Frequency of serous tubal intraepithelial carcinoma (STIC) in patients with high grade serous ovarian cancer.

OBJECTIVE: Serous tubal intraepithelial carcinoma (STIC) is a known precursor of high-grade serous ovarian cancer (HGSOC). This study aimed to evaluate the proportion of STIC in patients with HGSOC and analyze the STIC-related prognosis in patients with HGSOC. MATERIALS AND METHODS: All pathology reports at our institution that included bilateral salpingectomies of patients with HGSOC from January 2013 to December 2018 were reviewed by two experienced pathologists. The specimens from the ovaries and the salpinx including fimbria were examined. We analyzed the correlation between STIC and HGSOC and compared the clinical characteristics and STIC-related prognostic outcomes in patients with HGSOC. RESULTS: Eleven of the 76 cases were STIC. BRCA mutations were found in 16.9% of patients with HGSOC. STIC was observed in 30.0% of patients with BRCA mutations and in 14.3% of patients without BRCA mutations. The incidence of STIC in patients with BRCA mutations was approximately twice that in patients without BRCA mutations; however, the difference was not statistically significant (P = 0.231). Further, the 5-year survival rate of patients without STIC appeared to be high; nevertheless, the difference was not statistically significant (59.7% vs. 47.4%, P = 0.633). Moreover, there was no significant difference in disease-free survival rate according to STIC (36.4% vs. 33.1%, P = 0.956). CONCLUSION: STIC was identified in patients with HGSOC, and STIC incidence was prominent in HGSOC related to BRCA mutation. Although low frequency, STIC was detected in patients without BRCA mutation. Therefore, prophylactic salpingectomy may be useful for prevention of HGSOC.

The clinical significance of HERV-H LTR -associating 2 expression in cervical adenocarcinoma.

ABSTRACT: HERV-H LTR -associating 2 (HHLA2) is a recently discovered member of the B7-family of immune checkpoint molecules that is overexpressed in several types of cancer. The aim of the present study was to investigate the expression of HHLA2 in cervical adenocarcinoma (AC) and the relationship between its expression and clinicopathological factors to assess its use as a potential marker for AC prognosis.This study included 76 patients diagnosed with cervical AC. Their resected specimens were obtained and a tissue microarray was constructed. Expression of HHLA2 was detected by the immunohistochemistry. Based on the follow-up data, correlation of HHLA2 expression and clinicopathological features, including overall survival (OS) and disease-free survival, was evaluated. Furthermore, we investigated the correlation between the expression of HHLA2 and programmed death ligand 1 (PD-L1).A total of 76 cases of invasive cervical AC were evaluated. High HHLA2 expression was detected in 62 cases (81.6%) and low HHLA2 expression was presented in 14 cases (18.4%). HHLA2 expression showed a significant negative correlation with lymph node metastasis (P = .011). Disease free survival was 75.0% and 49.0% in high-expression and the low expression group, respectively (P = .057). Although there was no statistical significance, an improved OS was observed in the high expression group (83.1% vs 64.9%, P = .479). Further, the expression of HHLA2 and PD-L1 correlated positively (P = .005). Thus, an improved OS was observed in the PD-L1 expression group (90.7% vs 66.2%, P = .037).High expression of HHLA2 is related to tumor progression and prognosis in patients with cervical AC. Therefore, HHLA2 may be a potential biomarker for predicting prognosis of cervical AC.

Neonatal outcomes between discordant monochorionic and dichorionic twins.

OBJECTIVES: This study aimed to compare obstetrical complications and neonatal outcomes between monochorionic and dichorionic discordant twin pregnancies. STUDY DESIGN: We enrolled 296 patients with twin pregnancy who delivered at Busan Paik Hospital between January 2014 and December 2017. The prevalence of obstetrical complications, neonatal mortality between monochorionic and dichorionic twins was compared. We also investigated whether there is a difference in neonatal outcome and neonatal morbidity between monochorionic discordant twins without monochorionic-specific complications and dichorionic discordant twins. RESULTS: The risk of fetal death in utero (13.2 versus 5.2%, p = .025) and inter twin birth weight discordance (35.1 versus 20.8%, p = .031) is increased in monochorionic twins than in dichorionic twins. However, no difference was noted in obstetrical complication and neonatal mortality and morbidity between two groups. Among twin pregnancies with intertwin birth weight discordance, after excluding fetal death in utero and monochorionic specific complication, there was no difference in obstetrical complication and neonatal mortality and morbidity according to chorionicity. There was no difference in neonatal morbidity between monochorionic twins and dichorionic twins when comparing larger neonates and smaller neonates of each group. CONCLUSIONS: Risk of birth weight discordance is higher in monochorionic twin but no significant difference was observed in maternal outcomes, neonatal mortality and morbidity between noncomplicated monochorionic and dichorionic discordant twins.

Placental Pathologic Changes Associated with Fetal Growth Restriction and Consequent Neonatal Outcomes.

OBJECTIVE: To evaluate the pathological changes of the placenta to determine the mechanism underlying placenta-derived fetal growth restriction (FGR) and investigate its influence on neonatal outcomes. Study design: This retrospective case-control study included 120 singleton pregnancies with FGR as well as 120 gestational age-matched controls. We compared the placental pathological findings and neonatal outcomes according to the presence of placental malperfusion. Results: The FGR group demonstrated lower placental weight (350.8 ± 118.8 vs. 436.1 ± 109.7g, P < .0001), smaller chorionic plate area (157.7 ± 48.0 vs. 201.5 ± 53.4 cm2, P < .0001), and higher rate of villous change lesions (84.2% vs. 52.5%, P < .0001) than the control group. FGR neonates with placental malperfusion had a higher rate of adverse neonatal outcomes (87.1% vs. 63.2%, P = .0175). Conclusion: Small placentas and placental malperfusion reflected in villous changes are associated with FGR. FGR neonates with placental malperfusion are more susceptible to adverse neonatal outcomes.

Ovarian dysgerminoma with Müllerian anomaly: a case report.

Müllerian anomalies are rare deformities in women, and only a few cases concerning gynecologic malignancies arising in patients with congenital uterine malformations have been reported. Herein, we present the case of a 34-year-old woman with dysgerminoma with a Müllerian anomaly (uterus didelphys). She had secondary amenorrhea, and an ovarian mass and uterus didelphys were discovered during examination. After right salpingo-oophorectomy, the tumor was confirmed as dysgerminoma, and a chromosome study revealed a normal female karyotype (46, XX). The patient completely responded to 6 cycles of chemotherapy. To our knowledge, this is the first reported case of dysgerminoma with uterus didelphys. Although gynecologic malignancies in patients with Müllerian anomalies are very rare, clinicians should be aware of the coexistence of gynecologic malignancies and uterine malformations.

The first case of vaginal angiomatoid Spitz nevus causing vaginal bleeding.

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.

The first case of Anti-N-methyl-d-aspartate receptor encephalitis (Anti-NMDAR encephalitis) associated with ovarian mucinous cystadenoma: A case report.

OBJECTIVE: Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune and paraneoplastic encephalitis caused by the N-methyl-d-aspartate receptor antibody which is related to tumors, such as teratomas of the ovaries. To our knowledge, this is the first reported case of Anti-NMDAR encephalitis associated with ovarian mucinous cystadenoma. CASE REPORT: A 23-year-old woman with a flu-like illness, confused mental status, and behavioral changes presented to the hospital. A right-sided ovarian tumor was detected during the work-up and was suspected to be a teratoma that might have caused the encephalitis. A laparoscopic right salpingo-oophorectomy (RSO) was performed. Histopathological examination revealed a mucinous cystadenoma. She recovered gradually and had complete resolution of symptoms after surgical removal of the mucinous cystadenoma and immunotherapy. CONCLUSION: Even though anti-NMDAR encephalitis is caused by ovarian teratoma because it contains various types of tissues, ovarian tumors in anti-NMDAR encephalitis may not be limited to ovarian teratomas.

Arsenic trioxide and tetraarsenic oxide induce cytotoxicity and have a synergistic effect with cisplatin in paclitaxel-resistant ovarian cancer cells.

Background: Arsenic compounds (As2O3 and As4O6) have demonstrated anticancer effects in various malignancies. In this study, the cytotoxicity of arsenic compounds on ovarian cancer cell lines and the anticancer activity of the combination of arsenic compounds and cisplatin IN chemoresistant ovarian cancer cells were investigated.Methods: We investigated the cytotoxicity of As2O3 and As4O6 and their combinations with cisplatin in the paclitaxel-sensitive ovarian cancer cell lines SKOV3ip1 and HeyA8 and paclitaxel-resistant ovarian cancer cell lines SKOV3TRip2 and HeyA8-MDR. Growth and apoptosis were evaluated by MTT assay and annexin V assay using flow cytometry, respectively. For detection of apoptotic cells, immunofluorescence was performed using a cleaved caspase-3 antibody. Cell-cycle distribution was determined by propidium iodide staining and flow cytometry.Results: Treatment of each cell line with As2O3 or As4O6 led to a marked dose-dependent inhibition of cell growth. As2O3 and As4O6 treatment induced caspase-3-dependent apoptosis in all cell lines compared to the respective control groups (p < .05). As2O3 and As4O6 induced apoptosis of paclitaxel-sensitive and -resistant cancer cell lines following G2/M cell cycle arrest (p < .05). A synergistic effect was achieved by combining cisplatin with As2O3 or As4O6 in the paclitaxel-resistant ovarian cancer cell lines.Conclusions: As2O3 and As4O6 can inhibit cell growth and induce apoptosis in paclitaxel-sensitive and -resistant ovarian cancer cell lines. Their combination with cisplatin resulted in a synergistic effect in paclitaxel-resistant cancer cell lines. These results suggest that arsenic compounds may be given in monotherapy or combination therapy with cisplatin for treating paclitaxel-resistant ovarian cancer.

Clinical significance of the pattern-based classification in endocervical adenocarcinoma, usual and variants.

BACKGROUND: The Silva system is a pattern-based classification system that stratifies endocervical adenocarcinomas (AC) into 3 categories to assess the risk of lymph node (LN) metastasis. This study aimed to evaluate whether this novel risk stratification system is applicable to all endocervical AC, including usual and variant, and to suggest a suitable management plan for cervical AC. METHODS: We retrospectively retrieved consecutive pathology cases with a final diagnosis of endocervical AC treated via radical hysterectomy and pelvic lymphadenectomy. Specimens were classified by consensus according to the Silva system based on "pattern of invasion" as A, B, or C, further clinical/pathologic features were assessed according to pattern-based classification. RESULTS: A total of 76 cases of invasive cervical AC were evaluated. Of these, 63 (82.9%) were categorized as usual-type endocervical AC and 13 (17.1%) as special types. Among those with usual and variants, all patients with pattern A tumor had no LN metastasis and did not develop recurrence. Likewise, multivariate analysis revealed that LN metastasis and pattern C or B tumors are significant independent predictors of disease-free survival (DFS). Although pattern A tumors had no LN metastasis, they also developed complications after surgery, similar to pattern B or C tumors. CONCLUSION: Regardless of histologic subtypes, pattern A tumors had no LN metastasis and no recurrence. Thus, the Silva classification system can influence the clinical management of all types of endocervical AC. Conservative management is reasonable in all patients with endocervical AC with pattern A tumors.

Persistent HPV-16 infection leads to recurrence of high-grade cervical intraepithelial neoplasia.

High-grade cervical intraepithelial neoplasia (CIN) is a precancerous lesion of cervical cancer. The aims of this study were to evaluate the risk factors for recurrence of high-grade CIN and to determine if the specific genotype of human papillomavirus (HPV) is a predictor of recurrent high-grade CIN. Between January 2010 and December 2014, 172 patients with CIN 2+ underwent cold knife conization or a loop electrosurgical excision. The HPV DNA chip was used to detect HPV. Recurrent lesions were histologically confirmed and considered to be recurrence of CIN2+. We compared the recurrence rate in patients who did and did not have HPV infection after treatment. One hundred forty-eight (86%) patients had HPV infection before treatment. The first follow-up HPV test was performed on average 4.6 months after treatment and the recurrence rate for high-grade CIN was 3.5%. Fifty-eight patients (33.7%) were found to have HPV infection after treatment; of these, 14 (24.1%) had HPV genotype 16 and/or 18. Eleven patients had persistent HPV16 and/or 18 infection and 3 had new HPV 16 infection after treatment (78.6% and 21.4%, P = .001); the HPV 16 genotype was significantly correlated with recurrent disease and persistent infection after treatment (P = .013 and P = .054, respectively, [OR], 19.4; 95% [CI], 1.89-198.79). Recurrence of high-grade CIN was related to HPV infection after treatment, and persistent HPV16 infection was the most important factor for recurrence. Therefore, HPV vaccination for the HPV16 genotype and regular follow-up with HPV testing after treatment may be useful for preventing recurrent high-grade CIN.

Prevalence of group B streptococcus colonization in pregnant women in a tertiary care center in Korea.

OBJECTIVE: The purpose of this study was to evaluate the group B streptococcus (GBS) colonization rate in pregnant Korean women using selective culture media for GBS and to identify obstetrical complications and GBS-induced early-onset neonatal sepsis. METHODS: We evaluated 1,014 pregnant women who delivered at Busan Paik Hospital between January 2015 and December 2016. GBS colonization was assessed using chromID Strepto B agar. We evaluated GBS colonization in pregnant women, as well as the obstetrical complication and GBS-induced neonatal sepsis rates. RESULTS: The total GBS colonization rate was 11.6% (117/1,014). No significant increase was observed in the rate of pregnancy-related complications between the GBS-positive and the GBS-negative groups. Among the 134 neonates born to colonized mothers, early neonatal sepsis was reported in 2 neonates (1.5%); however, these were cases of non-GBS-induced sepsis. CONCLUSION: The GBS colonization rate (using selective culture media) in this study involving pregnant Korean women showed a higher colonization rate than that previously reported in Korea. Therefore, based on this study, we recommend GBS screening and the administration of intrapartum antibiotic prophylaxis in pregnant Korean women.

Thrombosed Fetal Dural Sinus Malformation: Correlation Between Prenatal Ultrasound and Autopsy Findings.

INTRODUCTION: Dural sinus malformations, which are characterized by massively dilated dural sinuses, are one of the etiologies of an intracranial fetal cystic mass. Thrombi within these dural sinus malformations can develop while in-utero, and can be visualized by ultrasound in fetal life. Definitive postnatal diagnosis requires an autopsy. CASE REPORT: We report two thrombosed fetal dural sinus malformations which are prenatally suspected during the second trimester with ultrasonography and postnatally confirmed with autopsy. CONCLUSION: Prenatal ultrasound images and fetal autopsy findings can be useful to establish the prenatal diagnosis of thrombosed dural sinus malformation.

Overexpression of peroxiredoxin-3 and -5 is a potential biomarker for prognosis in endometrial cancer.

Endometrial cancer is the sixth most common cancer in women worldwide. Peroxiredoxins (PRDXs) are antioxidant enzymes that serve important roles in cell differentiation, proliferation, and apoptosis. In the present study, the potential associations between PRDX expression and endometrial cancer were investigated. The expression levels of various PRDX mRNAs were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) in endometrial cancer tissues (n=26) and normal endometrial tissues (n=10). Additionally, the expression of PRDX isoforms was immunohistochemically examined in endometrial cancer tissues and adjacent normal endometrial tissues from 42 patients. Finally, the associations between high PRDX expression levels and clinicopathological features were examined in patients with endometrial cancer. Analysis of PRDX expression in endometrial cancer tissues and normal endometrial tissues by semi-quantitative RT-PCR showed that all PRDX isoforms had increased expression in the endometrial cancer tissues compared with that in the normal endometrium, and the differences in the expression levels of PRDX1 and PRDX3 between cancer and normal tissues were statistically significant (P=0.0015 and P=0.0134, respectively). Additionally, analysis of PRDX expression in endometrial cancer and paired normal endometrial tissues by immunohistochemistry showed strong cytoplasmic staining of PRDX3 and PRDX5 in cancer tissues, with high PRDX3 (25/42, 59.5%) and PRDX5 (32/42, 76.2%) appearing more frequently in endometrial cancer than in normal endometrial tissues (P=0.0001 and P=0.0023, respectively). Furthermore, high expression of PRDX5 was associated with advanced-stage endometrial cancer (P=0.0399). Although the 5-year survival rate was marginally higher in patients with low expression of PRDX3 and PRDX5, this result was not statistically significant. In summary, PRDX3 and PRDX5 are highly expressed in endometrial cancer and could be associated with advanced stage and poor prognosis. Therefore, these proteins may potentially be used as prognostic markers for endometrial cancer.

Placental pathologic changes and perinatal outcomes in placenta previa.

INTRODUCTION: Placenta previa is a condition in which the placenta implants in the poorly vascularized lower uterine segment, which may result in inadequate uteroplacental perfusion, in turn, adversely affect the neonatal outcome. Abnormal placentation may also lead to severe postpartum hemorrhage as placenta separation proceeds. We aimed to evaluate the differences in placental histopathology and perinatal outcomes in pregnancies complicated with placenta previa and controls. METHOD: We undertook a retrospective case-control study of 93 pregnancies with placenta previa and 81 controls between 2011 and 2017. RESULTS: Gross findings of the placenta showed that the placentas in placenta previa had significantly higher mean large chorionic plate diameters (18.5 ±â€¯3.2 vs 17.5 ±â€¯2.6 cm, P = .0298), chorionic plate areas (218.4 ±â€¯62.9 cm2 vs 198.7 ±â€¯56.0 cm2, P = .0344), and marginal cord insertion (19.8% vs 8.6%, P = .0411) than control groups. Placental histopathological findings showed that placentas in placenta previa was significantly associated with maternal underperfusion, including villous infarction (50.5% vs 25.9%, P = .0009) and increased intervillous fibrin deposition (38.7% vs 7.4%, P < .0001). Also, women in the placenta previa group had a higher rate of abnormally invasive placenta and severe postpartum hemorrhage. However, placenta previa was not associated with the increased risk of neonatal mortality and morbidity. DISCUSSION: Abnormal placentation into the poorly vascularized lower uterine segment induces compensatory placental growth and increased surface area in response to reduced placental perfusion, which was consistent with the histopathological findings of coagulative necrosis of chorionic villi and fibrin deposition in the intervillous space. The morphological changes occurring in placenta previa may have important roles in maintaining adequate uteroplacental-fetal perfusion, which may prevent adverse neonatal outcomes.

Antenatal magnesium sulfate for both tocolysis and fetal neuroprotection in premature rupture of the membranes before 32 weeks' gestation.

OBJECTIVE: We aimed to assess the impact of antenatal MgSO4 therapy given to women with PPROM before 32 weeks' gestation on latency, maternal outcomes, perinatal outcomes, and neurodevelopmental outcomes. METHODS: We undertook a retrospective cohort observational study of 184 singleton pregnancies complicated by PPROM at 23°-316 weeks who were hospitalized and received magnesium therapy for tocolysis (MgSO4 group) or did not receive tocolytic therapy (no MgSO4 group) between 2005 and 2013. Furthermore, patients were subdivided into two groups based on the gestational age at the onset of PPROM (23°-276 weeks' gestation and 28°-316 weeks' gestation). RESULTS: We included 184 women, of whom 143 received magnesium therapy and 41 did not. The latency period was significantly longer in the MgSO4 group compared with no MgSO4 group (7.9 ± 9.0 versus 4.0 ± 6.0 days, p = .0017). Antenatal magnesium therapy was significantly associated with decreased stillbirth (1.4% versus 14.6%, p = .0012) and perinatal mortality (7% versus 19.5%, p = .0375) without significant increase in the risk of neonatal morbidities and chorioamnionitis. However, neonates who were exposed to antenatal MgSO4 were associated with higher Mg levels (3.63 ± 1.05 mg/dl versus 2.13 ± 0.48 mg/dl, p < .0001) and phosphate levels (6.90 ± 1.36 mg/d versus 6.40 ± 1.01 mg/dl, p = .0459) than those who were not exposed. Neonates who were exposed to MgSO4 showed significantly reduced risks of IVH (20.4% versus 58.3%; RR, 0.35; 95%CI, 0.17-0.71) and PVL (27.8% versus 58.3%; RR, 0.48; 95%CI, 0.25-0.91) in the subgroup of 23°-276 weeks' gestation. And the incidence of developmental delay in the subgroup of 23°-276 weeks' gestation was significantly lower in the MgSO4 group (6.5% versus 36.4%; RR, 0.18; 95%CI, 0.05-0.69). However, there were no significant differences in the development of IVH, PVL, and developmental delay between the two groups for patients in the subgroup of 28°-316 weeks' gestation. A similar trend was observed for cerebral palsy, with 22.2% of unexposed children affected compared with only 7.0% of exposed children (RR, 0.31; 95%CI, 0.10-1.00). CONCLUSIONS: Antenatal magnesium therapy in women with PPROM before 32 weeks' gestation could prolong latency period, allowing for corticosteroid benefit. Moreover, MgSO4 showed fetal neuroprotective effects for neonatal IVH and PVL, and for developmental delay in infancy while prolonging latency. However, these benefits were primarily limited to the subgroup of 23°-276 weeks' gestation and prolonged in utero exposure to MgSO4 was associated with bone mineralization in the neonates.

Laparoscopic total extraperitoneal hernia repair of fallopian tube indirect inguinal hernia in reproductive aged woman: a case report.

An indirect inguinal hernia containing the fallopian tube alone is extremely rare in reproductive-aged women without any genital tract anomalies. Despite this rarity, early diagnosis and adequate management is important to prevent strangulation and recurrence. We present a case of an indirect inguinal hernia containing only the fallopian tube in the hernia sac, which was successfully reduced by using a laparoscopic total extraperitoneal approach and repaired with a polypropylene mesh.

Different features of the histopathological subtypes of ovarian tumors in pre- and postmenopausal women.

OBJECTIVE: To date, epidemiological evidence has consistently supported a link between ovarian cancer risk and menopause. However, little is known about how menopause status affects the risk of specific histological subtypes of ovarian tumors. We aimed to analyze the differences in various histopathological subtypes of ovarian tumors between pre- and postmenopausal women. METHODS: We reviewed the medical records of women who underwent surgery for ovarian tumors and received histopathological confirmation at the Busan Paik Hospital between January 1997 and October 2016. Pathological findings were regrouped according to 2014 World Health Organization (WHO) classification and subdivided into the following five main categories: epithelial, germ cell, sex cord-stromal, tumor-like lesions, and secondary tumors. RESULTS: A total of 4,683 cases (3,404 premenopausal and 1,279 postmenopausal) were included in this study. Among the 4,683 neoplasms, epithelial tumors accounted for 52.6%, germ cell tumors for 27.1%, sex cord-stromal tumors (SCSTs) for 4.1%, tumor-like lesions for 14.0%, and secondary tumors for 0.8%. Among the epithelial tumors, malignant epithelial tumors were significantly associated with postmenopausal women (5.4% vs 22.1%, P < 0.0001), whereas benign epithelial tumors were significantly associated with premenopausal women (40.5% vs 31.9%, P < 0.0001). Among the 1,271 cases of germ cell tumors, most (97.6%) were benign mature teratoma and 2.4% were malignant germ cell tumors. Germ cell tumors were noted more frequently in premenopausal women than in postmenopausal women (31.3% vs 16.1%, P < 0.0001). Among the 194 cases of SCSTs, fibrothecoma was the most common (71.6%) followed by adult granulosa cell tumor (12.9%). The majority of SCSTs occurred in postmenopausal women (2.1% vs 9.5%, P < 0.0001). Among the 656 cases of tumor-like ovarian lesions, corpus luteum cyst was the most common (31.9%) followed by tubo-ovarian abscess (27.6%). Tumor-like ovarian lesions were significantly associated with premenopausal women (15.2% vs 10.7%, P = 0.0001). Among the 36 cases of secondary tumors, 66.7% of the metastatic ovarian tumors were Krukenberg tumors. There was no significant difference in the incidence of secondary tumors between the groups. CONCLUSIONS: We demonstrated the differences in diverse histological subtypes of ovarian tumors according to the menopause status based on the new WHO classification for Korean women.

Herlyn-Werner-Wunderlich syndrome: An unusual presentation with pyocolpos.

Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly of the urogenital tract, which is characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It usually presents at puberty with pelvic pain, dysmenorrhea, and a vaginal or pelvic mass. Although rare, it may present with purulent vaginal discharge due to secondary infection of the obstructed hemivagina, making diagnosis difficult. A careful pelvic examination to identify the cervix and vagina is the key to the diagnosis of Müllerian duct anomalies and magnetic resonance imaging can provide additional useful information. The optimal treatment is full excision and marsupialization of the obstructing vaginal septum so that both uteri can drain through the patent vagina. The authors report a case of a 22-year-old female with an unusual presentation of Herlyn-Werner-Wunderlich syndrome complicated by pyocolpos, which was successfully managed by vaginal septum resection and drainage of pus.

Female with 46, XY karyotype.

Disorders of sex development (DSD) are congenital conditions characterized by atypical development of chromosomal, gonadal, and phenotypic sex. 46, XY DSD can result from disorders of testicular development or disorders of androgen synthesis/action. Prophylactic gonadectomy should be considered in patients with 46, XY DSD because of the increased risk of gonadal malignancy. We report two rare cases of 46, XY DSD, including XY pure gonadal dysgenesis and complete androgen insensitivity syndrome, who underwent a prophylactic gonadectomy.