ADVANCES IN OBSTETRICS AND GYNECOLOGY
Online ISSN : 1347-6742
Print ISSN : 0370-8446
ISSN-L : 0370-8446
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Volume 65, Issue 4
Displaying 1-23 of 23 articles from this issue
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ARTICLES
Clinics
  • Seven cases of endometrial carcinoma diagnosed by hysteroscopic surgery
    Mika YASUDA, Hisayoshi YASUKAWA, Kana IWAI, Fuminori ITOU, Akira NAGAI ...
    2013 Volume 65 Issue 4 Pages 381-385
    Published: 2013
    Released on J-STAGE: December 27, 2013
    DOIhttps://doi.org/10.11437/sanpunosinpo.65.381
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    The recent popularization of endoscopic surgery is remarkable. Particularly, Hysteroscopic transcervical resection (TCR)has become popular in treating benign intrauterine lesion (submucosal uterine myoma and endometrial polyps among others). Of the 139 cases of TCR performed at our facility between January 2009 and May 2012, we identified seven cases of confirmed uterine cancer by histopathological analysis of the patients that were initially identified as cancer positive after cytological analysis of the endometrium. Specifically, the diagnosis before undergoing TCR for the seven cases was endometrial polyps (three cases), endometrial hyperplasia (one case), and atypical endometrial hyperplasia (three cases). All seven patients were premenopausal women and had grade 1 endometrial adenocarcinomas; six patients showed cancer stage Ia and 1 showed cancer stage Ib (JSOG1995). Five patients received additional operations, while the remaining two underwent medroxyprogesterone acetate (MPA)treatment. TCR performed in patients with uterine abnormalities resulted in early-stage detection of uterine corpus cancer, suggesting that the method contributes to the identification and administration of fertility sparing treatment methodologies. [Adv Obstet Gynecol, 65 (4) : 381-385, 2013 (H25.11)]
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Case Report
  • Wunderlich syndrome preoperatively diagnosed by magnetic resonance imaging
    Kumi MASUDA, Asako MIYAKE, Kasumi YAMAMOTO, Ryoko MINEKAWA-Mehandjiev, ...
    2013 Volume 65 Issue 4 Pages 386-390
    Published: 2013
    Released on J-STAGE: December 27, 2013
    DOIhttps://doi.org/10.11437/sanpunosinpo.65.386
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    Wunderlich syndrome is a rare condition affecting the female genital tract. It is characterized by the presence of a double uterus,a paracervical cyst caused by unilateral cervical atresia and ipsilateral renal agenesis. We, herein, report a case of diagnosis of Wunderlich syndrome before the operation by using magnetic resonance imaging (MRI). A 17-year-old girl (G0P0) visited our hospital due to persistent abdominal and pelvic pain that worsened during the menstrual period. On observing a pelvic mass in the transabdominal ultrasound, her private physician diagnosed the mass as an endometrioma. An MRI performed at our hospital revealed a double uterus, cervical atresia on the left side causing a hematometra of 7.5 cm in diameter, a paracervical cyst, a left-sided hematosalpinx and ureterocele on the left ureter. We additionally confirmed agenesis of the left kidney by computed tomography (CT). Thus, a diagnosis of Wunderlich syndrome was considered. Supposing that the hematometra and paracervical cyst were causing the pelvic pain in our patient, we performed drainage and fenestration surgery through the vagina. After the surgery, the abdominal pain subsided. Thus far, the patient has been visting our hospital for regular check- ups and has showed no recurrence. This case indicates that preoperative MRI can help diagnose Wunderlich syndrome, making it possible correct the condition minimally invasive surgery. Early diagnosis and treatment of this malformation is recommended to alleviate exacerbation of endometriosis, pelvic adhesion, tubal obstruction, and permanent infertility. [Adv Obstet Gynecol, 65 (4) : 386-390, 2013 (H25.11)]
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  • A case of pelvic actinomycosis difficult to differentiate from a malignant tumor
    Sakiko NANJO, Shigetaka YAGI, Nami OTA, Yasushi MABUCHI, Masaaki IWAHA ...
    2013 Volume 65 Issue 4 Pages 391-396
    Published: 2013
    Released on J-STAGE: December 27, 2013
    DOIhttps://doi.org/10.11437/sanpunosinpo.65.391
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    Actinomycosis is a rare, chronic, suppurative, granulomatous infection caused by a group of Actinomyces. This infection occurs rarely in pelvic, but relatively frequently in intrauterine contraceptive device (IUD) users. Its association with the use of IUD is known. We recently encountered a patient with actinomycosis with a strongly positive PET scan, difficult to differentiate from a malignant tumor. A 55-year-old, para-2 woman with a history of IUD use visited a local medical clinic with chief complaints of left lower abdominal pain and constipation. Since a 10cm, slightly mobile tumor was palpable in the left lower abdomen, she was referred to our hospital for further evaluation and treatment. MRI showed contrast enhancement of a tumor on the left side of the uterine fundus as well as pelvic lymph node enlargement. The sigmoid colon had a thickened wall, and had conglomerated with the pelvic tumor. PET/CT was performed for further evaluation, which revealed increased FDG uptake in the pelvic mass. Colonoscopy was performed, which showed significant stricture of sigmoid colon, but its biopsy resulted in no evidence of malignant tumor. Blood tests showed leukocytosis and a positive CRP but no significant increase in tumor markers. Since a malignant tumor in pelvic was strongly suspected, the patient was scheduled for abdominal surgery, and underwent abdominal total hysterectomy, bilateral adnexectomy, and colostomy. Subsequent histopathological examination of permanent tissue sections showed an abscess containing granules of Actinomyces in the left ovary. She was treated postoperatively with penicillin therapy under a diagnosis of pelvic actinomycosis. We conclude that it is also necessary to consider the possibility of this disease in IUD users with a suspected pelvic malignant ovarian tumor. In addition, it is necessary to ask a patient about her history of IUD use. [Adv Obstet Gynecol, 65 (4) : 391-396 , 2013(H25.11)]
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  • A case of fetomaternal transfusion syndrome with fetal anemia suspected on doppler ultrasonography
    Takatsuna SASAKI, Emiko NIIRO, Aiko SHIGEMITSU, Sayaka MASAKI, Eiko YA ...
    2013 Volume 65 Issue 4 Pages 397-401
    Published: 2013
    Released on J-STAGE: December 27, 2013
    DOIhttps://doi.org/10.11437/sanpunosinpo.65.397
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    Fetomaternal transfusion syndrome (FMT) can be diagnosed by the detection of fetal hemoglobin (HbF) in the maternal blood. Prenatal diagnosis of FMT is difficult and severe FMT is rare. We reported a case of FMT in which fetal anemia was suspected on doppler ultrasonography findings. A previously healthy 38-year-old primigravida with an uneventful pregnancy was admitted to hospital at 40 weeks and two days of gestation after spontaneous rupture of the membrane. Variable decelerations of the fetal heart rate were observed during the first stage of labor. The amniotic fluid volume was normal, but uterine inertia was noted. Augmentation of oxytocin showed minimal variability and decelerations of the fetal heart rate. Fetal ultrasonography showed an increased cardiothoracic area ratio (CTAR) of 40% and a peak systolic velocity of middle cerebral artery (MCA⋅PSV) of 102.0 cm/s. Fetal heart failure with anemia was diagnosed, and cesarean section was performed. The female infant weighed 2682g, and had Apgar score was 2 at 1 min and 9 at 5 min. Her skin was very pale and she had a hemoglobin concentration of 6.2 g/dl. The mother’s HbF concentration was markedly increased at 5.7%. A diagnosis of FMT was established. [Adv Obstet Gynecol, 65 (4) : 397-401, 2013 (H25.11)]
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  • Usefulness of immunostaining for diagnosis of vulvar Paget’s disease : a case report
    Yusuke SAGAE, Nozomi WATANABE, Kazutoshi INADA, Yumiko MIYAZAKI, Reiko ...
    2013 Volume 65 Issue 4 Pages 402-407
    Published: 2013
    Released on J-STAGE: December 27, 2013
    DOIhttps://doi.org/10.11437/sanpunosinpo.65.402
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    Vulvar Paget’s diseases are divided into primary and secondary types. The former are neoplasms of the skin or dermal appendage, while the latter are manifestations of anal-rectal adenocarcinoma, urothelial carcinoma, or other adenocarcinomas. This classification is important when deciding on the treatment. We report a case of secondary vulvar Paget’s disease. In this case, the patient was initially treated for primary vulvar Paget’s disease because there were no malignant diseases in the urinary tract, genitalia, and intestines. However, after operation, immunopathological investigation suggested secondary vulvar Paget’s disease, and finally urethral carcinoma was revealed. If immunopathological study is performed preoperatively, we can choose the most appropriate treatment. In the diagnosis of vulvar Paget’s disease, immunostaining is recommended. [Adv Obstet Gynecol, 65 (4) : 402 - 407, 2013 (H25.11)]
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  • Pregnancy complicated with Takayasu’s disease : a report of four cases
    Kana DEGUCHI, Kenji TANIMURA, Ayako SONOYAMA, Shinya TAIRAKU, Mayumi M ...
    2013 Volume 65 Issue 4 Pages 408-413
    Published: 2013
    Released on J-STAGE: December 27, 2013
    DOIhttps://doi.org/10.11437/sanpunosinpo.65.408
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    Takayasu’s disease is characterized by vasculitis of the aorta and its main branches. The disease often affects the outcome of pregnancy. We report four cases of pregnancy complicated with Takayasu’s disease. All four were diagnosed as Takayasu’s disease, and allowed to get pregnant before pregnancy. Two had undergone surgery for affected vessels and/or cardiac valves before their pregnancies; one had vascular graft for the ascending aortic arch for the dilation of ascending aorta, aortic valve replacement for the AR IV°, and vascular graft for the abdominal aorta for the dilation of abdominal aorta. The other one had aortic valve replacement for AR IV° and aortic left subclavian artery bypass grafting for the stenosis of the left subclavian artery. All four received prednisolone treatment. Three of the pregnancies ended in vaginal deliveries with epidural analgesia. One resulted in an elected cesarean section because of disease deterioration. The mothers and babies experienced uneventful puerperal periods. To assess the state of disease before pregnancy and careful management of medication during pregnancy and delivery is very important. [Adv Obstet Gynecol, 65 (4) : 408-413, 2013(H25.11)]
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  • Five cases of breast cancer during pregnancy
    Mirei NISHIZAWA, Keiko UYAMA, Takashi NAKANISHI, Takako AKASHI, Hitomi ...
    2013 Volume 65 Issue 4 Pages 414-421
    Published: 2013
    Released on J-STAGE: December 27, 2013
    DOIhttps://doi.org/10.11437/sanpunosinpo.65.414
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    Breast cancer, after cervical cancer, is the second-most-frequently occurring form of cancer during pregnancy, and considering its increase in incidence in recent years, it is by no means rare to encounter it during daily examination. In this study, we analyze our experience at this hospital with five cases of breast cancer during pregnancy, and consider problems related to diagnosis and treatment. The average age of the five subjects was 35.8 years old, from a range of 32 to 39 years. Initial symptoms for four cases were a lump in the breast discovered by the subject, while in the remaining case, the subject experienced a bloody discharge from the nipple. At the time they were diagnosed, two of the subjects were in their first trimester of pregnancy, one was in her second trimester, and two were in their third trimester. One subject underwent surgery after artificial termination of pregnancy; three subjects, during pregnancy; and one subject, after giving birth. Histologically, one case was a ductal carcinoma in situ, and the remaining four cases were invasive ductal carcinomas. With regard to clinical stage, one case was at Stage 0, two were at Stage I, and two were at Stage IIB. Except for the Stage 0 ductal carcinoma in situ, all subjects underwent adjuvant therapy, and the subject suffered a recurrence in two of these cases. Early diagnosis of breast cancer during pregnancy is by no means straightforward. Based on this study, the importance was reaffirmed of enhancing of screening system and promoting awareness, including self-checks, as well as of being conscious not to overlook patients’ complaints, and to refer them to specialist facilities. The close cooperation between obstetrics and breast surgery departments in planning treatment is a matter of vital importance. [Adv Obstet Gynecol, 65 (4) : 414-421, 2013 (H25.11)]
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OPINIONS
Clinical view
Current topic
TRANSACTIONS of SECTIONAL MEETING
Gynecologic Oncology (in the 127th Meeting of the OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN)
“Diagnosis and treatment of ovarian cancer”
“The pros and cons of neoadjuvant chemotherapy against ovarian cancer, and its indication”
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