ADVANCES IN OBSTETRICS AND GYNECOLOGY
Online ISSN : 1347-6742
Print ISSN : 0370-8446
ISSN-L : 0370-8446
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Volume 67, Issue 1
Displaying 1-9 of 9 articles from this issue
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ARTICLES
Original
  • Tissue trauma in abdominal and vaginal hysterectomy
    Hikari UNNO, Hiroyuki HASHIMOTO, Ruriko YAMAZAKI, Masumi TAKEDA, Takas ...
    2015 Volume 67 Issue 1 Pages 1-6
    Published: 2015
    Released on J-STAGE: March 30, 2015
    DOIhttps://doi.org/10.11437/sanpunosinpo.67.1
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    To compare the degree of tissue trauma between total abdominal hysterectomy (TAH) and total vaginal hysterectomy (TVH), we retrospectively assessed levels of C-reactive protein (CRP),creatine phosphokinase (CK) and lactic dehydrogenase (LDH) in blood samples obtained on the first postoperative day. Between January 2008 and September 2012, 468 women underwent hysterectomy in our clinic. Of those, we identified two groups who underwent TVH (n=168) or TAH(n=226) for uterine fibroids or adenomyosis. All charts of these women were reviewed for data on age, body mass index(BMI), parity, uterine weight, operation time and operative blood loss. No differences were observed in BMI or operation time. Uterine weight was lower in TVH (220g) than in TAH(528g ; p<0.01), but operative blood loss was higher in TVH (254 ml) than in TAH (208 ml, p<0.001). Mean plasma levels of postoperative CRP and CK were significantly higher in the TAH group than in the TVH group (CRP : TVH, 1.1 mg/dl vs. TAH, 3.1 mg/dl ; CK : TVH, 78 IU/l vs. TAH, 145 IU/l ; p<0.01 for each). The post-operative serum CRP and CK level could be a marker in the degree of tissue trauma between vaginal and abdominal hysterectomy. [Adv Obstet Gynecol, 67(1) : 1- 6 , 2015 (H27.2) ]
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Case Report
  • Late relapse of clear cell adenocarcinoma in the bladder seven years after treatment of recurrent ovarian cancer -- a case report
    Yoshiki SAKAMOTO, Tsutomu TAKAKI, Manabu UCHIDA, Hideo TAHARA, Shigeo ...
    2015 Volume 67 Issue 1 Pages 7-13
    Published: 2015
    Released on J-STAGE: March 30, 2015
    DOIhttps://doi.org/10.11437/sanpunosinpo.67.7
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    Bladder metastasis from ovarian carcinoma is a rare clinical event. We experienced clear cell adenocarcinoma in the bladder after seven years of treatment of recurrent ovarian clear cell adenocarcinoma. A 60-year-old woman had surgery and chemotherapy for right ovarian clear cell adenocarcinoma pT2cN0M0. Three years later, pelvic peritoneum recurrence of clear cell adenocarcinoma of ovary was detected, and tumorectomy and postoperative chemotherapy were performed. After seven years of treatment for tumor recurrence in the pelvis, transvaginal ultrasonography discovered an intravesical tumor. Transurethral bladder tumor resection (TUR-Bt) was performed, and pathological diagnosis was made as clear cell adenocarcinoma. As for bladder, both primary clear cell adenocarcinoma and relapse of ovarian clear cell adenocarcinoma are very rare, and it is important to clarify differential diagnosis in this case. This case could be diagnosed as primary clear cell adenocarcinoma in the bladder if there was a mix of tissues such as endometriosis, remnant of mullerian duct, differentiation of bladder primary adenocarcinoma and metaplasia of urothelial carcinoma. However such findings were not observed in this case. In addition, the immunohistochemical analysis could not distinguish which organ clear cell adenocarcinoma was derived from. Therefore, we finally diagnosed ovarian cancer recurrence since clear cell adenocarcinoma was present in the connective tissue under the normal transitional epithelium. Three years later after TUR-Bt for the recurrence in the bladder, intravesical tumor redeveloped and TUR-Bt was performed. Tumor was again diagnosed as recurrence of clear cell adenocarcinoma of ovary. To date she is alive with no recurrence of tumor. [Adv Obstet Gynecol, 67 (1) : 7-13, 2015 (H27.2)]
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  • A case of large postmenopausal ovarian tumor with massive peritoneal fluid
    Reisa KAKUBARI, Hisashi KONISHI, Eriko TANAKA, Miho MURAJI, Hiromi UGA ...
    2015 Volume 67 Issue 1 Pages 14-20
    Published: 2015
    Released on J-STAGE: March 30, 2015
    DOIhttps://doi.org/10.11437/sanpunosinpo.67.14
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    A-55-year-old nulliparous postmenopausal woman visited our clinic complaining of three weeks of continuous abdominal pain and mild fever. Her past medical history included type2 diabetes mellitus, hypertension and left sided paralysis due to an old brain infarction. She was remarkably obese, her BMI was 47 and she had gained 30 kg in the past year. Ultrasonography detected a right ovarian cyst with a diameter of 20 cm, with massive ascites. Serum CA19-9 was 496 U/ml and CA125 was 238 U/ml. No malignant cells were detected during repeated aspiration cytology of ascites. Enhanced MRI of the pelvis showed the same findings as with ultrasonography. Cyst wall and visceral peritoneum were partially thickened and enhanced ; thus, ovarian cancer with carcinomatous peritonitis was included in differential diagnosis. Considering her multiple complications, we performed laparoscopic right adnexectomy for an operative diagnosis. We removed 22400 ml of reddish ascites from the peritoneal cavity. The ovary weighed 1180g, after removing 4200 ml brownish fluid in the tumor. The post operative course was routine and she was discharged seven days after the surgery without additional treatment. Histological diagnosis was an suspected endometriotic cyst of the ovary. This is a case report of a large ovarian cyst after menopause with massive ascites, mimicking malignancy. We successfully treated the case with laparoscopy, in spite of her multiple complications, including prominent obesity. Although we could find some reports of endometriotic cysts with ascites, this is possibly the first case of such tumor after menopause. [Adv Obstet Gynecol, 67 (1) : 14-20, 2015 (H27.2)]
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  • Two cases of heparin-induced thrombocytopenia in ovarian cancer complicated with pulmonary arterial thrombosis
    Atsushi MATSUKI, Koji KAJITANI, Tomotaka YOSHIYAMA, Minako NISHIZAWA, ...
    2015 Volume 67 Issue 1 Pages 21-27
    Published: 2015
    Released on J-STAGE: March 30, 2015
    DOIhttps://doi.org/10.11437/sanpunosinpo.67.21
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    We encountered two patients with heparin-induced thrombocytopenia (HIT), both of whom were diagnosed with pulmonary thromboembolism before undergoing surgery for ovarian cancer and were treated with heparin as anticoagulant therapy. Postoperatively, both experienced thrombocytopenia and were diagnosed clinically with HIT. Serologically, patient one was diagnosed with type II HIT, because HIT antibody was positive, whereas patient two was diagnosed with type I HIT, because HIT antibody was negative. After diagnosis, heparin was stopped in both patients and argatroban was started. Thrombosis is a frequent complication of gynecologic disease, especially malignancy, providing many opportunities to use heparin. Nevertheless, there have been few reports of HIT in gynecology patients, so its recognition remains low. Type II HIT is a life-threatening immune-mediated complication of heparin exposure, with a mortality rate of 4.8-10.6%, emphasizing the need for its rapid diagnosis and treatment. [Adv Obstet Gynecol, 67(1) : 21-27 , 2015 (H27.2)]
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  • Two cases of adenofibromatous ovarian clear cell carcinoma with high serum estrogen level
    Yoshiyuki TSUJI, Koichi ITO, Maiko NOSAKA, Yoko KUBOTA, Hiroshi KATO, ...
    2015 Volume 67 Issue 1 Pages 28-32
    Published: 2015
    Released on J-STAGE: March 30, 2015
    DOIhttps://doi.org/10.11437/sanpunosinpo.67.28
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    Estrogen producing clear cell carcinoma of the ovary has rarely been reported. We herein present two elderly menopausal women with adenofibromatous clear cell carcinoma. Both had hard ovarian tumors, high serum estradiol (E2), and endometrial hyperplasia or endometrial carcinoma. The first case was 70 years old, had an 8 cm -in-diameter hard tumor in her right ovary and complained of slight genital bleeding. Her serum E2 was 58 pg/ml but decreased to normal postmenopausal levels after surgery. Histological examination showed adenofibromatous clear cell carcinoma of the ovary and endometrial carcinoma within atypical endometrial hyperplasia, presumally due to prolonged estradiol exposure. The second case, a 68 years old menopausal woman had a 14 cm in diameter hard tumor in the left ovary. Serum E2 was 90 pg/ml before treatment, but decreased to normal postmenopausal levels after tumor removal. The Histological examination demonstrated adenofibromatous clear cell carcinoma and endometrial hyperplasia without atypism. Both cases were treated with postoperative chemotherapy and there has been no recurrence for over three years and four years , to date, respectively. Hard ovarian tumors associated with high serum estrogen might be adenofibromatous clear cell carcinoma, rich in stroma, functioning to produce estrogen in some cases. [Adv Obstet Gynecol, 67(1) : 28 - 32, 2015 (H27.2)]
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