Coexistence of Ovarian Endometrioma and Ovarian Pregnancy: A Case Report.

Both ovarian pregnancy and endometrioma can rupture and cause life-threatening hemoperitoneum. However, little is known about their coexistence. We report the case of a 34-year-old Japanese woman with a life-threatening hemoperitoneum in the first trimester coexisting with ovarian endometrioma and ovarian pregnancy. The patient was hospitalized in our department for acute hypogastric pain and massive hemoperitoneum during pregnancy. She had a history of miscarriage at eight weeks of gestation one year prior. Her serum beta-human chorionic gonadotropin (hCG) level was >2,000 mIU/mL. Also, a transvaginal ultrasound showed an empty uterus, an intact right ovary, an inhomogeneous left ovary, and a massive hemoperitoneum. An exploratory laparoscopy revealed a rupture of the left ovarian endometrioma, a left corpus luteal cyst, and intraperitoneal bleeding of approximately 1,200 mL. However, no ectopic lesions were observed. Microscopic examination revealed an endometriotic cyst with decidual changes in the stroma, a corpus luteal cyst, and chorionic villi with hemorrhage. Serum beta-hCG levels became negative on the 27th postoperative day. The postoperative course was uneventful. This case shows that, in addition to the differential diagnosis of ovarian pregnancy from ovarian endometrioma, clinicians should consider the coexistence of both conditions.

Prophylactic oophorectomy and aromatase inhibitors for premenopausal deep angiomyxoma: A case report and literature review.

Deep angiomyxoma is a rare, infiltrative, hormone-dependent, benign-mesenchymal neoplasm that occurs in the deep soft tissues of the perineal regions. In total, 33% females with newly diagnosed deep angiomyxoma will typically relapse within 5 years after the standard treatment of radical resection. Postoperative hormone therapy is frequently administered to prevent recurrence, but the role of prophylactic oophorectomy in premenopausal women remain to be fully elucidated. In the present report, a 42-year-old Japanese woman was referred for a refractory Bartholin's cyst that is 14 cm in diameter. Based on the results of imaging (unenhanced CT and MRI) and histopathology, deep angiomyxoma was suspected, but no definitive diagnosis was possible. Tumor resection and bilateral salpingo-oophorectomy were performed before the postoperative diagnosis was confirmed to be deep angiomyxoma. The patient received an aromatase inhibitor (2.5 mg letrozole daily) as adjuvant hormonal therapy. There was no evidence of recurrence at the 1-year postoperative follow-up. In conclusion, prophylactic oophorectomy and postoperative adjuvant therapy with aromatase inhibitors may be a promising treatment option for deep angiomyxoma to optimize the outcome of surgical treatment. Long-term follow-up is required to monitor for the late and/or local recurrence of deep angiomyxoma and possible adverse effects of adjuvant hormonal therapy.

The inhibitory effect of AMP-activated protein kinase (AMPK) on chemokine and prostaglandin production in human endometrial stromal cells.

BACKGROUND: To investigate the role of adenosine monophosphate (AMP)-activated protein kinase (AMPK) on the production of interleukin (IL)-8, monocyte chemoattractant protein (MCP)-1, prostaglandin E2 and F2α induced by IL-1ß in endometrial stromal cells (ESCs) following treatment with 5-aminoimidazole-4- carboxamide ribonucleoside (AICAR). METHODS: Endometrial specimens were obtained and cultured. We examined the effects of IL-1ß, IL-1 ra and AICAR on the production of IL-8, MCP-1, PGE2 and PGF2α in human ESCs. The phosphorylations of AMPK, IκB, 4EBP-1, p70S6K and S6 ribosomal protein were analyzed by Western immunoblotting. RESULTS: Following stimulation by IL-1ß, the production of IL-8, MCP-1, PGE2 and PGF2α showed significant increases, and these increases were suppressed by AICAR. The expression of cyclooxygenase-2 (COX-2) induced by IL-1ß and suppressed by AICAR. The phosphorylation of IκB, 4EBP-1, p70S6K and S6 ribosomal protein were inhibited via an AMPK-dependent signal transduction. CONCLUSIONS: The production of IL-8, MCP-1, PGE2 and PGF2α induced by IL-1ß in ESCs were involved in the negative regulatory mechanisms of AMPK. The substances that activate AMPK may be promising agents for the treatment of pathological problems such as dysmenorrhea.

Effect of the Propionylation Method on the Deformability under Thermal Pressure of Block-Shaped Wood.

Converting wood waste into thermoplastic materials is an attractive means of increasing its utilization because complex three-dimensional molded products can easily be obtained by press molding wood with thermoplasticity. Chemical modification, especially esterification, is a promising method for imparting thermoplasticity to wood. In this study, we produced multiple propionylated wood specimens using several propionylation methods and elucidated the factors affecting the deformability of the wood. Regardless of the method, all of the propionylated wood samples showed deformability in the tangential direction. However, in the longitudinal direction, not only the degree of propionylation but also the propionylation method had a significant influence on the deformability. The flow in the tangential direction occurred under a relatively low pressure, whereas the flow in the longitudinal direction occurred under higher pressure. The chemical composition and motility of each sample were evaluated using solid-state NMR measurements. With some propionylation methods, decomposition of the cellulose main chain occurred during the reaction, which had a dominant effect on the deformability of the wood in the longitudinal direction. These results indicate that the deformability of wood can be controlled by the appropriate selection of a propionylation method and its treatment conditions.

Rapid Benzylation of Wood Powder without Heating.

Converting wood waste into thermoplastic materials is an attractive means of increasing its utilization. A promising method for imparting thermoplasticity to wood is chemical modification, in which the hydroxyl groups in wood are substituted with benzyl groups. In the common method, wood powder is first treated with a highly concentrated aqueous NaOH solution, and then reacted with a benzylation reagent by heating for a long time under stirring. In this study, a 50% aqueous tetra-n-butylphosphonium hydroxide solution was used for the pretreatment of wood powder. This modified alkaline treatment enhanced the efficiency of the subsequent benzylation reaction, which could be conducted without heating over a shorter time. The effects of various conditions on the efficiency of the benzylation reaction were evaluated. Both the alkali pretreatment and the subsequent benzylation required only ~5-10 min of stirring without heating to obtain benzylated wood with a similar degree of benzylation as that achieved by the common method. The chemical structure of the benzylated wood powder was characterized by Fourier-transform infrared and solid-state NMR spectroscopies, and its thermal softening characteristics were evaluated by thermomechanical analysis. Finally, a translucent film could be obtained by hot-pressing the benzylated wood powder.

Port-site implantation of parasitic leiomyoma after laparoscopic myomectomy and its histopathology.

Although parasitic leiomyoma could be spontaneous or iatrogenic in origin, port-site implantation of parasitic leiomyoma is an iatrogenic benign sequela of laparoscopic surgery. A 30-year-old, primigravida Japanese woman was referred after unresponsiveness to preoperative gonadotropin-releasing hormone for intramural fibroids. Magnetic resonance imaging showed multiple intramural fibroids and left ovarian endometrioma with no malignant features. Laparoscopic myomectomy with power morcellation and ovarian cystectomy were performed, followed by treatment with a combined oral contraceptive. Seven years after the primary surgery, she underwent abdominal myomectomy for a port-site, and peritoneal recurrence of the leiomyoma and intramural leiomyomas was detected. Microscopic examination revealed that resected specimens from the port-site demonstrated leiomyoma with lesser cell density and more prominent hyalinization than those from the uterus. Therefore, clinicians should counsel patients regarding the risks and benefits of laparoscopy with morcellation versus laparotomy. Further development of techniques for uterine tissues extraction is warranted.

Small-Cell Carcinoma of the Uterine Cervix Discovered With Quadriplegia Caused by Cervical Spine Metastasis.

Small-cell carcinoma of the uterine cervix is a rare and aggressive tumor, and the prognosis is poor compared with those of squamous cell carcinoma and adenocarcinoma of the uterine cervix, even when discovered at an earlier stage. We treated a patient with progressive small-cell carcinoma of the uterine cervix that metastasized to the cervical spine. The patient, a 73-year-old woman, presented with the symptom of numbness in her limbs. As she had difficulty moving her limbs (ie, quadriplegia), she was carried to an emergency room. A metastatic cervical spine tumor from the uterine cervical cancer was revealed by a computed tomography scan, and the patient was then transferred to our hospital's neurosurgery department for treatment. We performed a resection of the cervical spine tumor and fixation of the spinal bone. Because the patient's performance status was 4 and she remained bedridden 24 h/day, we could not perform systemic chemotherapy. We thus provided palliative care, including palliative radiotherapy, pain control, and rehabilitation to improve her limbs' functioning. The patient died of the uterine cancer within approx. 6 months after the initiation of treatment. There is no established treatment for small-cell carcinoma as a gynecological lesion. For patients with progressive uterine cancer, the optimal treatments, including palliative care, must be determined.

Reactions of Bifunctional Perfluoroarylsilanes with Activated C-F Bonds in Perfluorinated Arenes.

Reactions of bifunctional perfluoroarylsilanes, p- and m-C6F4(SiMe3)2 as well as o-BrC6F4SiMe3, with substituted perfluoroarenes having electron-withdrawing groups were investigated using NMR and density functional theory calculation techniques. The C-F bond in perfluoroarenes was activated by the para-position of an electron-withdrawing group, such as CF3, C6F5, CN, and NO2. The reaction of C6F4(SiMe3)2 mainly occurred at the para-position of the perfluoroarenes and also occurred at the ortho-position of C6F5CN and C6F5NO2. Two equivalent reactions of perfluoroarenes with bifunctional p- and m-C6F4(SiMe3)2 provided disubstituted perfluoroarenes, along with a small amount of protonated monosubstituted perfluoroarenes. The reaction of o-BrC6F4SiMe3 with the CF3- and CN-substituted pentafluorobenzenes provided unexpected coupling products between C-Br and C-F bonds, in addition to the coupling products between C-SiMe3 and C-F bonds.

Small cell carcinoma of the uterine cervix during pregnancy.

Small cell carcinoma of the uterine cervix is a rare histological entity that has a poor prognosis. We report the case of a patient with small cell carcinoma of the uterine cervix who underwent a radical hysterectomy during pregnancy. A 33-year-old Japanese woman with genital bleeding was referred at 15 weeks' gestation. A speculum exam revealed a 5.4-cm-dia. mass in the cervix, and a cervical biopsy revealed small cell carcinoma of the uterine cervix. Imaging studies demonstrated a tumor confined to the cervix, swelling of intra-pelvic lymph nodes, and no distant spread of the tumor. She was diagnosed as having small cell carcinoma of the uterine cervix, stage IB2, and underwent a radical hysterectomy with pelvic lymphadenectomy. She refused any adjuvant therapies, had a systemic relapse 4 months after surgery, and died of the disease 5 months after surgery. Early-stage small cell carcinoma of the uterine cervix should be treated with a definitive therapy soon after diagnosis whether the patient is pregnant or not. Saving the mother's life should be the top priority.

Variable temperature solid-state NMR spectral and relaxation analyses of the impregnation of polyethylene glycol (PEG) into coniferous wood.

To investigate the behaviours of polyethylene glycol (PEG) and its interaction with biomass constituents in coniferous wood (Japanese cypress), variable temperature solid-state NMR spectra and relaxation times were measured from 20-80 °C. Signal intensities in the 1H and 13C PST-MAS NMR spectra changed depending on both the measurement temperature and the melting point of the impregnated PEG. In the 13C CP-MAS NMR spectra with increasing temperature, although the signal intensities of biomass constituents slightly decreased, signal intensities of PEG molecules in the cypress maximized at 80 °C. PEG impregnation into cypress decreased the T 1H values at 80 °C for short to medium chain PEG in the liquid phase while it decreased T 1H values at ambient temperature for long chain PEG in the solid phase because the interactions of PEG molecules and the biomass constituents of coniferous wood were different for different chain lengths of the PEG. These variable temperature measurements of both solid-state NMR spectra and relaxation time indicated that impregnation of longer chain PEG molecules produced higher hydrophobicity because of the increased steric hinderance of PEG attached to carbohydrates. The variable temperature measurements also showed that long chain PEG molecules were restricted to the lumen while short to medium chain length PEG molecules infiltrated into the intercellular region of the cell wall in addition to the lumen. These results obtained from the variable temperature NMR measurements were also supported by ATR-IR spectroscopy analyses.

Multi-scale instrumental analyses of plasticized polyhydroxyalkanoates (PHA) blended with polycaprolactone (PCL) and the effects of crosslinkers and graft copolymers.

Details of the mechanism underlying the tensile properties of plasticized polyhydroxyalkanoates (PHA) including poly(butylene succinate) (PBS) were investigated by blending with poly(ε-caprolactone) (PCL) as well as the addition of compatibilizers. Multi-scale instrumental analyses employed micro-focus X-ray CT to provide micro-scale morphology information on the order of ten microns while solid-state NMR spectral and relaxation time analyses contributed knowledge of the environment and molecular mobility of each constituent at the molecular to nano-scale. The blend of plasticized PHA with 50% PCL adopted a sea-island morphology to improve elongation at break in a quasi-static tensile test, which was dominated by the tensile properties of the added PCL. However, impact tensile properties were less improved by PCL addition, because its molecular mobility was suppressed by blending. Meanwhile, peroxy crosslinkers changed the sea-island morphology to homogenous in X-ray CT observations. Although the homogenous morphology sharply lowered the elongation at break in a quasi-static tensile test, the homogenous morphology improved impact tensile properties. Furthermore, graft polymers having acrylonitrile-styrene side-chains did not change the sea-island morphology but increased the molecular mobility of PBS in the plasticized PHA. This weak interaction between the plasticized PHA and PCL improved tensile properties in both quasi-static and impact tensile tests.

Nucleating and Plasticization Effects in Drawn Poly(Lactic Acid) Fiber during Accelerated Weathering Degradation.

Changes in the polymer properties of poly(lactic acid) (PLA) fibers during drawing and degradation processes were analyzed using solid-state NMR, with the goal of elucidating morphological changes that influence fiber tensile properties. Combination of X-ray diffraction (XRD) and differential scanning calorimeter (DSC) indicated that the drawn PLA fibers consisted of different proportions of α crystalline and amorphous forms. 13C CP-MAS NMR spectra showed amorphous-like broad singlet signals, of which the full width at half maximum (FWHM) decreased with increasing crystallinity and crystal orientation. The T1H value decreased by interaction with additives and increased with increasing crystal orientation. The interaction with additives also reduced T1C values, which increased with increasing crystallinity. Use of organic clay enhanced the crystallization of high draw-ratio PLA fibers due to nucleation, which increased tensile strength; this effect gradually decreased with time during accelerated weathering. In contrast, the plasticization due to the addition of flexible polymers increased fiber elongation, which rapidly dropped during the degradation. Changes of FWHM, T1H, and T1C values indicated that the degradation occurred at sites within the amorphous portions of the PLA fibers containing organic clay, while the flexible polymers were preferentially degraded if they were present in the PLA fibers.

Solid-State Nuclear Magnetic Resonance (NMR) and Nuclear Magnetic Relaxation Time Analyses of Molecular Mobility and Compatibility of Plasticized Polyhydroxyalkanoates (PHA) Copolymers.

The molecular mobility and compatibility of plasticized polyhydroxyalkanoates (PHA) were investigated, focusing on changes due to copolymerization using either flexible poly (butylene succinate) (PBS) or rigid poly(lactic acid) (PLA) units. For the case of a poly(3-hydroxybutyrate) (PHB) unit in plasticized PHA, copolymerization of either PBS or PLA decreased ¹H and 13C spin-lattice relaxation times in the laboratory frame (T1H and T1C) in the same manner, while PBS produced a lower ¹H spin-lattice relaxation time in the rotating frame (T1ρH) than PLA. Both the signals of ¹H MAS (magic-angle spinning) and 13C PST (pulse saturation transfer) MAS nuclear magnetic resonance (NMR) spectra were sharpened and increased by copolymerization with PBS. A variable temperature relaxation time analysis showed that the decrease of T1H values was dominated by the ¹H spin diffusion via the interface between PHB and the added polyester because of the good compatibility. Meanwhile, the decrease of T1C values was dominated by increasingly rapid molecular motions of PHB because of the lowered crystallinity due to the plasticization. Slow molecular motions (kHz order) were enhanced more by the addition of PBS than PLA, although rapid molecular motions (MHz order) were enhanced by either polyester. Several NMR parameters were beneficial for analyzing the manufacturing process as the indexes of polymer compatibility and molecular motions.

A Case of Neuroendocrine Carcinoma Developing from the Broad Ligament of the Uterus.

Neuroendocrine carcinoma (NEC), also called small cell carcinoma or large cell carcinoma, is a rare and aggressive tumor that develops mainly in the lung and intestine. More rarely, NEC develops in gynecologic organs, with poor prognoses. We experienced a case of NEC in the broad ligament of the uterus. The patient was a 74-year-old woman with symptoms of abdominal distension and constipation. Ultrasound sonography detected an abdominal tumor larger than 10 cm. She was then admitted to our hospital. She underwent surgery under the diagnosis of ovarian cancer, but the bilateral ovaries and uterus were normal in appearance, and a tumor was developing instead from the broad ligament of the uterus. The patient then received a hysterectomy, salpingo-oophorectomies, and lymphadenectomy, and the peritoneal membrane was stripped around the pelvic space. Despite our suggestion, she never accepted the adjuvant treatment. She discontinued her periodic follow-up with and was followed in another hospital. Generally, the prognosis of NEC is poor, and there is no established treatment for a tumor in a gynecologic lesion. However, we anticipate that the accumulation of experience treating such cases will eventually lead to a standard treatment for NEC.

Solid-state NMR study on changes of phosphate and proton species in metal pyrophosphate composite (MP2 O7 -MO2 ) ceramics.

In order to investigate the effects of composite production and the role of the counter cation for metal phosphate conductors, changes in the solid-state nuclear magnetic resonance (NMR) spectra and magnetic relaxation times caused by the removal of volatile products and water washing were examined for various metal pyrophosphate (MP2 O7 -MO2 ; M = Sn, Si, Ti, and Zr). Acidic species could be detected by 1 H MAS NMR spectra for all the composites except ZrP2 O7 -ZrO2 that had the lowest conductivity. The 31 P DD-MAS NMR spectra for MP2 O7 -MO2 composites showed different signal patterns depending on the counter cations participating in the ion exchange as a result of different microstructures. Combinational analysis of 31 P DD-MAS and 31 P CP-MAS NMR spectra of the composites indicated that protonic bulk phosphates were observed at slightly lower fields than non-protonic bulk phosphates in all of the MP2 O7 -MO2 composites. After water washing, the acidic species and the protonic bulk phosphates of MP2 O7 -MO2 composites disappeared or were reduced to trace amounts. The T1 H values of the water-washed composites lengthened because of removal of orthophosphoric acid, although the T1 P values remained almost unchanged. The results of the solid-state NMR studies suggest that the protonic bulk phosphates of MP2 O7 -MO2 composites do not generally distribute in the bulk but exist in the interface between excess H3 PO4 and the bulk. Copyright © 2016 John Wiley & Sons, Ltd.

Combined large-cell neuroendocrine carcinoma and endometrioid adenocarcinoma of the endometrium: A case report and survey of related literature.

Primary large-cell neuroendocrine carcinoma of the endometrium is extremely rare and has a poor prognosis. This report describes a case of combined large-cell neuroendocrine carcinoma and endometrioid adenocarcinoma of the endometrium diagnosed as stage IIIA. The patient underwent surgery and chemotherapy and has been well with no evidence of disease for 20 months. The optimal treatment for this rare tumor has not been established. Considering its rarity and variability, it is difficult to establish an evidence-based therapeutic regimen.

A Case of Lymphoepithelioma-like Carcinoma in the Uterine Cervix.

Lymphoepithelioma-like carcinoma occurring in the reproductive organs is a rare variant of squamous cell carcinoma, and this tumor of the uterine cervix accounts for 0.7% of all primary cervical uterine neoplasms. Associations with Epstein-Barr virus (EBV) and human papilloma virus (HPV) have been demonstrated in some studies. Some investigators suggested that EBV has an important role in the initiation of lymphoepitheliomalike carcinoma in Asian women. Here we report the case of a 45-year-old Japanese woman, gravida 2 and parity 2. She was admitted due to severe atypical genital bleeding caused by uterine cervical cancer. A >60-mm tumor was detected at the uterine cervix, and no distal metastasis or swallowing of lymph nodes was revealed by magnetic resonance imaging and a computed tomography scan. The cervical cancer stage FIGO Ib2 was diagnosed, and a radical hysterectomy was performed for this malignant tumor. The in situ hybridization for EBV was negative. HVP infection was strongly suspected because the squamous cell carcinoma was observed macroscopically in the uterine cervix. The prognosis of uterine lymphoepithelioma-like carcinoma is thought to be better than those of other cervical cancer types, but careful follow-up at fixed intervals is recommended. The patient has been followed up for 4 months since her surgery, and no evidence of recurrence has been detected.

A case of successful laparoscopic surgery for tubal stump pregnancy after tubectomy.

The incidence of ectopic pregnancy is approximately 1.3-2% of all pregnancies, and more than 90% of ectopic pregnancies are detected in the ampulla of the fallopian tube. Ectopic pregnancy occurring in tubal stump after tubectomy is extremely rare, and the frequency of tubal stump pregnancy is approximately 0.4% of all pregnancies. We report one of these rare cases of ectopic pregnancy in a 26-year-old Japanese woman, gravida 4, parity 1. She had undergone laparoscopic tubectomy because of a tubal pregnancy two years ago. She was presented to our hospital with a positive pregnancy test, but no gestational sac was detected in the uterus by echography, even though the level of human chorionic gonadotropin (hCG) in the blood was elevated to 8,900 mIU/mL. Laparoscopic surgery for ectopic pregnancy was performed. During surgery, the position of the pregnancy was found to be in the tubal stump, where tubectomy had already been performed, and the gestational sac was successfully removed. After the surgery, the condition of the patient uneventfully improved and she was discharged from the hospital three days after the surgery. The diagnosis of tubal stump pregnancy is more difficult than that of the more common positions of an ectopic pregnancy in the fallopian tube, and so it is more important to carefully examine the patients with suspected ectopic pregnancy. Laparoscopic surgery is one of the options for tubal stump pregnancy if diagnosed early and if the condition of the patient is stable.

Functioning endometrium and endometrioma in a patient with mayer-rokitanski-kuster-hauser syndrome.

Mayer-Rokitanski-Kuster-Hauser (MRKH) syndrome is a rare disease. A 27-year-old woman was admitted for primary amenorrhea and cyclic pelvic pain. Magnetic resonance imaging (MRI) revealed bilateral Müllerian remnants with functioning endometrium and a pelvic mass considered to be an endometriotic cyst. Bilateral Müllerian remnants were removed, and right ovarian cystectomy was performed at laparoscopic surgery. Accurate evaluation before the operation and informed consent are necessary to treat patients with MRKH syndrome.

Three cases of immature teratoma diagnosed after laparoscopic operation.

While mature cystic teratoma of the ovary is the most common ovarian tumor in young women, immature teratoma is a very rare tumor, representing only 1% of all ovarian cancers. In the three cases presented here, young women who were suspected to have mature cystic teratoma, based on CT scan and MRI, were ultimately diagnosed with immature teratoma Ic (b) G1 after laparoscopic operation. They underwent salpingo-oophorectomy of the affected side only and have shown no sign of recurrence during follow-up. We sometimes encounter patients with immature teratoma who have no findings pointing to malignancy on CT or MRI. Generally, if the components of immature nerve cells that represent immature teratoma are very few, it is difficult to diagnose the entity as immature teratoma with imaging evaluations such as CT or MRI. In many hospitals, laparoscopic surgery is selected for patients with ovarian mature teratoma. Therefore, it is essential to attempt as much as possible not to disseminate the fluid content of the tumor into the intra-abdominal space during laparoscopic operation, because in rare cases the tumor turns out not to be benign mature teratoma.