant metastases of ovarian cancer.

Actinomycosis is a chronic disease characterized by abscess, tissue fibrosis and draining sinuses. Pelvic actinomycosis in women most commonly occurs during ascending infections, which are usually associated with intrauterine devices; however, secondary hepatic actinomycosis, while rare, can also occur. We describe a patient with an unusual case of metastatic hepatic actinomycosis misdiagnosed as distant metastases of ovarian cancer.

The presence of centrioles and centrosomes in ovarian mature cystic teratoma cells suggests human parthenotes developed in vitro can differentiate into mature cells without a sperm centriole.

In most animals, somatic cell centrosomes are inherited from the centriole of the fertilizing spermatozoa. The oocyte centriole degenerates during oogenesis, and completely disappears in metaphase II. Therefore, the embryos generated by in vitro parthenogenesis are supposed to develop without any centrioles. Exceptional acentriolar and/or acentrosomal developments are possible in mice and in some experimental cells; however, in most animals, the full developmental potential of parthenogenetic cells in vitro and the fate of their centrioles/centrosomes are not clearly understood. To predict the future of in vitro human parthenogenesis, we explored the centrioles/centrosomes in ovarian mature cystic teratoma cells by immunofluorescent staining and transmission electron microscopy. We confirmed the presence of centrioles and centrosomes in these well-known parthenogenetic ovarian tumor cells. Our findings clearly demonstrate that, even without a sperm centriole, parthenotes that develop from activated oocytes can produce their own centrioles/centrosomes, and can even develop into the well-differentiated mature tissue.

Hereditary non-polyposis colorectal cancer/Lynch syndrome in Korean patients with endometrial cancer.

OBJECTIVE: We investigate the frequency of hereditary non-polyposis colorectal cancer among Korean endometrial cancer patients according to two clinical criteria and the uptake rate of a genetic test and genetic status of such patients in routine clinical practice. METHODS: This was a retrospective study involving 161 consecutive endometrial cancer patients. Patients were classified into clinical and suspected hereditary non-polyposis colorectal cancer. Using direct sequencing, germline mutations were analyzed in the MLH1 and MSH2 genes. RESULTS: There were four (2.5%) clinical hereditary non-polyposis colorectal cancer patients, three of whom underwent genetic testing, and a mutation (c.882delT) in the MSH2 gene was identified in one patient. There were also 14 (8.7%) suspected hereditary non-polyposis colorectal cancer patients, 6 of whom underwent genetic testing; 1 [1/6 (16.7%)] patient had a mutation (c.1757_1758insC) in the MLH1 gene and 1 patient had a sequence variant of unknown significance (c.1886A < G) in the MSH2 gene. Half of the patients (9 of 18) who met clinical or suspected hereditary non-polyposis colorectal cancer criteria declined genetic testing mainly for the reason of financial factor (8 of 9). CONCLUSIONS: The proportion of hereditary non-polyposis colorectal cancer [11.2% (18 of 161)] was significant to offer genetic counseling and genetic testing in Korean endometrial cancer patients. Optimal financial support is crucial to increase the uptake rate of a genetic test.

Lower urinary tract injuries diagnosed after hysterectomy: seven-year experience at a cancer hospital.

AIM: The aim of this study was to determine the incidence, patterns of development and treatment outcomes of lower urinary tract injuries (LUTI) after hysterectomy. METHODS: A retrospective analysis was conducted on 1443 hysterectomy cases (678 total laparoscopic hysterectomies, 65 laparoscopic radical hysterectomies, 455 total abdominal hysterectomies and 245 radical hysterectomies). LUTI diagnosed intraoperatively were excluded. RESULTS: The incidence of post-hysterectomy LUTI was 0.8% (11/1443). LUTI were more commonly associated with laparoscopic hysterectomies (1.1%) than hysterectomies performed via laparotomy (0.4%). Amongst 11 patients with LUTI, six had gynecological malignancies. Ureteral and bladder injuries were identified in eight and three patients, respectively; one patient had bilateral ureteral injuries. Most of the cases involving post-hysterectomy LUTI developed within 2-4 weeks. The high incidence of LUTI following laparoscopic hysterectomies, and the time of development after hysterectomy, are suggestive of electrocautery injuries rather than physical trauma as the cause of delayed diagnosis of LUTI. Four of five surgeons experienced LUTI in the first 10 hysterectomies. Proper training and guidance by an experienced attending physician are required when first performing hysterectomies. CONCLUSIONS: The incidence of post-hysterectomy LUTI was 0.8%. Five of the nine ureteral injuries and one of the three bladder injuries healed after double-J stents and a Foley catheter were inserted, respectively.

Minimizing tumor burden by extensive cytoreductive surgery decreases postoperative venous thromboembolism in ovarian clear cell carcinoma.

PURPOSE: A venous thromboembolism (VTE) is prevalent in patients with ovarian clear cell carcinoma (OCCC). Tumor burden and extensive cytoreductive surgery are well-known risk factor for a VTE. The purpose of this study was to define the incidence of VTE after extensive cytoreductive surgery and to clarify the relationship between VTE and extensive cytoreductive surgery in patients with OCCC. METHODS: We reviewed the medical charts of 43 patients treated at the National Cancer Center between June 2000 and July 2007. Most surgical procedures were performed with peri-operative thrmoboprophylaxis. RESULTS: Eight (18.6%) patients had deep vein thromboses and three of eight patients had a pulmonary thromboembolism. A VTE was identified at initial presentation in four patients, at recurrence in one patient, and during 3rd line chemotherapy in three patients when the patients had a bulky tumor burden. The rate of optimal debulking surgery was 95.3% and no patient had a VTE during the postoperative recovery period and adjuvant chemotherapy. A VTE was associated with disease status only (P=0.042). CONCLUSION: Minimizing residual tumor by extensive cytoreductive surgery with peri-operative thromboprophylaxis may decrease the incidence of a postoperative VTE in patients with OCCC. Larger, prospective studies are needed to confirm these preliminary findings.

Skin-derived stem cells in human scar tissues: a novel isolation and proliferation technique and their differentiation potential to neurogenic progenitor cells.

Adult tissues contain stem cells that can transdifferentiate into other cell lineages besides forming differentiated cells of their own tissue of origin. However, human adult skin-derived stem cells have a very low efficiency. Here we established a novel culture system involving bone morphogenetic protein-4 and a floating culture system with sphere-producing medium that can enrich adult stem-cell populations in vitro. Adult stem cells were isolated from useless human scar tissue. Like mesenchymal stem cells, cultured human scar tissue-derived stem cells (hSTSCs) altered their morphology and significantly increased the number of Nestin-positive cells in proportion to the alkaline phosphatase-positive cell ratio. Moreover, the expression of the pluripotency regulator Oct-4 and its target transcripts, Sox-2, c-kit, and Rex-1, was also stimulated by this culture system. Differentiation of neurogenic progenitor cells using basic fibroblast growth factor and Neurogen 2 was successfully performed in vitro more rapidly than previous reports. Neuronal differentiation results showed that our hSTSCs expressed marker of neurogenic genes, such as glial fibrillary acid protein, neural cell adhesion molecules, neuron filament-M, and microtubule-associated protein 2. These results suggest that bone morphogenetic protein-4 and the floating culture system with sphere-producing medium induced significant proliferation of hSTSCs and mediated reprogramming of the cells from adult somatic tissue into precursor state to some degree. It is thought that this new culture system might be a simple, effective, and easily manageable process for regenerative tissue repair and autotransplantation.

BRCA1 and BRCA2 germline mutations in Korean ovarian cancer patients.

PURPOSE: To evaluate the proportion of Korean ovarian cancer patients with a strong family history and the genetic status in such patients. METHODS AND PATIENTS: Pedigree analysis and genetic counseling were performed on 337 ovarian cancer patients in the National Cancer Center Korea between January 2005 and June 2008. Patients with a strong family history were defined as (1) patients with double primary ovarian and breast cancer and (2) ovarian cancer patients with one or more first-degree relatives with breast or ovarian cancer. Lymphocyte specimens from peripheral blood were processed for BRCA1 and BRCA2 by direct sequencing. RESULTS: Sixteen percent (54/337) of patients had a strong family history. Of the 54 patients with a strong family history, 40 patients (74%) accepted the genetic test. Thirteen deleterious mutations (11 in BRCA1 and 2 in BRCA2) were identified (33%). Twenty-three of 283 patients (8%) without a strong family history underwent genetic testing and two deleterious mutations in BRCA1 were identified (9%). Eight of 15 mutations (53%) were novel, and c.1041delAGCinsT and c.2081insC in the BRCA1 gene were recurrent in two patients. CONCLUSIONS: The proportion of Korean ovarian cancer patients with a strong family history was significant, and the prevalence of BRCA1 and BRCA2 mutations in such patients was high.

Clinical manifestations in patients with ovarian clear cell carcinoma with or without co-existing endometriosis.

OBJECTIVES: The symptoms associated with ovarian cancer are vague. Endometriosis, which causes dysmenorrhea and dyspareunia, is frequently detected along with ovarian clear cell carcinoma (OCCC). We have therefore evaluated the clinical manifestations of OCCC based on the co-existence of endometriosis. METHODS: A retrospective analysis was conducted on 43 patients who had been treated for OCCC at the National Cancer Center between June 2000 and July 2007. Using medical records and the cancer registry, the clinical features and laboratory findings were analysed. RESULTS: Endometriosis was identified in 16 (37.2%) of the 43 patients with OCCC. The main presenting symptoms included a hard, palpable mass (32.6%), and newly developed or an exacerbation of dysmenorrhea (32.6%) and dyspareunia (25.6%). Gastrointestinal symptoms, pelvic pain, and abdominal distension existed in nine (20.9%), eight (18.6%) and one (2.3%) of the patients, respectively. The symptoms did not differ statistically in patients with or without endometriosis. Thirty-seven percent (11/30) of the patients had a normal CA-125 level (<35 U/ml); 18.8% (3/16) of the patients without endometriosis and 57% (8/14) of the patients with endometriosis had normal levels of CA-125 (<35 U/ml). Nine of 16 (56.3%) patients with early stage OCCC had a normal CA-125 level. CONCLUSIONS: The main presenting symptoms in patients with OCCC include a hard, palpable mass, dysmenorrhea and dyspareunia, irrespective of co-existing endometriosis. A normal CA-125 level has limited value in excluding OCCC, especially in the early stages.

Prenatal diagnosis of fetal seizure: a case report.

A 35-yr-old woman carrying a 17-week-old fetus presented with right hydronephrosis and a single umbilical artery. Karyotyping was normal and targeted ultrasonography showed an otherwise normal fetus. After 28 weeks of gestation, the mother felt rapid, repetitive fetal movement and an ultrasound at 30 weeks of gestation revealed tonic clonic movements of the fetal trunk and extremities. At 36 weeks of gestation, an emergency repeat Cesarean section was performed because of a premature rupture of the membranes and a male infant weighing 4,295 gm was delivered. After birth, the infant continued to have movements suggestive of a generalized tonic clonic seizure. Brain computed tomography and magnetic resonance imaging revealed normal structures and an electroencephalography showed generalized suppression. Treatment with phenobarbital resulted in substantial improvement in the number of seizure episodes, however fine seizure-like movement continued in both of the hands, feet and in the tongue until the five-month follow-up. This is the first Korean report of a fetal seizure being diagnosed during the prenatal period.

Two dermoid cysts developing in an accessory ovary and an eutopic ovary.

Accessory ovary is a rare gynecologic condition, and tumors arising in accessory ovaries are extremely rare. Accessory ovary may result from separation of migrating ovaries during embryogenesis and injuries such as inflammation and operation on normal ovary. Congenital malformations, most frequently malformations of the genitourinary organ, are seen in connection with the accessory ovary. We experienced the first case of two dermoid cysts developing in an accessory ovary located in the left infundibulopelvic ligament and another in the eutopic ovary at the same side concurrently. Here, we present this extremely rare case with a review of the literature.

Fate of donor mitochondrial DNA in cloned bovine embryos produced by microinjection of cumulus cells.

This study examined the fate of donor mitochondrial DNA during preimplantation development after nuclear transfer (NT) in cattle. Frozen-thawed cumulus cells were used as donor cells in the nuclear transfer. Mitochondrial DNA heteroplasmy in the nuclear transfer embryos was analyzed by allele-specific PCR (AS-PCR), direct DNA sequencing, and DNA chromatography. AS-PCR analysis for the detection of donor mitochondrial DNA was performed at the 1-, 2-, 4-, 8-, 16-cell, morula, and blastocyst stages of the embryos. The mitochondrial DNA from donor cells was detected at all developmental stages of the nuclear transfer embryos. However, mitochondrial DNA heteroplasmy was not observed in direct DNA sequencing of displacement-loop sequence from nuclear-transfer-derived blastocyst embryos. To confirm the mtDNA heteroplasmy in cloned embryos, the AS-PCR product from NT-derived blastocysts was analyzed by DNA sequencing and DNA chromatography. The nucleotides of NT-derived blastocysts were in accordance with the nucleotides from donor cells. These results indicate that the foreign cytoplasmic genome from donor cells was not destroyed by cytoplasmic events during preimplantation development that followed nuclear transfer.