Conservative management of decidualized ovarian endometriotic cyst during pregnancy mimicking malignancy: case report and a review of the literature.

We report here the case of a 30-year-old woman with a decidualized ovarian endometriotic cyst (DOEC) during pregnancy mimicking malignancy occurring after fertility-preserving surgery for ovarian carcinoma arising from an endometriotic cyst. Intracystic excrescences appeared in the left ovarian endometriotic cyst at five weeks and three days of gestation. The serum CA-125 level rose to 676.7 U/ml (normal, 0-35). Based on these findings, ovarian carcinoma arising from the left ovarian cyst was strongly suspected. Frequent sonographic examinations revealed that the sizes and quality of the intracystic excrescences remained essentially unchanged. The cyst was evaluated for DOEC during pregnancy. The patient eventually delivered a male infant by normal vaginal delivery. After the delivery, the intracystic excrescences in the left ovarian endometriotic cyst disappeared. Close observation may be a reasonable alternative to antepartum surgery in patients with a DOEC during pregnancy.

Ovarian sex cord-stromal tumor, unclassified: case report of endocrinologic findings and review of the literature.

Endocrinologic findings and a successful pregnancy in a 39-year-old woman with significant androgen excess due to a biologically active, virilizing ovarian sex cord-stromal tumor, unclassified, are described. She had secondary amenorrhea, infertility, and hirsutism. Her basal plasma testosterone level was high at 187 ng/mL (normal range: 10-85 ng/mL). Tumor resection resulted in resumption of ovulation, pregnancy, and delivery.

Complete remission of ovarian endometrioid adenocarcinoma associated with hyperamylasemia and liver metastasis treated by paclitaxel and carboplatin chemotherapy: a case report.

Complete remission in the case of a 45-year-old woman with ovarian endometrioid adenocarcinoma associated with hyperamylasemia and liver metastasis is described. Ultrasound examination and CT scan revealed several large solid and cystic intra-abdominal tumors and a metastatic liver tumor. The serum amylase was 600 micro/l (normal value: 60-200 micro/l), and electrophoresis identified isoamylases of the salivary type. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed for invasive carcinoma of the left ovary. The histology of the left ovary showed endometrioid adenocarcinoma. Immunohistochemically, the adenocarcinoma cells were diffusely and strongly positive for amylase. The patient received six courses of paclitaxel and carboplatin combination chemotherapy. Two years later, the patient is alive and well, without evidence of disease. The prognosis of patients with ovarian cancer metastatic to the liver is uniformly poor. This represents the first report of complete remission of such a patient in the literature.

Effect of repeated local minocycline administration on periodontal healing following guided tissue regeneration.

BACKGROUND: Infection after a periodontal surgical site has been prepared for guided tissue regeneration (GTR) is one of the common complications that can compromise healing. The purpose of this study was to assess the effect of repeated local antimicrobial therapy following GTR for improving clinical attachment gains, and to histologically evaluate the various cell populations and bacterial contamination of the retrieved expanded polytetrafluoroethylene membrane (ePTFE). METHODS: Forty periodontal intrabony defects in 40 patients were treated by a flap procedure that included the use of ePTFE membranes to allow GTR. Patients were randomly assigned to 2 treatment groups: 20 patients were treated with the ePTFE alone (control group), and the other 20 were treated with the ePTFE combined with the administration of a weekly repeated local application of minocycline ointment for 8 weeks after membrane placement (test group). The membranes were retrieved 6 weeks after the initial surgery and sectioned serially in a coronal-apical plane. The sections were then divided into 9 fields and examined by light microscopy for the presence of inflammatory cells and oral bacteria. Clinical measurements were taken at the time of baseline examination and at a 6-month follow-up examination after removal of the ePTFE. RESULTS: At the 6-month follow-up examination, control and test groups showed significant improvement; i.e., reduction in the probing depth and increased clinical attachment gain compared with the values at the baseline examination. However, the mean clinical attachment gain of the test group (3.0+/-0.3 mm) was significantly (P = 0.03) greater than that of the control group (2.0+/-0.5 mm). Histologically, the total number of the cells of both groups was similar. In both groups, mononuclear cells were dominant and fibroblasts, neutrophils, and plasma cells were rarely encountered. There was a tendency for the number of macrophages to be somewhat higher in the control group. The total number of bacteria in the test group was significantly less than that in the control group. The number of bacteria in both control and test groups decreased toward the apical portion. CONCLUSIONS: In the present study, clinical attachment gain of intrabony defects following GTR was favorable with repeated local administration of minocycline ointment. However, a complete microbial eradication was not achieved.

Unsuspected extra-adrenal pheochromocytoma simulating ovarian tumor.

We report on a case of an extraadrenal pheochromocytoma simulating an ovarian tumor. Before intervention, the patient exhibited no symptoms suggestive of pheochromocytoma. Nevertheless, during surgery she experienced marked blood pressure fluctuations, and an unsuspected extraadrenal pheochromocytoma was diagnosed. Thus, although rare, when preparing to remove a pelvic mass, the gynecologist should consider the possibility of an extraadrenal pheochromocytoma.

Inflammatory cell population and bacterial contamination of membranes used for guided tissue regenerative procedures.

The purpose of this study was to determine the types of inflammatory cells and bacterial contamination on expanded polytetrafluoroethylene (ePTFE) membranes which might affect new tissue formed by guided tissue regeneration (GTR). Forty periodontal bony defects were treated by the flap procedure, which included the use of an ePTFE membrane. Twelve months after the second surgery, the defect sites were re-evaluated for changes in probing depth and clinical attachment level. The ePTFE membranes were retrieved after 4 to 6 weeks of healing and sectioned serially at 3 microm in a coronal-apical plane. The ePTFE membrane was divided into 3 portions: cervical, middle, and apical, each of which was subdivided into outer, central, and inner segments, providing a total of 9 fields. Cells and bacteria were analyzed by light microscopy for their types: mononuclear cell, erythrocyte, fibroblast, neutrophil, plasma cell, T lymphocyte, B lymphocyte, macrophage, and oral bacteria. Both cells and bacteria decreased in number towards the apical portion and were present even in the central part. Most cells were mononuclear cells. Erythrocytes, fibroblasts, neutrophils, and plasma cells were rarely encountered. Bacteria, most of which were Gram-positive, were observed in almost the same number in the outer and inner parts. The results indicate that numerous inflammatory cells adhered to and invaded the ePTFE membranes accompanied by bacterial contamination and that there was a tendency for a negative correlation between the increment number of bacteria and the gain of clinical attachment level.

Mucinous adenofibroma of the ovary: case report of the endocrinologic findings.

Endocrine and clinicopathologic findings in a 77-year-old woman with ovarian mucinous adenofibroma of borderline malignancy are reported. The preoperative levels of testosterone, androstenedione, estrone, and estradiol in her peripheral blood were 91 ng/ml, 3.78 ng/ml, 82 pg/ml, and 35 pg/ml, respectively, abnormally high. Those of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were < 0.5 mIU/ml and 12.1 mIU/ml, respectively. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Pathologic diagnosis of the right ovarian tumor was mucinous adenofibroma of borderline malignancy with hyperthecosis. Postoperatively, the levels of sex steroids and gonadotropin returned to the normal range of a postmenopausal woman. The patient remains well 2 years and 6 months after the operation.

Scanning electron microscopic and immunohistochemical studies of pelvic endometriosis.

The pathogenesis of pelvic endometriosis has been studied by using scanning electron and light microscopy, observing the surface structure of bluish lesions obtained from 26 patients during laparotomy. Paraffin sections included another 17 tissue samples of endometriosis, based on immunohistochemical responses to epithelial membrane antigen, keratin and vimentin. Ultrastructurally, the surface epithelial cells could not be detected in 13 out of 17 pelvic peritoneal endometriosis samples. In one case in which the surface peritoneal cells were seen histologically to dip into the subperitoneal stroma, many surface peritoneal infoldings were observed, and ciliated cells were detected at the edge of these infoldings. Ovarian endometriosis was composed of three types of cells, none of which had any cilia. These findings were observed in continuity with adjacent normal mesothelial cells. No characteristic structure of the endometrial surface was observed for the bluish lesion, but the gland surface of endometriosis located in the subperitoneal stroma initially had ciliated cells. The immunoreactions in both the columnar mesothelial cells with surface peritoneal infoldings and the glands of endometriotic tissues were similar to those of normal endometrial glands, but different from those of normal mesothelial cells. Pelvic endometriosis might originate by a process of metaplasia from the pelvic peritoneum.

[Endosalpingosis in the pelvic peritoneum and pelvic lymph nodes].

The pelvic peritoneum with macroscopic findings characteristic of endometriosis was biopsied in 18 cases at conservative surgery for endometriosis and examined. Pelvic lymph nodes removed in 76 cases at radical surgery for uterine cervical, corpus cancer or ovarian cancer patients were examined. In 3 of the 18 cases, endosalpingiosis was encountered in the pelvic peritoneum. In 2 of these 3 cases combined lesions of endometriosis and endosalpingiosis were observed. On the other hand, in 4 of the 76 patients with gynecological malignancies, benign glandular inclusions were found in pelvic lymph nodes. In 3 of these 4 patients, there was endosalpingiosis, and another there was endometriosis. Endosalpingiosis is an interesting lesion offering some clues to the histogenesis of endometriosis, and important in the differential diagnosis of malignant tumors.

Human T-cell leukemia virus type I infection as an oncogenic and prognostic risk factor in cervical and vaginal carcinoma.

The seroprevalence of human T-cell leukemia virus type I (HTLV-I) antibody in 6701 healthy females and 226 women with gynecologic malignancies, all living in an adult T-cell leukemia-endemic area in southwestern Japan, was investigated to determine whether HTLV-I infection was a risk factor influencing oncogenesis and prognosis. The seroprevalences in cervical carcinoma patients younger than 59 years and in vaginal carcinoma patients of all ages were significantly higher than in age-matched healthy controls. The ratios of observed to expected HTLV-I seroprevalence in patients younger than 59 with cervical carcinoma and in vaginal carcinoma patients were 2.92 and 7.36, respectively. Among the patients with cervical carcinoma or vaginal carcinoma, the tumor recurrence rate in HTLV-I carriers was significantly higher than that in HTLV-I seronegative patients. Our results suggest that HTLV-I infection may be oncogenic and may affect the prognosis in some patients with cervical or vaginal carcinoma.

Angiosarcoma of the vagina. A light and electronmicroscopy study.

A 73-year-old woman, whose medical history reported radical hysterectomy and radiotherapy for squamous cell carcinoma of the cervix uteri 20 years earlier, was found to have an angiosarcoma of the vagina. The histological diagnosis was confirmed by immunohistochemical staining of tumor cells for factor VIII-related antigen and ultrastructurally defined vasoformative structures. Primary angiosarcoma of the vagina is quite rare and reported in only two published cases. The present case is a third in general, and the first report confirmed by light microscopy, immunohistochemical, and electronmicroscopy studies.

Theca lutein cysts with maternal virilization and elevated serum testosterone in pregnancy.

A clinicopathological study was performed on a pregnant patient with bilateral multiple ovarian cysts, who presented with pre-eclampsia, marked virilization and exceedingly high levels of serum testosterone. The female fetus showed no evidence of virilization. Microscopic examination of the ovaries revealed theca lutein cysts with granulosa cells which showed the existence of testosterone by immunoperoxidase staining.

Second trimester abortion using laminaria tents followed by 16, 16-dimethyl-trans-delta2-prostaglandin E1 methyl ester gemeprost for missed abortion and for legal abortion.

PIP: In an effort to reduce the side effects associated with use of prostaglandins for 2nd-trimester abortion, some prostaglandin analogues with abortifacient agents have been synthesized and subjected to clinical trials. 1 such synthetic analogue, Gemeprost, is effective in 1st and 2nd-trimester abortion without cervical dilatation when laminaria tents are used. This study examined the efficacy of gemeprost in 2nd-trimester missed abortion (10 women) and in normal pregnancies selected for legal abortion (10 women). Laminaria tents were inserted for 10 hours and then removed. At this point, a vaginal pessary containing 1 mg of gemeprost was inserted in the posterior fornix every 3 hours until the uterine contents were expelled. Gemeprost was most effective in the missed abortion group (8/10 cases of complete abortion compared to 4/10 cases of complete abortion in the normal pregnancies). The mean induction-delivery interval was shorter (223 minutes) in the missed abortion group than in the legal abortion group (396 minutes), even though the mean number of laminaria tents used was smaller in the former group (3 versus 8). The total dose of gemeprost per mcg/kg of body weight was also less in the missed abortion group (mean of 26.1) than in the legal abortion group (36.4). 9 of the 20 patients reported side effects, predominantly diarrhea, but all were reversible and mild. The overall complete abortion rate in this study was 60%. It is concluded that gemeprost used after laminaria is convenient, safe, and effective for the termination of 2nd-trimester pregnancy especially in cases of missed abortion.^ieng

A case of meconium peritonitis: the pathological findings.

An autopsy case of meconium peritonitis is described. This baby was born at 24 weeks of gestation. The pathological findings were generalized peritonitis and this inflammation spread to the umbilical cord. It can be thought that the cause of premature labor may be in part some inflammatory process.

Small cell carcinoma of the endometrium associated with adenosquamous carcinoma: a light and electron microscopic study.

This report describes a 64-year-old woman with a primary small cell carcinoma of the endometrium associated with adenosquamous carcinoma. The light microscopic features resembled those of small cell carcinoma of the lung and those of the uterine cervix, and foci of adenosquamous carcinoma lay scattered sparsely in the small cell carcinoma. Electron microscopy revealed cytoplasmic neurosecretory type granules. The neoplasm behaved in a very aggressive manner such that at 3 months after surgery a metastatic neoplasm appeared in the vagina. This case is a rare example of an endometrial carcinoma with differentiation toward endocrine as well as adeno and squamous cell carcinoma.

[Clinical studies of 145 cases of endometrial carcinoma--analysis of prognostic factors, especially pathological types].

One hundred and forty-five patients with confirmed endometrial carcinoma treated at Kumamoto University Hospital were studied from the clinicopathological point of view. As risk factors, the incidence of high age, postmenopause, atypical genital bleeding, sterility, nulliparity, diabetes mellitus, hypertension and obesity was showed to be high. These factors may be expected to assist in screening for early diagnosis by using each factor or combination of factors. As prognostic factors, we examined the relationship between stage, depth of myometrial invasion, histological grade, histological type and survival rate. The stage was shown to be a most important predicator of survival. The depth of myometrial invasion and the histological grade closely correlated with the stage. The relationship between the histological subtype, especially papillary serous carcinoma (PSC) and prognosis, was investigated in our series of studies. PSC found in an incidence of 9.4% had a relatively poor prognosis compared with endometrioid carcinoma. Its 5-year survival rate was only 30%. Because PSC has a potential for aggressive invasion and rapid metastasis as compared to endometrioid carcinoma, careful histological examination and aggressive treatment are warranted.