Next-generation sequencing (NGS) was performed on tumor samples after obtaining ethical approval in June 2018. The current status of NGS for gynecological cancers was assessed in the present study. [Methods] Medical records of patients with gynecological cancers who received NGS were retrospectively reviewed. In total, 41 patients (median age, 64 years) underwent molecular profiling by NGS. The primary sites included ovary/fallopian tube/peritoneum in 14 patients, uterine body in 14 patients, and cervix in 11 patients. Cancer associated panels included FoundationOne^Ⓡ CDx in 28 patients and PleSSision in eight patients. The gene alterations, wherein we could propose respective drugs in our hospital included PIK3CA/PI3KR1/PTEN mutations (jRCTs051190006) in 16 patients and homologous recombination repair gene mutations in eight patients. Four patients with cervical cancer and two patients with POLE mutated endometrial cancer had MS-stable/TMB-high tumors. Hereditary cancer was diagnosed in five (12%) patients after NGS. To assess the inherited mutations in tumors using NGS, we created a graph of variant allele frequency and tumor nuclei percentage according to the two-hit theory. Gene mutations of five patients with hereditary cancer were marked in the theoretical position in the graph. The proportion of patients subjected to targeted drugs after NGS was higher than expected. [Adv Obstet Gynecol, 73(1) : 1-9, 2021 (R3.2)]

The primary purpose of fibroid removal is to treat symptomatic fibroids and preserve uterine function including fertility. Open or laparoscopic myomectomy is recommended for the surgical procedure. Successful laparoscopic removal of uterine fibroids is dependent on the skill of the surgeon. The bottom-up suturing technique (BUST) and a novel two-step suturing technique (TSST) can be used to repair the endometrium and myometrium in total laparoscopic myomectomy (TLM). The utilization of these two techniques provides the chance of precise repair and completion in surgery. We report and consider the usefulness of BUST and TSST in two cases of patients with multiple fibroids and one patient with a large submucosal fibroid. Laparoscopic myomectomies were performed successfully without losing the incision sites utilizing BUST or TSST for them. In this report, the applications of BUST and TSST in TLM are described using intraoperative surgical techniques and illustrations. [Adv Obstet Gynecol, 73(1) : 10-16, 2021 (R3.2)]

Most primary amenorrhea patients have a significant medical history, for example, a background of chromosome abnormalities. In making the diagnosis of ovarian dysgenesis, we based our diagnosis solely on blood analysis and symptoms, and not on ovarian morphology itself. We report a case of ovarian dysgenesis with normal karyotype. An 18-year-old nulligravid woman was admitted to our hospital with the complaint of primary amenorrhea. Minimal axillary and pubic hair was present and she had Tanner stage II mammary development. Hormone analysis showed high gonadotropins and low estradiol. Magnetic resonance images revealed a small-sized uterus and absent ovaries. Her peripherical blood karyotype analysis showed a 46, XX normal karyotype. We suspected ovarian dysgenesis and performed a diagnostic laparoscopy. Laparoscopic findings were of a normal uterus and normal fallopian tubes bilaterally. The left ovary was a streak gonad and the right was hypoplastic. She is currently receiving hormonal replacement therapy using estradiol patches. A progestin drug will be added later. We concluded that diagnostic laparoscopy for patients with ovarian dysgenesis is a beneficial to understand and evaluate this disease. [Adv Obstet Gynecol, 73(1) : 17-21, 2021 (R3.2)]

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome or sudden death and often remains undetected. However, SCAD is closely associated with myocardial infarction during pregnancy and in the postpartum period. We report the case of a patient who developed SCAD after undergoing cesarean section. A 37 year old woman (G2P1) underwent elective cesarean section at 38 weeks of pregnancy for previous cesarean section and cystectomy for an ovarian endometriotic cyst. She returned to our hospital 33 days after the operation with complaints of chest and back discomfort and vomiting. Blood test revealed elevated CK, CK-MB, and troponin T levels. Echocardiography showed decreased inferior wall motion; however, the electrocardiogram revealed no changes. She was diagnosed with SCAD based on the outcomes of coronary angiography that revealed the presence of a diffuse smooth stenosis in the right coronary artery that could not relieved by administering nitroglycerin into the coronary artery. Methylergometrine maleate was administered orally to relieve uterine blood retention at the onset of SCAD, but it was discontinued because of the possible association of coronary vasospasm with SCAD. Her symptoms were subsequently treated with conservative treatment and she was recommended contraception owing to the risk of recurrence. In such cases, hormonal therapy is recommended to prevent the recurrence of ovarian endometrial cyst in the long term; however, the possible association of SCAD with female hormones should be taken into consideration. In conclusion, SCAD is a rare but important cause of acute coronary syndrome among women of reproductive age. Therefore, obstetricians and gynecologists must collaborate with cardiologists starting from the acute phase to manage the long-term health of such patients. [Adv Obstet Gynecol, 73 (1) : 22-27, 2021 (R3.2)]

Small intestinal endometriosis is a relatively rare disease among rare site endometriosis, but in the case of large mass, stenosis or compression of the mass may cause intestinal obstruction and require surgical resection. In the present case, we experienced a case of increased small intestinal endometriosis during medication of dienogest and capsul endoscopy incarceration. A 50-year-old woman with a small intestinal tumor suspected to be bilateral ovarian chocolate cysts and intestinal endometriosis taking dienogest was given a disintegrating patency capsule of the same size as the capsule endoscope to evaluate the gastrointestinal tract openness. After confirmation of passage, the capsule endoscope was performed, and the patient presented with symptoms of intestinal obstruction. CT showed tumor enlargement and capsule endoscopic dislocation. Conservative treatment with the ileus tube did not improve her symptoms, and the search with double-balloon endoscopy and dilatation of the stenosis were not successful, so she underwent ileocecal resection with the mass and bilateral accessory resection 10 days after capsule endoscopy was performed. Histopathology diagnosed endometriosis of the small intestine, with a fresh bleeding lesion internally, which was thought to be the cause of the rapid growth of the tumor. Small intestinal tumors with suspected endometriosis may show tumor enlargement during intaking dienogest, so capsule endoscopy should be performed with caution even if the patency capsule is passed. [Adv Obstet Gynecol, 73 (1) : 28-34, 2021 (R3.2)]

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized by periodic fever and serositis such as peritonitis and pleuritis. Herein, we present a case of FMF diagnosis based on the patient’s medical history of periodic fever and diagnostic administration of colchicine. Although a few reports have suggested that menstrual attacks in FMF exhibit symptoms similar to endometriosis, we required differentiation. A 19-years-old-female presented with complaints of severe abdominal pain during menstruation. She also suffered from fever of more than 38˚C and general fatigue every three months. We prescribed her colchicine with norethisterone and ethinylestradiol for diagnostic treatment. We noticed that the patient’s general fatigue converted to a mild fever, but the menstruation pain persisted. Gene mutations of exon 10 were not observed at the first genetic search, but repeat genetic search revealed hetero mutations of E84K and R410H in the MEFV gene. The patient was accordingly diagnosed with an FMF variant. For managing menstrual pain, the patient was administered a combination of colchicine and dienogest. Patients suspected of having FMF may present to obstetrics and gynecology and pediatric clinics. FMF should be suspected when the patient has recurrent fever of more than 38˚C, - without an obvious source of infection-, but with abdominal and chest pain. [Adv Obstet Gynecol, 73(1) : 35-40, 2021 (R3.2)]

We present a case of interstitial pregnancy in the remnant tube after ipsilateral salpingectomy. The patient was a 26-year-old gravida four, para two woman who underwent left salpingectomy due to left-side ampulla of a fallopian tube pregnancy two years earlier. On admission, she was at seven weeks gestation and presented with severe low abdominal pain and shock. Preoperatively, we diagnosed rupture of ectopic pregnancy on the basis of transvaginal ultrasonography and physical findings. Laparoscopic findings revealed massive haemorrhagic ascites and rupture of interstitial pregnancy in the remnant tube after ipsilateral salpingectomy. Laparoscopic corneal wedge resection was performed. We believe that careful clinical consideration and attention must be paid to ectopic pregnancy in the remnant tube following salpingectomy, including the possibility of interstitial pregnancy. [Adv Obstet Gynecol, 73(1) : 41-46, 2021 (R3.2)]

Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disease characterized by tumors derived from smooth muscles throughout the abdominal cavity. In recent years, DPL after laparoscopic surgery with unconfined power morcellation has become a problem. We present a case of DPL resulting from previous laparoscopic morcellation and a review of the existing literature. A 48-year -old patient underwent laparoscopic uterine myomectomy 11 years ago. The abdominal masses on imaging were found during a routine medical checkup. The MRI revealed DPL, and the patient underwent surgery. In abdominal, there were some masses independent from the uterus. patient had excision of DPL, abdominal total hysterectomy, bilateral salpingo-oophorectomy and rectal resection. The histology report confirmed DPL. Based on the literature review of systematic reviews and case reports and this case, it was suggested that DPL often occurs especially after uterine fibroids operation using power morcellators. Therefore, clinical caution ought to be exercised when using power morcellators and laparoscopic morcellation should be operated in bag if practicable. [Adv Obstet Gynecol, 73 (1) : 47-53, 2021 (R3.2)]

Sub-chorionic hematoma is defined as marginal hemorrhage of the placenta between the chorionic plate and the underlying decidua during the 1st and 2nd trimesters of pregnancy. We report three cases of sub-chorionic hematoma that occurred during late pregnancy. Using ultrasonography and MRI, patients were diagnosed with sub- chorionic hematoma between 28 - and 32 - weeks’ gestation (late pregnancy). Particularly, MRI was useful for distinguishing between a sub- chorionic hematoma and placental abruption. Pregnancy sustained and vaginal delivery was possible in the patients. Two patients delivered at 34 weeks’ gestation, and the pregnancy progressed uneventfully, and an elective cesarean section was performed at 38 weeks for the third patient. Neonatal outcomes were good in all cases.Subchorionic hematoma is associated with perinatal complications such as preterm labor and fetal growth restriction. MRI can accurately determine the location and size of the hematoma. Obstetricians should consider a diagnosis of sub-chorionic hematoma in patients with lower abdominal pain in whom a hematoma is observed near the placenta during late pregnancy. Thus, MRI can be used to distinguish between sub-chorionic hematoma and placental abruption. [Adv Obstet Gynecol, 73 (1) : 54-61, 2021 (R3.2)]

Spinal cord neoplasm is an extremely rare type of tumor, and there are few reports of spinal cord neoplasm complicating pregnancy. We report a case of spinal hemangioblastoma complicating pregnancy, with symptoms present from the first trimester. The patient was 25 years old, gravida two, para one. She presented with hiccupping from the first trimester, and in the final trimester, while being managed as an inpatient for suspected premature labor, she developed nausea, vomiting, and numbness in the fingers. A plain magnetic resonance imaging (MRI) examination of the head at 31 weeks zero days of pregnancy showed the presence of a spinal cord neoplasm complicating the pregnancy. The woman was transported to a tertiary medical facility, and since her neurological symptoms were worsening, an emergency cesarean section was performed at 31 weeks two days. A pre-operative assessment of the spinal cord neoplasm was carried out with contrast MRI and angiography, and a spinal hemangioblastoma at the 4^th-5^th cervical vertebrae was observed. On the second day after delivery, the spinal cord neoplasm was surgically excised with the patient in the prone position by neurosurgery specialists. Postoperatively, she experienced mild numbness in the fingers, but the neurological symptoms, such as hiccupping, were alleviated, and she was discharged on the 21^st postpartum day. [Adv Obstet Gynecol, 73(1) : 62-67, 2021 (R3.2)]

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune limbic encephalitis that is prevalent in young women with ovarian teratoma. In the present study, we report a case of symptomatic improvement after laparoscopic right salpingo-oophorectomy for anti-NMDA receptor antibody encephalitis associated with a micro ovarian immature teratoma without obvious ovarian enlargement on imaging. A 19-year-old woman was admitted due to seizures to our hospital. She was transferred to our neurology department due to the progression of disorientation and involuntary movements, and encephalitis was suspected. Seventh day of hospitalization, anti-NMDA receptor antibodies were found to be positive. MRI and CT showed an area in the right ovary that was undefined but very faintly suspicious of fatty components, suggesting the presence of a micro ovarian teratoma. The patient underwent a laparoscopic right salpingo-oophorectomy. Pathological examination was immature teratoma, Grade1. Macroscopically, a right ovarian tumor (three mm in size) containing a small amount of fatty tissue was observed. The patient was weaned off the respirator on the fourth postoperative day. Her conscious level gradually improved and she was able to communicate. Careful scrutiny is necessary, bearing in mind that even microscopic teratomas that are difficult to detect on imaging can cause the disease. [Adv Obstet Gynecol, 73 (1) : 68-72, 2021 (R3.2)]