ADVANCES IN OBSTETRICS AND GYNECOLOGY

Show abstractHide abstract

In the prenatal diagnosis field, amniocentesis is used as standard diagnostic method to identify chromosomal aberrations and genetic disorders of the fetus. But though a definite diagnosis is possible, amniotic fluid sampling remains an invasive method and puts the patient at risk for miscarriage. Because of this there has been a widespread search for biomarkers of chromosomal aberrations, unique markers which could be used for a safer yet reliable diagnostic procedure. In this study we used a protein chip system to examine protein differences in the amniotic fluid from normal chromosome and trisomy 21 pregnancies. This system, an up-to-date biomarker search technique, was developed over the past few years as an aid to proteomic analysis. Amniotic fluid supernatant (chromosome normal pregnancy [50 samples], trisomy 21 pregnancy [7 samples] : all samples between15 and 16 gestational weeks) were subjected to protein profile analysis using this protein chip system. The entire quantity of protein expressed in the amniotic fluid supernatant was the same in both the chromosome normal group and the trisomy 21 group. Furthermore, patients in both groups expressed a maximum of 274 types of protein. However, when inspected to determine individual expression patterns in the chromosome normal and trisomy 21 groups, significant differences were detected in the expressed quantity of 5 of the 274 protein types. Of these protein types, 3 had a significantly higher expression in the chromosome normal group, and 2 in the trisomy 21 group. Even though our study analysis did not allow specific identification of these proteins, knowledge of the protein expression profile could nevertheless be an important diagnostic tool in the future. In addition, although this research used amniotic fluid supernatant, these low-molecular proteins are also present in maternal blood, and we believe that our results could be reproduced by direct analysis of maternal blood samples. And if we can see significant differences in protein density, even though we do not know specific protein types, this information will be sufficient to develop a reliable and safe testing method for detecting chromosomal aberration pregnancy. [Adv Obstet Gynecol, 60 (2) : 55-64, 2008 (H20.5)]

View full abstract

Download PDF (612K)

Ectopic ovary is a rare gynecologic condition that is classified into two subtypes, supernumerary ovary and accessory ovary. Herein, we report a case of mature cystic teratoma originating in an ectopic ovary. A 38-year-old woman (gravida 2, para 2) visited a physician with a complaint of constipation. Computed tomography showed a round cystic mass with a diameter of 4.5cm and a calcified surface, adjacent to the uterus. She was referred to our hospital because the mass had been considered to be an ovarian tumor. On pelvic examination, a hard right adnexal tumor was palpated, although the uterus was normal sized and the left adnexa was not palpable. Ultrasound examination revealed similar findings to those of CT. Magnetic resonance imaging revealed a cystic lesion adjacent to the uterus, with high T1 and T2 intensities. Fat saturated image showed a mass with low intensity. Laboratory data were within normal ranges. The preoperative diagnosis was suspected a right ovarian mature cystic teratoma, and laparoscopic surgery was performed. At the operation, a tumor, 4 cm in size, was noted in her cul de sac, which was firmly adherent to the uterus and uterosacral ligament. The bilateral ovaries were normal in appearance and were in the proper position. The tumor was isolated from both ovaries and was completely resected. Intraoperative bleeding was extremely small and the feeding vessel to the tumor was not evident. The wall of the tumor was hard with calcification and it contained hair, adipose tissue and calcification. Spindle-shaped theca cells were noted in the capsule of the tumor, although a primordial follicle was absent. In conclusion, the tumor was diagnosed as a mature cystic teratoma originating in an ectopic supernumerary ovary. [Adv Obstet Gynecol, 60(2) : 65-69, 2008 (H20.5)]

View full abstract

We report a case of Gastrointestinal stromal tumor (GIST) complicated with autoimmune hemolytic anemia (AIHA), which was difficult to diagnose differentially from ovarian tumor.
A 72-year-old woman was diagnosed with AIHA in another hospital in October 200X. At that time, it was also pointed out that she had a large mass in the pelvis. She was admitted to our hospital for treatment of AIHA and possible abdominal tumor. Prednisolone was administered at the dose of 50mg/day to control AIHA which resulted in improvement of anemia. Some elevation of serum CEA (7.2ng/ml) was observed. Magnetic resonance imaging (MRI) and ultrasonography detected a large multicystic mass (about 11x12cm) with solid parts in the pelvic cavity. On suspicion of ovarian carcinoma, we performed an abdominal operation which revealed a pelvic tumor that developed externally from the small intestine. Extirpation of the tumor and partial resection of the small intestine were performed. In addition, bilateral salpingo-oophorectomy was done for histological diagnosis although macroscopically the uterus and ovaries appeared normal. Pathological diagnosis was GIST that developed from small intestine with characteristic spindle cells positive for c-kit immunohistochemically. After surgery, AIHA was improved, which led us to conclude that AIHA occurred with GIST. [Adv Obstet Gynecol, 60(2) : 70-76, 2008 (H20.5)]

View full abstract

A 31-year-old primigravid, who had been dignosed as having placenta previa during pregnancy, felt numbness and weakness on the left half of the body at 26 weeks and two days of gestation, and was referred to our hospital for further investigation of a cerebrovascular ischemic event. Subsequent examinations demonstrated an acute lacunar infarction around the right thalamus. Antiplatelet treatment with sodium ozagrel was carried out for eleven days, and then changed to aspirin therapy for secondary prophylaxis. She made good functional recovery, although an involuntary chorea-like movement of the left hand was demonstrated as a sequela. Aspirin therapy was stopped at 34 weeks and two days of gestation due to pinkish stain. The gestational course itself was uneventful without antepartum bleeding. She delivered a male baby by cesarean section at 37 weeks and one day of gestation. In this case, it was important to pay much attention to antepartum bleeding from placenta previa during antiplatelet therapy. [Adv Obstet Gynecol, 60(2) : 77-82, 2008 (H20.5)]

View full abstract

Register with J-STAGE for free!