Ovarian dysgerminoma with Müllerian anomaly: a case report

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.

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.

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.

Is massive proteinuria associated with maternal and fetal morbidities in preeclampsia?

OBJECTIVE: The aim of this study was to investigate whether massive proteinuria in preeclampsia is associated with maternal and fetal complications. METHODS: We retrospectively analyzed the clinical records of 233 patients who were diagnosed with preeclampsia. We divided the preeclamptic patients into three groups based on the amount of proteinuria: massive (≥5 g/24 hr), moderate (2 to 5 g/24 hr) and mild (<2 g/24 hr) proteinuria group. We analyzed the clinical characteristics and maternal and neonatal complications among three groups. RESULTS: Gestational age at diagnosis and delivery were lower in women with massive and moderate proteinuria group than women with mild proteinuria group (31.5±3.1 vs. 32.3±3.6 vs. 34.0±3.5 weeks, P<0.001 for gestational weeks at diagnosis; 34.6±3.6 vs. 35.1±4.1 vs. 36.9±4.0 weeks, P=0.001 for gestational age at delivery). In maternal complications, the incidences of pleural effusion and retinal detachment were significantly different among three groups (29.9% vs. 22.4% vs. 9.0%, P=0.004 for pleural effusion; 11.5% vs. 3.0% vs. 1.3%, P=0.009 for retinal detachment). Creatinine levels were higher and albumin levels were lower in the massive proteinuria group than in the moderate and mild groups. However, other maternal and neonatal complications were not significantly different among three groups. CONCLUSION: Massive proteinuria might be associated with renal albumin excretion-related morbidity, such as pleural effusion, retinal detachment, and low serum albumin levels. Furthermore, it was associated with early-onset preeclampsia and early delivery.

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.

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.

Chorioamniotic membrane separation caused by the seromucinous collection from a placental chorioangioma

Placental chorioangioma is a benign non-trophoblastic tumor of the placenta that can have various adverse effects on the mother and fetus depending on its size. Chorioamniotic membrane separation is rare condition of detachment between the amniotic membrane and chorionic membrane. Chorioamniotic membrane separation after the second trimester of pregnancy is usually occurs after invasive procedures or may occur spontaneously; it is mostly associated with fetal abnormalities. Here, we report a case of chorioamniotic membrane separation that might be occurred caused by the seromucinous secretion from a placental chorioangioma.

Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge

OBJECTIVE: We investigated the features of endometrial hyperplasia with concurrent endometrial cancer that had been diagnosed by endometrial sampling. Further, we attempted to identify an accurate differential diagnostic method. METHODS: We retrospectively studied 125 patients who underwent a diagnostic endometrial biopsy or were diagnosed after the surgical treatment of other gynecological lesions, such as leiomyoma or polyps. Patients were diagnosed between January 2005 and December 2013 at Busan Paik Hospital. Clinical and histopathological characteristics were compared in patients who had atypical endometrial hyperplasia with and without concurrent endometrial cancer. RESULTS: The patients were grouped based on the final pathology reports. One hundred seventeen patients were diagnosed with endometrial hyperplasia and eight patients were diagnosed with endometrioid adenocarcinoma arising from atypical hyperplasia. Of the 26 patients who had been diagnosed with atypical endometrial hyperplasia by office-based endometrial biopsy, eight (30.8%) were subsequently diagnosed with endometrial cancer after they had undergone hysterectomy. The patients with endometrial cancer arising from endometrial hyperplasia were younger (39.1 vs. 47.2 years, P=0.0104) and more obese (body mass index 26.1+/-9.6 vs. 23.8+/-2.8 kg/m2, P=0.3560) than the patients with endometrial hyperplasia. The correlation rate between the pathology of the endometrial samples and the final diagnosis of endometrial hyperplasia was 67.3%. CONCLUSION: In patients with atypical endometrial hyperplasia, the detection of endometrial cancer before hysterectomy can decrease the risk of suboptimal treatment. The accuracy of endometrial sampling for the diagnosis of concurrent endometrial carcinoma was much lower than that for atypical endometrial hyperplasia. Therefore, concurrent endometrial carcinoma should be suspected and surgical intervention should be considered in young or obese patients who present with atypical endometrial hyperplasia.

Clinical efficacy review on cases of laparoscopic myomectomy / 대한산부인과내시경학회지

OBJECTIVE: To report the safety and clinical efficacy of laparoscopic myomectomy. METHODS: We analyzed retrospectively the data for 74 laparoscopic myomectomy performed at Inje University Busan Paik Hospital beween 2005 and 2009. With medical records, we analyzed data on the patient's age, parity, BMI, size, weight and location of myoma, previous operative history, preoperative indication, operating time, blood loss, change of hemoglobin concentration from preoperative to postoperative state, hospital stay. RESULTS: The mean age of the patients was 39.5+/-6.9 years, parity was 1.4+/-1.0 and BMI was 22.1+/-2.6 kg/m2. The size of myoma by preoperative ultrasonography was 5.2+/-1.9 cm, the weight of removed myoma was 95.1+/-88.1 g. Most myomas were subserosal and intramural type. The operating time was 95.9+/-34.4 minutes, the change of hemoglobin concentration was 1.3+/-0.78 g/dL, and the hospital stay was 4.7+/-1.1 days. Postoperatively, transfusion was done in 2 cases, one patient was pregnant and underwent an cesarean section delivery during follow-up. CONCLUSION: Laparoscopic myomectomy was performed regardless of the size, the location of the myoma or the previous operative history and had good outcomes without complications in our hospital. Laparosocpic myomectomy is considered safe and reliable procedure in various types of myoma.

Experience of laparoscopic-assisted radical vaginal trachelectomy for 2 patients with cervical cancer stage I / 대한산부인과내시경학회지

Because of the organized screening programs, incidence and mortality of cervical cancer has been decreased and cervical cancer is diagnosed in relatively young age women and early stages. Traditional treatments for early cervical cancer are radical hysterectomy or chemoradiation, which irreversibly destroy reproductive capacity. Radical vaginal trachelectomy could be an alternative option for young women with early cervical cancer wishing to preserve fertility. Here, we report 2 cases of our initial experiences with Laparoscopy-Assisted Radical Vaginal Trachelectomy (LARVT) for patients with cervical cancer stage I. Two cases of 29 and 31-year-old nulliparous women were diagnosed with cervical cancer IA1-IA2. They underwent LARVT with permanent cervicoisthmic cerclage with 3 cycles of adjuvant chemotherapy. LARVT can be the procedure of choice for women with early stage cervical cancer who desire a fertility preservation.

Inhibition of cell growth and apoptosis in CaSki, cervical cancer cell line by arsenic compounds / 대한산부인과학회지

OBJECTIVE: To compare inhibition of cell growth and apoptosis in human cervical cancer cell lines (CaSki) by paclitaxel, cisplatin, arsenic trioxide and tetraarsenic oxide. METHODS: Inhibition of cell growth was determined by the water-soluble tetrazolium salts (WSTs) -1 assay. For apoptosis analysis in CaSki cell line treated with single or combination of two agents, CaSki cell line treated with each agent was stained with annexin-V/PI and flow cytometry was performed. RESULTS: Progression of apoptosis in CaSki cell line treated with paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide was time dependent. Inhibition of cell growth in CaSki cell line by paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide was dose and time dependent. Especially, tetraarsenic oxide was more effective in inhibition of CaSki cell growth compared to arsenic trioxide. Group treated with combination of cisplatin and tetraarsenic oxide showed more progressive apoptosis compared to other combination group. CONCLUSION: Tetraarsenic oxide has more potent anti-tumor effects than other agents on CaSki cell line. We need to consider further study about antitumor effect of tetraarsenic oxide through clinical study.

Two Case Review of Transvaginal Cervicoisthmic Cerclage / 대한주산의학회잡지

The conventional treatment of cervical incompetence is cerclage operation. In most cases, the classical surgical cerclage methods described by McDonald and Shirodkar are performed. The cervicoisthmic cerclage is beneficial for the treatment of patients who have short cervix due to conization, cervisectomy or congenital anatomical deformity of uterus. This procedure is different from the classical McDonald and Shirodkar cerclages in that the suture site is placed at the junction of the cervix and the isthmus of uterine body. There are two approaches in cervicoisthmic cerclages, transabdominal and transvaginal ones. The transvaginal cervicoisthmic cerclage is easier to perform and less dependent on uterine size compared with the transabdominal cerclage. In addition there is less chance of direct uterine handling associated with bladder laceraton or fetal loss in transvaginal cervicoisthmic cerclage. We report two cases of transvaginal cervicoisthmic cerclage for the first time in Korea, in which patients have delivered at full term by cesarean section.

A study on clinicopathological characteristics of ovarian masses / 대한산부인과학회지

OBJECTIVE: The aim of this study was to know the clinicopathological characteristics that help to make a decision about diagnosis and treatment of ovarian masses in Korean women. METHODS: Women who were undergone operations and histopathologically confirmed as ovarian masses at Inje University Busan Paik Hospital and Donrae Paik Hospital from January of 1997 to June of 2009 were enrolled in this study. Distribution according to histopathological types and ages were analyzed. RESULTS: Of the 2875 cases, there were 1078 cases (37.5%) of non neoplastic masses and 1797 cases (62.5%) of neoplastic masses. In the neoplatic masses, there were 1286 cases (44.7%) of benign tumors, 140 cases (4.9%) of borderline tumors and 371 cases (12.9%) of malignant tumors. Endometriomas were most common tumors (644 cases, 59.7%) among non-neoplastic masses. Mature cystic teratomas were the most common tumors (598 cases, 46.5%) among benign tumors. Mucinous cystadenomas were the most common types (105 cases, 75.0%) among borderline tumors. Epithelial ovarian cancers were the most common types (267 cases, 72.0%) among malignant tumors. As the result of age distribution, mature cystic teratomas were the most common types of the women of the first and second decade, endometriomas were the most common types of the women of the third and fourth decade, and benign epithelial tumors were the most common types of the women of fifth and after sixth decade. CONCLUSION: Taken as a whole, neoplastic ovarian masses were more common than non-neoplastic masses, but most common ovarian mass was endometrioma which is non-neoplastic mass.

A Case of Congenital Right Diaphragmatic Eventration / 대한주산의학회잡지

Congenital diaphragmatic eventration is defined as an abnormal elevation of the diaphragm resulting from developmental abnormality of muscle fibers during gestation. Differentiation between congenital diaphragmatic hernia (CDH) and eventration is very difficult but important for perinatal management and prognosis, because CDH is associated with higher perinatal and neonatal mortality. We describe a case that was initially diagnosed by prenatal sonography as a right CDH and later confirmed as a congenital diaphragmatic eventration after the delivery with a brief review of the literatures.

Maternal and Perinatal Outcomes of Early- and Late-onset Preeclampsia / 대한주산의학회잡지

PURPOSE: Early-onset preeclampsia is thought to be associated with fetal mortality and maternal complications. We compared maternal clinical characteristics, complications, and perinatal outcome between early- and late-onset preeclampsia. METHODS: We analysed retrospectively 212 pregnant women with preeclampsia between 2004 and 2008 at a tertiary university hospital. We divided preeclamptic women as early-onset (n=58), with an onset before 32 weeks gestation, and late-onset (n=154), with an onset after 32 weeks gestation. We compared maternal characteristics, maternal complications, and neonatal outcomes between the two groups. RESULTS: There were no significant differences in maternal age, parity, BMI, previous history of preeclampsia, hypertension, and DM between early- and late-onset preeclampsia. Among the maternal complications, maternal blood pressure was higher in early-onset preeclampsia without any statistical significance, but the amount of 24 hours urine protein was significantly higher in early-onset preeclampsia than late-onset (P=0.003). There were significantly higher rate of visual disturbance, elevated liver enzyme, pulmonary edema and severe disease in early-onset preeclampsia (all P<0.05). Comparing neonatal outcome, there were higher rate of fetal death in uterus (FDIU) (P=0.0001), low Apgar score (P<0.0001), and perinatal death (P<0.0001) in early-onset preeclampsia. Fetal birth weight and onset of preeclampsia were significant covariate factors for perinatal mortality. CONCLUSION: Early-onset preeclampsia was related to poor perinatal and materanl outcomes, but there was no difference in maternal characteristics. Further studies are necessary for prediction, pathogenesis, and therapy of early-onset preeclampsia.

The relationship between serum human papillomavirus 16 DNA and clinicopathological prognostic factors in cervical cancer patients / 대한산부인과학회지

OBJECTIVE: To study the relationship between serum human papillomavirus (HPV) deoxyribonucleic acid (DNA) and clinicopathologic prognostic factors and the clinical usefulness of serum HPV 16 DNA in cervical cancer patients. METHODS: All the patients were treated at our institution, from January, 2002 to February, 2007. DNA extracted from serum of 17 patients with HPV 16 infected carcinoma in situ and 65 patients with HPV 16 infected squamous cell carcinoma of the uterine cervix (stage IA-IIIB) were examined for HPV 16 DNA using polymerase chain reaction with types 16 specific E6 primer. Clinicopathological parameters were obtained from medical records, and the relationship between the discrete variables and serum HPV 16 DNA status were evaluated. RESULTS: HPV 16 DNA was not detected in serum from all patients with carcinoma in situ. However, among the 65 patients with HPV 16 infected squamous cell carcinoma of the uterine cervix, we detected 17 HPV 16 DNA positive samples (26.2%) in serum. Positive HPV 16 DNA in serum was correlated with age (P=0.0071), serum squamous cell carcinoma (SCC) antigen (P=0.0034), tumor size (P=0.0029), clinical stage (P<0.0001), deep stromal invasion (P=0.0048), resection margin positivity (P=0.0008), and pelvic lymph nodal metastasis (P=0.0040). CONCLUSION: The serum HPV 16 DNA in patients with cervical cancer was correlated with poor prognostic factors that need adjuvant treatment.

Analysis of residual tumor based on pathologic severity and site of positive margin after cold-knife conization of the uterine cervix / 대한산부인과학회지

OBJECTIVE: To evaluate correlation of sites of positive margin and residual tumor and to establish management after conization. METHODS: Of 599 cold-knife conizations [15 (2.6%) with cervical intraepithelial neoplasia (CIN) I, 37 (6.1%) with CIN II, 450 (75.1%) with CIN III, 97 (16.2%) with microinvasion] performed at our institution from January, 1993 to June, 2006, 144 patients (24.0%) had positive margins and 113 patients were included in the retrospective study excluding 31 cases that were not followed more than 12 months. Correlation of conization pathology and residual tumor according to sites of positive margin were evaluated. RESULTS: The prevalence rates of positive margins were 6.7% (1/15) in CIN I, 21.6% (8/37) in CIN II, 21.1% (95/450) in CIN III, and 41.2% (40/97) in microinvasion. The prevalence rate of positive margin increased with severity of conization pathology (P=0.0001). Of 113 patients followed more than 12 months, 27.4% (31/113) had residual tumor [0.0% (0/1) in CIN I, 12.5% (1/8) in CIN II, 18.9% (14/74) in CIN III, and 53.3% (16/30) in microinvasion]. The prevalence rate of residual tumor increased with severity of conization pathology (P=0.0028). Residual tumor was more common in patients in whom both endocervical and exocervical margins or in whom only the endocervical margin were involved than in those in whom only exocervical margin was involved [87.5% (7/8) or 35.3% (24/68) versus 0% (0/37), respectively]. CONCLUSIONS: Expectant management is reasonable for patients with positive margin after conization. However, careful follow-up of these patients is essential, particularly in endocervical involvement.

Comparisons of clinicopathologic characteristics and prognostic factors between squamous cell carcinoma and adenocarcinoma of the uterine cervical cancer patients underwent radical hysterectomy and pelvic lymphadenectomy / 부인종양

OBJECTIVE: To compare clinicopathologic characteristics and prognostic factors between squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the uterine cervix. METHODS: We reviewed medical records and pathologic reports of 568 patients with SCC and 78 patients with AC who underwent radical hysterectomy and pelvic lymphadenectomy from January 1988 to December 2004. We analyzed clinicopathologic factors and 5-years survival rate (5-YSR), and than compared 5-YSR between SCC and AC according to clinicopathologic factors. RESULTS: At the stage I, the incidence of AC (82.0%) was more than SCC (69.6%) and at the stage II, the incidence of SCC (30.4%) was higher than AC (18.0%). The rate of lymph-vascular space invasion was higher in SCC (28.2%) than AC (15.4%). The 5-YSR was not different between SCC (85.7%) and AC (86.9%). In multivariate analysis, depth of invasion, resection margin, pelvic lymph node metastasis were independent prognostic factors in SCC and FIGO stage, pelvic lymph node metastasis were independent prognostic factors in AC significantly. At the 5-YSR between SCC and AC, the prognosis of AC (50.0%) was poorer than SCC (78.0%) in the case of the one pelvic lymph node metastasis (p=0.0632). CONCLUSION: The FIGO stage and lymph-vascular space invasion were significant different in clinicopathologic characteristics between SCC and AC. The prognosis of AC was poorer than SCC in the case of the one pelvic lymph node metastasis (p=0.0632). But, the overall 5-YSR was not different between SCC and AC.

Peripartum Cardiomyopathy: 12 Cases / 대한산부인과학회지

OBJECTIVE: Our objective was to describe the clinical characteristics, diagnosis and treatment of 12 cases of peripartum cardiomyopathy (PPCM). METHODS: We retrospectively reviewed 12 cases of PPCM diagnosed by clinical and echocardiographic criteria between Jan 1997 and Dec 2004. RESULTS: The incidence of PPCM was 1 in 576 deliveries. The most common clinical and laboratory findings were dyspnea (100%), pulmonary edema (83.3%), and tachycardia (83.3%). The mean left ventricular ejection fraction (EF) was 34.2% (range, 23-44.6%), and the mean fractional shortening (FS) on echocardiography was 15.9% (range, 10.2-23%). Eight patients (67%) were diagnosed after delivery, and four patients (33%) were diagnosed before delivery. The mean interval from the onset of symptoms to evaluation with echocardiography was 72 hours (range, 7 hr-10 day). Suspicion and evaluation of PPCM was delayed in discharged women, our period of inexperience, and during the antepartum period. We did not observe any mortality case in our study population. Six patients improved, while three patients showed persistent ventricular dysfunction at follow-up echocardiography. CONCLUSION: All of our patients represented with the symptoms and sings of congestive heart failure, although which were similar to those of late pregnancy. Therefore, we suggest that PPCM should be considered and evaluated, whenever peripartum dyspnea, pulmonary edema, and tachycardia especially develop.