A link between endometrial cysts and ovarian cancer has been demonstrated in a few previous studies, and in Japan, this risk is considered in the management of endometriosis, despite the fact that the carcinogenic mechanisms remain unknown. The aim of this study was to investigate the relationship between endometrial cysts and the development of ovarian cancer, especially clear cell carcinoma. We analyzed three cases of ovarian clear cell carcinoma arising from endometriosis in Kindai University Hospital alongside 51 cases from previous reports. We found that most patients diagnosed with ovarian cancer were in their 40s, and that cancerous cysts were significantly larger than that of endometrial cysts. Their cancer diagnosis was received at a median of three years after the endometrial cyst diagnosis and within a maximum of 10 years. Given the relatively early development of cancer in these patients, the hypothesis that environmental factors such as oxidative stress on iron inside endometriosis could be a cause of ovarian carcinogenesis seems unlikely. Further research is needed to determine the pathogenesis of ovarian cancer, and a new management policy concerning endometrial cysts should be established. [Adv Obstet Gynecol, 71(3) : 237-246, 2019 (R1.8) ]

Labial adhesion is often seen in females with low estrogen status. Local application of estrogen ointment or minimally invasive surgical procedures may suffice to improve the conditions but recurrence of the adhesion is not rare. We report herein a case of labial adhesion that was successfully treated with Z-plasty. A 56-year-old postmenopausal woman who complained of recurrent rash with tenderness on her external genitalia and dyspareunia for 3 years. Since symptomatic treatment with ointments had been unsuccessful, she was referred to us by her physician. Upon examination, her bilateral labia minora were fused and forming a bridge under which the urethral orifice was visualized. Based on her history of repetitive adhesion we chose Z-plasty to prevent the recurrence. Under spinal anesthesia we manually separated the adhesion. We then performed Z-plasty on each side by suturing the labium minus to majus of the same side. Postoperatively, estrogen vaginal suppository was used and the genitalia were irrigated 3times per day. There have been no pains, rashes, or signs of re-adhesion for 11 months. We believe Z-plasy is an effective surgical procedure to prevent labial re-adhesion. [Adv Obstet Gynecol, 71 (3) : 247-252, 2019 (R1.8)]

We experienced a case of secondary glaucoma due to treatment for diabetic iritis in a pregnant woman that was treated with mannitol and acetazolamide. A 34-year-old woman (gravida 3, para 1) was diagnosed with overt diabetes in the first trimester of pregnancy when a blood test revealed an HbA1c level of 7.9%. At nine weeks of gestation, she complained of pain and lacrimation in the right eye and was diagnosed with diabetic iritis. Her symptoms were relieved by Tenon’s capsule steroid injection. At 20 weeks, her right eye pain exacerbated and intraocular pressure increased. She was diagnosed with secondary glaucoma and treatment with eye drops was started. Inspite of the treatment, the intraocular pressure gradually increased to the extent that she lost her vision temporarily. Systemic mannitol and acetazolamide treatment was initiated and her symptoms had resolved and intraocular pressure had decreased to what it was at 20 weeks. To maintain normal intraocular pressure and blood pressure during labor, labor induction had been introduced under a control of epidural anesthesia, and the patient had an alive infant. Pregnant women with diabetes mellitus should be tested for ocular diseases. Use of epidural anesthesia and labor induction is an option to facilitate successful delivery in pregnant women with glaucoma. [Adv Obstet Gynecol, 71 (3) : 253-258, 2019 (R1.8)]

Female adnexal tumor of probable Wolffian origin (FATWO) is a rare tumor that develops preferentially in the broad ligament of the uterus and mesosalpinx. Cases with relapse and metastasis have been reported, and no treatment has been established yet. We report a case of FATWO treated with fertility-sparing surgery thereafter, the patient attained spontaneous pregnancy. A 35-year-old primigravida woman presented with a palpable mass on the Douglas pouch on pelvic examination. Pelvic contrast-enhanced magnetic resonance imaging revealed a 7.5 cm mass on the left dorsal side of the uterus. Taking into consideration the possibility of subserous uterine fibroids, a laparoscopic myomectomy was performed. The laparoscopic findings showed a goose egg-sized mass in the left oviduct membrane, which was then resected. Pathological findings showed homogenous, medium-sized, heteromorphic, columnar epithelial cells proliferating with tubular and cord-like shapes. Immunohistochemical examination of the mass revealed calretinin, CAM5.2, androgen receptor, CD10, and AE1/AE3 expressions. Thus, the patient was diagnosed as having FATWO. Fertility-sparing surgery (left laparoscopic salpingo-oophorectomy) was subsequently performed. In FATWO, diagnosis of clinical malignancy is difficult. While fertility sparing surgery should be considered in young patients, careful long-term follow-up is also necessary. [Adv Obstet Gynecol, 71 (3): 259-267, 2019 (R1.8)]

Ovarian vein thrombosis (OVT) is one of the postoperative complications of pelvic surgery. While OVT has rarely been reported, there are a few reports of this as a complication during the postpartum period. We report a case with OVT which was diagnosed with fever on the fourth day after total laparoscopic hysterectomy surgery for benign disease. A 48-year-old woman with uterine myoma and anemia received a gonadotropin-releasing hormone agonist and underwent total laparoscopic hysterectomy and bilateral salpingectomy. On postoperative day 4, she experienced fever and abdominal pain. Contrast computed tomography revealed bilateral OVT. The patient received oral administration of an anticoagulant as a treatment for 3 months. The disappearance of the thrombus was confirmed 27 days after the operation. The OVT as shown in this case is considered to be caused by pneumoperitoneum, blood flow stagnation, and vascular endothelial dysfunction. Although OVT can cause pulmonary thromboembolism, which is a potentially life-threatening disorder, a method for prevention of OVT has not yet been specified. More cases need to be clarified in investigating the mechanism of onset and prophylactic strategy for OVT. [Adv Obstet Gynecol, 71 (3) : 268-273, 2019 (R1.8)]

A perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor that arises in various organs, including the lung, kidney, and uterus, and is associated with tuberous sclerosis. Herein, we report a case of low-grade endometrial stromal sarcoma (ESS) with a histological feature of a PEComa-like structure. The patient was a forty-five-year-old woman with a history of tuberous sclerosis and a uterine leiomyoma. She visited our hospital for further examination of lung nodules detected by a chest X-ray at a health checkup. A chest computed tomography examination identified multiple nodules in both lungs, suggesting metastatic lung tumors. However, other than the lung nodules, she had only a uterine tumor, which was diagnosed as a degenerated leiomyoma through a pelvic magnetic resonance imaging examination. Therefore, she underwent a thoracoscopic partial resection of the lung nodules, which resulted in a histopathological diagnosis of a PEComa family tumor. She was then treated with sirolimus. Two years later, she underwent an abdominal hysterectomy and a bilateral salpingo-oophorectomy because the uterine tumor had increased in size. The histopathological diagnosis of the uterine tumor was a low-grade ESS with a histological feature of a PEComa-like structure. The lung tumor was then diagnosed as a metastatic tumor of low-grade ESS by pathological review. After the pelvic surgery, the patient’s lung nodules decreased, and there was no recurrence of ESS in the abdomen. [Adv Obstet Gynecol, 71 (3) : 274-281, 2019 (R1.8)]