ADVANCES IN OBSTETRICS AND GYNECOLOGY
Online ISSN : 1347-6742
Print ISSN : 0370-8446
ISSN-L : 0370-8446
Volume 66, Issue 1
Displaying 1-13 of 13 articles from this issue
ARTICLES
Original
  • Eriko KUSABIRAKI, Ichiro YAMADE, Sachiko SANADA, Tatsuo SUDO, Shinsuke ...
    2014 Volume 66 Issue 1 Pages 1-5
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    Vulvar or paravaginal hematomas are important causes of puerperal hemorrhage. These sometimes extend into retroperitoneal space, forming retroperitoneal hematomas that are difficult to treat. We analyzed the cases of vulvar or paravaginal hematoma at our hospital between January 2010 and December 2011. Nineteen cases of hematoma (0.8%) were experienced among 2215 cases of term vaginal delivery. Among them, six cases (0.2%) were transferred to tertiary medical centers. Primiparity was identified as a significant risk factor for these hematomas (p<0.05). Birth weight of delivered infants and maternal weight gain among the hematoma cases was significantly lower than those in non-hematoma cases (p<0.05). In the 12 of 13 cases not transferred to the tertiary medical centers, hematomas developed in the same region as vaginal lacerations. In the five of six serious cases transferred to the tertiary centers, in contrast, hematoma developed without laceration of superficial vaginal tissues. In such case, identification of hematomas tends to be delayed, resulting in more serious developments. The possibility that a hematoma may develop without laceration of superficial vaginal tissues should be considered. [Adv Obstet Gynecol, 66 (1) : 1-5, 2014 (H26.2)]
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Clinical Report
  • Yoshimi TOKUGAWA, Hiroyuki HASHIMOTO, Sachi TAKAOKA, Masumi TAKEDA, Ta ...
    2014 Volume 66 Issue 1 Pages 6-10
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    Cervical neoplasia (CIN) is a non-invasive neoplastic lesion widely regarded as a precursor of squamous cell carcinoma (SCC) of the cervix. The highest incidence of CIN is seen during women’s reproductive years. Conization is required either to diagnose or to remove pre-cancerous cells. Furthermore, follow-up after treatment to identify residual and recurrent lesions is usually recommended. However, the follow-up interval after treatment has not been well-established. We analyzed the follow-up interval based on cervical cytology three and six months after conization. From april 2010 to september 2011, 94 women who were treated at Kaizuka Hospital for CIN3 were analyzed for follow-up interval. Three months after conization, cervical cytology abnormalities were detected in 21 of 94 patients: atypical squamous cells of undetermined significance (ASC-US) in four cases; atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion (ASC-H) in one case; low-grade squamous intraepithelial lesions (LSIL)in 13 cases ; and atypical glandular cells (AGC) in three cases. Among these, cervical cytology anomalies were found to have recurred in six cases after six months ; two cases were ASC-US, three cases were LSIL, and one case was HSIL. Patients whose cytology was LSIL or HSIL underwent a colposcopic directed biopsy. These patients were found to have chronic inflammation or mild dysplasia. As a result, no patients who received follow-up post-conization cytology required additional treatment six months post-conization. We concluded that follow-up post-conization cytology is needed six months post-conization. Further study is required to clarify the appropriate follow-up interval for cervical cytology. [Adv Obstet Gynecol, 66 (1) : 6-10, 2014 (H26.2)]
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Case Report
  • Saeko IMAI, Haruto EGAWA, Kentaro SEKIYAMA, Kazutaka NANBA, Maiko KAKI ...
    2014 Volume 66 Issue 1 Pages 11-17
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    As Cushing’s syndrome is usually associated with amenorrhea and infertility in women with hypercortisolism, the occurrence of this syndrome in pregnant woman is rare. The presence of hypercortisolism is associated with increased maternal or fetal mortality, as well as premature delivery. Here, we present a case of Cushing’s syndrome that developed due to an adrenal adenoma, which was diagnosed at the 18th week of pregnancy. A 41-year-old woman, gravid 1 para 1, presented to our clinic with amenorrhea. She had been receiving treatment for hypertension and a psychiatric disorder. At the 15th week of pregnancy, she was admitted to our hospital because of difficulty in managing her hypertension. A physical examination indicated the presence of certain clinical features of Cushing’s syndrome, including moon face and buffalo hump. The plasma adrenocorticotropic hormone level was undetectable. On abdominal ultrasonography, a tumor measuring 2.0 cm was identified in the left adrenal gland. Thus, we suspected that the adrenal adenoma caused the development of Cushing’s syndrome. At the 22nd week of pregnancy, left adrenalectomy was performed, and her blood pressure remained stable. Five days after surgery, her blood pressure gradually worsened. Due to the development of severe superimposed preeclampsia complicated with maternal multiple organ failures and disseminated intravascular coagulation syndrome, the patient was transferred to another perinatal intensive care unit. Intrauterine fetal death was noted on the day of the transfer. After delivery, she exhibited an immediate and drastic improvement. Thus, early diagnosis of hypertension in pregnancy is crucial to avoid serious maternal and fetal complications. Moreover the treatment modalities employed and the optimal time of termination should be carefully chosen on a case-by-case basis. [Adv Obstet Gynecol, 66 (1) : 11-17, 2014 (H26.2)]
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  • Tamaki YAHATA, Michihisa SHIRO, Shigetaka YAGI, Sawako MINAMI, Kazuhik ...
    2014 Volume 66 Issue 1 Pages 18-23
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    Cervical pregnancy is a rare form of ectopic pregnancy. Since there is rich blood flow around the cervical canal, cervical pregnancy may cause massive bleeding, necessitating total hysterectomy. Recently, preservation of fertility has become possible by early diagnosis, but fertility-preserving treatment for cervical pregnancy has not been established. In this report, we present a case in which bleeding cervical pregnancy accompanied by a fetal heartbeat was successfully treated with a conservative approach. The patient was a 32-year-old nulliparous and nulligravid woman who had received fertility treatment. She noted a small amount of bleeding five weeks and five days after her last menstruation, and consulted her previous obstetrician, who suspected cervical pregnancy. On the next day, the patient consulted our hospital due to continuous massive bleeding. Transvaginal ultrasonography showed a gestational sac (GS) with a fetal heartbeat in the cervical canal, and, together with MRI findings, a diagnosis of cervical pregnancy was made. Since the patient was positive for a fetal heartbeat, showed a high hCG level of 15000 mIU/ml, and wished for the preservation of fertility, we performed intra-arterial infusion chemotherapy using actinomycin-D withuterine artery embolization to control active bleeding. On the day two after treatment, bleeding was decreased and GS disappeared from the cervical canal. The patients discharged on the day 16 without sever adverse effects.The serum hCG level became negative without additional treatment, and themenstrual cycle was normalized. [Adv Obstet Gynecol, 66 (1) : 18-23, 2014 (H26.2)]
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  • Megumi MAJIMA, Toshio YAMADA, Seiko KATO, Nozomi OGISO, Natsuko YAMAGU ...
    2014 Volume 66 Issue 1 Pages 24-29
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    Primary small cell carcinoma of the vagina is a rare, poor prognostic disease and only 29 cases have been reported so far. We here report a case of a 70 year-old, gravid 7, para 2 woman diagnosed with primary vaginal small cell carcinoma, who underwent surgery and adjuvant chemotherapy. She presented with atypical genital bleeding to a home doctor. A thumb -sized tumor was found in the vaginal wall. The patient was referred to our hospital for further examination. On examination, this tumor originated from the vaginal wall at the 9 o’clock position, in the upper one-third vaginal portion. The uterine cervix was shown to be intact. Two-thirds of the tumor was removed in the pelvic examination. The tumor consists of solid growth of small cells showing positive immunohistochemical staining for chromogranin A, synaptophysin and CD56. Magnetic resonance imaging showed a 6×11×15 mm sized tumor on the right side of the posterior vaginal wall. Computed tomography showed metastasis to the sacral and right obturatorius lymph node. Recognition of metastasis to the sacral and right obturatorious lymph node in the radical hysterectomy let us to give her five couses of adjuvant chemotherapy using etoposide and CDDP. Twenty five months has passed since the patient underwent the surgery and adjuvant chemotherapy, she has had no relapse or tumor recurrence. [Adv Obstet Gynecol, 66 (1) : 24-29, 2014 (H26. 2)]
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  • Ai KOGIKU, Yasuhito TAKEUCHI, Hitomi OKUSUGI, Eri KONDA, Yumiko SAHARA ...
    2014 Volume 66 Issue 1 Pages 30-35
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    Malignant transformation of leiomyoma is rare. Here, we report the case of leiomyosarcoma localized in a pedunculated subserosal leiomyoma, which rapidly deteriorated. A 47-year-old woman (1 gravid, 1 para) suffering from right lower abdominal pain visited a clinic. She was subsequently referred to our hospital because of the presence of a large lower abdominal mass. Ultrasonography revealed a 20 cm tumor lesion in the abdominal cavity. MRI revealed a 22×19×19 cm tumor on the uterine fundus, while T1/T2-weighted imaging revealed some highly intensified cystic areas. The tumor itself was a faintly enhanced tumor, but the wall surrounding the cysts were hyperintensified on the diffusion-weighted image. From these observations, although sarcoma was suspected, this case was diagnosed as degenerated leiomyoma. Intraoperative examination revealed that, the tumor had grown on the right anterior uterine wall with a pedicle that twisted 180 degrees. No disseminated lesions were found on the peritoneum. Cytological examination of a small amount of bloody ascetic fluid was negative. Tumorectomy and total hysterectomy with bilateral salpingo-oophorectomy were performed. The patient was pathologically diagnosed with leiomyosarcoma localized in a pedunculated leiomyoma, pT1b. The sarcoma was localized only in the cystic walls, with no invasion in the pedicle. According to the clinical guideline of endometrial cancer, adjuvant chemotherapy was not performed, and she was followed up as an outpatient. Four months after the surgery, she visited our hospital with a cough and an abdominal mass. CT showed the recurrence of an 8 cm tumor in the pelvis and multiple metastatic lesions in the lungs. The best supportive care was chosen after obtaining informed consent. Thereafter she died one month later. Although the leiomyosarcoma was localized in the pedunculated subserosal leiomyoma, it relapsed promptly after surgery and the patient died of the disease. The clinical course of this patient might suggested that leiomyosarcoma localized in benign leiomyoma demonstrate highly malignant behavior and that we should perform adjuvant chemotherapy in a case with a large number of mitoses in the leiomyosarcoma. [Adv Obstet Gynecol, 66 (1) : 30-35, 2014 (H26.2)]
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  • Hiroko MURAKAMI, Megumi YAMANISHI, Ikuko EMOTO, Tsuyoshi FUJII, Yumiko ...
    2014 Volume 66 Issue 1 Pages 36-42
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    Granulocyte-colony stimulating factor (G-CSF)-producing tumors are a relatively rare gynecological condition. We report a rare case of undifferentiated ovarian carcinoma producing G-CSF. The patient was a 47-year-old nulliparous woman who came to our hospital complaining of fever and abdominal pain. Upon examination, her white blood cell count was found to be high (21130/μl). A contrast enhanced CT image suggested localized peritonitis resulting from a perforated sigmoid colon carcinoma. We performed partial resection of the sigmoid colon, partial resection of the small intestine, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. The pathological diagnosis was an invasion of undifferentiated ovarian carcinoma. Since the patient had cerebral palsy, she didn’t undergo chemotherapy. Her white blood cell count was found to have decreased postoperatively. Three months after the operation, intraperitoneal tumors were discovered. With the recurrence of carcinoma, the patient’s white blood cell count increased until it reached 158930/μl. She died six months after surgery. From the considerable leukocytosis at the recurrence, the postoperative decrease in the white blood cell count, and the pathological diagnosis made during autopsy, we identified the tumor as an undifferentiated ovarian carcinoma producing G-CSF. We suggest that a diagnosis of G-CSF-producing carcinoma should be considered in cases of carcinoma with considerable leukocytosis. [Adv Obstet Gynecol, 66 (1) : 36-42, 2014 (H26.2)]
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  • Mari DEGUCHI, Rumiko YAMAMOTO, Hiromi MIYATA, Yusuke BUTSUHARA, Tomoat ...
    2014 Volume 66 Issue 1 Pages 43-49
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    We report a case with a recurrent right ovarian mature cystic teratoma which showed malignant transformation to squamous cell carcinoma (SCC) after laparoscopic enucleation of a right ovarian tumor. A 34-year-old patient, para 0, visited our hospital for evaluation of a mass 11 cm in diameter in the right ovary. The blood test findings were as follows : carbohydrate antigen (CA) 19-9, 904 U/ml; CA125, 29 U/ml; and SCC antigen, 2.8 ng/ml. Magnetic resonance imaging (MRI) showed no evidence of malignancy, and laparoscopic enucleation of a right ovarian tumor (pathological diagnosis of mature cystic teratoma) was performed. Nine months after this operation, she visited our department with a right ovarian tumor and ascites. Transvaginal sonography revealed a solid tumor 8 cm in diameter, and the serum SCC antigen level was 30.5 ng/ml. MRI showed a solid tumor 8 cm in diameter in the right ovary with enlarged pelvic lymph nodes. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) also showed FDG uptake not only at the tumor site (maximum standardized uptake value, 15.9) but also in the para-aortic lymph nodes suggestive of metastases. Contrast-enhanced CT also revealed an enlarged lymph node in the left supraclavicular fossa. The patient was diagnosed with stage IV ovarian cancer and underwent surgery. The tumor was present in the right adnexa, which had infiltrated the posterior lobe of the broad ligament of the uterus. The surgery was completed with excision of the right adnexa, biopsy of pelvic lymph nodes, omentectomy, and intraperitoneal administration of carboplatin. The final diagnosis was SCC of the ovary with only inflammatory changes in the biopsied lymph nodes (pT2bN0M0). There was a possibility that the lymph node in the supraclavicular fossa might also show inflammatory changes. Although radical surgery after biopsy was also suggested to the patient, she refused. Nine courses of chemotherapy with paclitaxel and carboplatin (TC therapy) were performed, and her clinical course has been uneventful without recurrence for 20 months to date since the second surgery. To our knowledge, there are no prior case reports describing metachronous malignant transformation to SCC after the enucleation of a mature cystic teratoma, as in our present case. Moreover, treatment was difficult due to the multiple suspected metastases to the lymph nodes in this case ; however, she has followed a favorable course thus far. Though extremely rare when the pathological diagnosis was benign tumor at the time of ovary-preserving surgery in young patients, we should keep in mind the possibility of recurrence as malignant transformation when treating patients with risk factors for malignant transformation. [Adv Obstet Gynecol, 66 (1) : 43-49, 2014 (H26.2)]
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  • Kenji OGAWA, Motohiro KAWA, Satoko ISHIBASHI, Atsushi SUGIURA, Hitoshi ...
    2014 Volume 66 Issue 1 Pages 50-55
    Published: 2014
    Released on J-STAGE: March 28, 2014
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    Posterior reversible encephalopathy syndrome (PRES) comprises clinical and radiological findings with rapid onset. Patients experience hypertension, seizures, headache, visual disturbance. Four cases with PRES were treated in our hospital during the past two years, and were analyzed retrospectively from clinical charts. The age of onset in each case is 29, 27, 41, and 23 years old. All of them were primiparous. The gestational age at delivery was 28, 39, 33, and 39 weeks. All of them underwent emergent Cesarean section. The type/ severity of pregnancy-induced hypertension syndrome in each case were early onset/ severe hypertension with proteinuria, not onset, late onset/ severe hypertension with proteinuria, and late onset/ mild hypertension. Onset of eclampsia in each case was recognized during pregnancy, at delivery, never, and at delivery. Onset of HELLP syndrome was suspected in the third case. Neurological symptom in each case was mild visual disturbance, not recognized, visual disturbance, and involuntary movement. The edematous lesions in each case were the occipital lobe, and the occipital lobe, basal ganglia, and the parietal lobe, frontal lobe, temporal lobe, occipital lobe , basal ganglia , thalamus , and the parietal lobe, occipital lobe, basal ganglia. Each case needed 11, 10, 27, and 16 days for recovery. In these four cases with PRES, neurological symptom and onset of eclampsia were not associated with edematous lesions of brain. However in the case that edematous lesions were more extensive, it needed more time for recovery. In order to elucidate the relationship of clinical symptoms and radiographic findings, it is necessary to build the cases further in the future. [ Adv Obstet Gynecol, 66 (1) : 50-55, 2014 (H26.2)]
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