Association between spontaneous ovulation and serum anti-Müllerian hormone levels in a premature ovarian insufficiency patient after a multimodal treatment for breast cancer.

The high toxicity of chemotherapy can damage a patient's gonadal function, leading to premature ovarian insufficiency (POI). Here, we report the case of a patient suffering from POI after chemotherapy for breast cancer, who 3 years later ovulated spontaneously and became pregnant. The patient, a 31-year-old infertile women, nulligravida, was diagnosed with breast cancer. The Anti-Müllerian Hormone (AMH) level in her serum was 1.85 ng/mL before multimodal treatment for cancer. She later visited our hospital for amenorrhea and 2 years after cancer treatment, she was diagnosed with POI. Her AMH level at that point was less than 0.1 ng/mL. One year after the diagnosis of POI, the patient's AMH level increased slightly to 0.14 ng/mL and she ovulated spontaneously. The patient later became pregnant using Assisted Reproductive Technology on the fourth attempt.During the course of treatment for infertility at our hospital, the AMH levels in her serum changed along with the recovery of ovarian function. These findings suggest the possibility that ovulation and pregnancy could be predicted by the chronological changes of the AMH levels in the patient's serum.

Possible Role of 5-Hydroxytryptamine (5-HT) Receptor on Human Sperm Motility Regulation.

The purpose of this study is to examine whether 5-hydroxytryptamine (5-HT, also known as serotonin) regulates human sperm motility, focusing on 5-HT receptors. Immunofluorescent staining revealed the existence of seven types of 5-HT receptors with a heterogeneous pattern of reactive sites. In detail, 5-HT1B, 5-HT6, and 5-HT7 were detected in the post-acrosomal and mid-piece regions. The 5-HT2A and 5-HT5A receptors were mainly localized in the equatorial segment. 5-HT3A and 5-HT4 receptors were present in the neck and post-acrosomal regions. When examining the effects of 5-HT receptor antagonists on sperm motility, only the 5-HT2A receptor antagonist significantly reduced sperm motility. This suggests that the 5-HT2A receptor may have a regulatory function in sperm motility. Eventually, progressive motility should be attenuated to penetrate the oocyte for fertilization. The current study indicated heterogenous expression patterns and plausible functions of 5-HT receptors in human sperm.

Extraskeletal Myxoid Chondrosarcoma of the Vulva: A Case Report.

Extraskeletal myxoid chondrosarcoma (EMC) of the vulva is extremely rare. We report our experience with a case of disease control by radiation therapy to a localized lesion of EMC. A 41-year-old woman presented to our clinic with a vulvar mass. Magnetic resonance imaging showed a 15 cm mass between the perineum and the medial thigh muscle. It was the "adductor magnus muscle." After the needle biopsy, a histopathological diagnosis of EMC was made. Tissue genomic analysis detected the EWSR1-NR4A3 fusion gene. A joint operation by the Department of Orthopedics, Gynecology, and Plastic Surgery was performed, which included a wide excision of the perineum, partial excision of the medial thigh muscle, and rectus abdominis valvuloplasty. Intraoperatively, pubic infiltration was detected. Postoperative pelvic radiotherapy was administered as adjuvant therapy. Recurrent common iliac lymph node metastases outside the irradiation field and multiple lung metastases were observed. Pazopanib was administered as adjuvant therapy. Pulmonary metastases were controlled, but the pelvic tumor had spread, so the patient underwent radiation therapy. After second-line chemotherapy with doxorubicin, left pleural effusion and mediastinal lymph node metastasis appeared, and third-line chemotherapy with eribulin mesylate was administered. The pleural effusion improved, but the patient developed cough again, and trabectedin was administered as the fourth chemotherapy. In this case, there was no local recurrence for three years after radiotherapy, suggesting the effectiveness of radiotherapy in local control.

Medroxyprogesterone as the Initial Systemic Treatment of Recurrent Endometrial Cancer: A Single Institutional Study.

BACKGROUND/AIM: Hormonal treatment is the preferred initial systemic therapy for patients with advanced or recurrent G1 or G2 endometrial cancer (EC) in terms of efficacy, toxicity, and economy. Few reports are available on the topic and we, therefore, conducted a retrospective study. PATIENTS AND METHODS: Patients with EC who received high-dose medroxyprogesterone (MPA) at our Hospital between January 2010 and December 2022 were reviewed. Patients who were treated for fertility preservation or had a history of systemic chemotherapy other than adjuvant therapy were excluded. RESULTS: Sixteen patients who were eligible for study inclusion had recurrent G1 or G2 EC. Their median age was 65 years (range=51-82 years), median body mass index was 22.6 kg/m2 (range=15.3-43.2 kg/m2), and all patients had an ECOG Performance Status of 0. All patients received 200 mg/day of MPA, and eight patients concomitantly received 100 mg/day of aspirin. None of the patients experienced severe adverse events. One patient had grade 2 deep vein thrombosis. Two patients discontinued MPA treatment because of adverse events. The response rate was 44% [95% confidence interval (CI)=20-68%] and median progression-free survival (PFS) was 6.9 months (95% CI=7.5-26 months). Four of 16 patients had PFS longer than 12 months, all of whom had positive tissue estrogen receptor (ER) and progesterone receptor (PR), and PFS at 2 years was 35% (95% CI=10.2-59.8%). CONCLUSION: Hormone therapy is effective long-term in ER- and PR-positive EC and can be recommended as initial systemic therapy. Toxicity is mild and manageable.

The chronological change in transvaginal ultrasound images of a hemorrhagic ovarian cyst observed during infertility treatment: A case report and literature review.

Insights gained from chronological ultrasonogram images in the current case report will provide useful information for diagnosing and conservatively treating HOC. This could help avoid unnecessary laparotomy.

A Case of a Pregnant Woman with Thrombosis in an Artificial Aortic Valve Resulting in Severe Cerebral Hemorrhage in the Newborn.

Many patients, after artificial valve replacement surgery, receive warfarin anticoagulant therapy. However, it has been reported that warfarin administration during pregnancy can cause fetal teratogenicity. With reference to this case, we will discuss how warfarin administration in mid-pregnancy caused severe cerebral hemorrhage in the newborn child. The 36-year-old patient in this case underwent aortic valve replacement surgery when she was 11 years old; this requires the continued use of warfarin after surgery. Although she was advised otherwise, the patient became pregnant. The warfarin treatment was discontinued at 5 weeks of gestation and she began self-injection of heparin; however, her health quickly deteriorated requiring an emergency, warfarin treatment. On gestation week 21, she was admitted to our hospital with a high likelihood of a spontaneous abortion. A week later, transesophageal ultrasonography revealed a thrombus in the patient's aortic valve. Because of this finding, we re-started warfarin administration. At 32 weeks of gestation, cardiotocography showed decreased fetal heart rate; thus, an emergency Cesarean section was performed. A baby was delivered, weighing 1,702 g with an Apgar Score of 1 at 1 minute and 4 at 5 minutes. Cranial computed tomography of the infant showed bilateral intraventricular hemorrhage and ventricular dilation. In order to protect the mother and prevent hemorrhage in the newborn, it is recommended that a continuous heparin infusion should be administered to the pregnant woman after the 36th week of gestation. Regarding the impact on the infant, it is considered that continuous intravenous administration of heparin is safer during the third trimester of pregnancy. However, administration of heparin alone makes the preventive effect of thrombosis uncertain. When warfarin is administered in pregnancy, pregnancy management should be performed bearing the risk of fetal cerebral hemorrhage in mind.