ADVANCES IN OBSTETRICS AND GYNECOLOGY

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This study was conducted to establish the strategy for diagnosis of deep vein thrombosis (DVT)in women with ovarian tumors before surgery in Kobe University Hospital. Medical charts of 193 women with ovarian tumors who had undergone surgery in Kobe University Hospital between January 2006 and June 2010 were systemically reviewed. Pathological examinations identified 115 cases with benign ovarian tumors, 15 cases with borderline malignancy and 63 cases with malignant ovarian tumors. Clinical and laboratory data were compared between patients diagnosed as having DVT and those with no evidence of DVT. Venous ultrasound imaging of the lower extremity was performed in 32 out of 193 patients. 18 out of 32 patients were diagnosed as having DVT before surgery, including 5 cases with benign ovarian tumors, 2 cases with borderline malignancy, and 11 cases with malignant ovarian tumors. The statistical analyses were performed between DVT patients and non-DVT patients in terms of benign-malignancy, ages, with or without symptoms, tumor maximum diameters, plasma D-dimer levels and BMI. The incidence of DVT was significantly higher in patients with malignant ovarian tumors compared with those with benign ovarian tumors. The incidence of DVT was not correlated with ages. The symptom such as limb pains, edema in the lower extremity clearly indicated the DVT existence compared with no symptom. The tumor maximum diameters had no significant differences in between DVT patients and non-DVT patients. But plasma D-dimer levels were significantly higher in patients with DVT than in those without DVT. Plasma D-dimer levels were found to be more than 3.0 μg/ml in all 18 cases with DVT. 12 out of 18 cases with DVT had symptoms. However, venous ultrasound imaging of the lower extremity demonstrated no findings of DVT in 6 patients who had both limb pains and plasma D-dimer levels less than 3.0μg/ml. In conclusion, the diagnosis of DVT by venous ultrasonography should be done in patients with ovarian tumors when their plasma D-dimer levels were at least more than 3.0μg/ml. [Adv Obstet Gynecol, 63(3) : 271-276, 2011 (H23.8)]

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Treatment with pegylated liposomal doxorubicin (PLD)was initiated for heavily treated patients with recurrent ovarian cancer (n=13)and peritoneal cancer (n=4)from July 2009 through June 2010 in our hospital. We experienced complete response in 1 case and partial response in 3 cases, with a response rate of 27% (4/15). Adverse effects included stomatitis (53%), hand-foot syndrome (71%), and myelosuppression (88%), but were not severe. The period from onset of the primary disease until PLD treatment (> 2 years)correlated with the anti-tumor effect of PLD, which implies that tumors in which previous chemotherapy had been effective are sensitive to PLD. Stomatitis also correlated with a tumor response (p<0.05). Although the overall anti-tumor effect in three cases that needed periodic removal of ascites prior to the PLD treatment was progressive disease, the retention of ascites in these three cases decreased prominently with the intravenous administration of PLD. Further study is desired to establish a protocol for the treatment of recurrent ovarian and peritoneal cancer by accumulating clinical data on the use of PLD in Japan from now on. [Adv Obstet Gynecol, 63(3) : 277-283, 2011 (H23.8)]

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The HELLP syndrome (HELLP), a serious complication of pregnancy, derives its name from the main findings of hemolysis, elevated liver enzymes and a low platelet count. Very few Japanese studies have been conducted comparing between antepartum and postpartum HELLP. We conducted a retrospective study of 9 women treated over the past 7 years, surveying maternal outcomes, complications, treatments and the time of onset. Pregnancy induced hypertension was also present in all 9 patients, and all were delivered by Caesarean section at 32~40 weeks of gestation. The onset of HELLP was prior to delivery in 6 cases (66.7%), with the remaining 3 cases developing within 4 days after delivery. Using the Tennessee Classification System, all 3 cases with postpartum HELLP were complete, whereas 2 of the 6 cases with antepartum HELLP were incomplete. Laboratory investigations revealed significantly higher serum AST levels in patients with postpartum HELLP than those with antepartum onset. Although the difference was not significant, platelet counts tended to be lower, and LDH levels higher, in patients with postpartum HELLP. Serious maternal complications such as acute pulmonary edema, acute renal failure or massive ascites were observed only in patients with postpartum HELLP, indicating that postpartum HELLP is more likely to be severe than disease of antepartum onset. [Adv Obstet Gynecol, 63(3) : 284-288, 2011(H23.8)]

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The rapid growth of recurrent adult granulosa cell tumor at the beginning of menstruation in the puerperium: a case report Granulosa cell tumors (GCTs)of the ovary are low-grade ovarian malignancies with a predilection for late recurrences in the pelvic cavity and occasionally distant metastases. They represent only 2-5% of all ovarian cancers. A right intra-pelvic mass was detected by ultrasound in a 29-year-old woman in the first trimester of pregnancy who was diagnosed with adult GCT (AGCT)pT1c(a)NXMO at the time of a right adenectomy for an adnexal mass 2 years before. The right intra-pelvic mass was resected 80% at 20 weeks of gestation and was confirmed to be a recurrent AGCT pathologically. The growth of residual tumors was evaluated by diffusion-weighted MR imaging during the pregnancy. The tumor size was correctly confirmed by this technique to have not changed. Cesarean section with suboptimal tumor reduction surgery excluding the tumors near the ileocecal region was performed at 37 weeks of gestation. No further treatment was performed after the cesarean section. Regarding tumor size, the tumor in the Morison cavity had rapidly grown by the beginning of the menstruation in the puerperium. Optimal tumor debulking including partial ileotomy was agreed upon and performed. The findings in this case were considered to correlate with hormone dependency, so hormone therapy may be a viable treatment option for any further recurrence. Several recent case reports have indeed raised the possibility of the use of hormonal therapy in the management of recurrent GCT. [Adv Obstet Gynecol, 63(3) : 289-294, 2011 (H23.8)]

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