This retrospective study aimed to investigate the incidence of abnormal cervical cytology in pregnant adolescent women (age < 21 years at the initial visit) and the follow-up course of these patients. We assessed 336 pregnancies in 306 women, and 17 (5.1%) had abnormal results, including 13 (3.9%) with atypical squamous cells of undetermined significance (ASC-US), three (0.9%) with low-grade squamous intraepithelial lesions (LSIL), and one (0.3%) with high-grade squamous intraepithelial lesions (HSIL). The patients with LSIL or HSIL were above aged 18 years or older, whereas even 14-year-old patients had ASC-US. Eight out of 11 ASC-US cases tested for high-risk human papillomavirus had positive results. In postpartum follow-up, six out of 12 women had abnormal cytology results, but none required cervical conization. Four cases with abnormal cervical smears during pregnancy were lost to postpartum follow-up. In conclusion, the incidence of abnormal cervical cytology was approximately 5% in pregnant adolescent women. Abnormal postpartum findings remained in nearly half of the cases. [Adv Obstet Gynecol, 74 (3) : 295-300, 2022 (R4.8)]

This study included 14 patients treated with microwave endometrial ablation (MEA) and 98 patients treated with first time insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS).Questionnaires were completed at baseline and at one, three, and six months, as well as one, two, three, four and five years after treatment. The cases of LNG-IUS expulsion were identified from the medical records. According to the measures assessed in the questionnaires, hypermenorrhea and general fatigue were significantly improved compared with baseline in both groups. Menstrual duration improved after treatment in the MEA group. Volume-related symptoms were significantly improved in the LNG-IUS-treated group. Pain scores before the treatment tended to be higher in the LNG-IUS group than in the MEA group; however, the scores decreased rapidly after treatment in both groups. The frequency of LNG-IUS expulsions was about 18% in the first year and 23%, 27%, 29%, and 32%, respectively, from the second to the fifth years. The majority of cases of LNG-IUS expulsion were associated with the presence of uterine myomas or adenomyosis or both. MEA and LNG-IUS are minimally invasive treatments that may be effectively applied to reduce symptoms and improve quality of life of women with hypermenorrhea. [Adv Obstet Gynecol, 74 (3) : 301-308, 2022 (R4.8)]

Seromucinous tumor is a new category of ovarian epithelial tumor in the revised 2014 WHO Classification of Tumours of Female Reproductive Organs. Little is known about its clinical features and treatment. Therefore, the purpose of this study was to clarify the clinicopathological characteristics of ovarian seromucinous tumors. We retrospectively assessed 12 patients with seromucinous tumors who underwent surgery at our hospital between 2015 and 2019. Of the 12 cases, 11 (91.7%) were borderline malignancies, accounting for 26.8% of all borderline malignancies during the same period. One (8.3%) was malignancy. The median age was 44.5 years (range, 23-71). Magnetic resonance imaging findings showed papillary projections with high signal intensity on T2-weighted image in ovarian cysts in 10 cases (83.3%). Endometriosis was seen in six cases (50.0%), of which three had undergone preoperative hormone therapy. Seven cases were stage (FIGO 2014) IA, four were stage IC1, and one was stage IC2. The median follow-up period was 24.5 months (range, 10-67); all cases had no recurrence postoperatively. Five patients aged < 40 years preserved fertility, and one of them delivered after the surgery. Since seromucinous tumors are often stage I borderline malignancy, fertility-sparing surgery may be an option for younger patients. [Adv Obstet Gynecol, 74 (3) : 309-317, 2022 (R4.8)]

In this study, obstetrical outcomes after a laparoscopic myomectomy were investigated. Thirty-seven cases with a cesarean section procedure performed after a laparoscopic myomectomy (LM group) from 2015 to 2019 at our institution were retrospectively reviewed. To compare outcomes of case with and without uterine surgery, 32 breech cesarean section patients who had not undergone a previous cesarean section or myomectomy (NS group), and 82 cesarean section patients who had undergone a previous cesarean section (RCS group) during the same period were also analyzed. Maternal age was significantly higher in the LM (median age 36 years) as compared with the NS (33 years, P=0.01) group, and uterine myoma was detected significantly more frequently in the LM(24.3%)than in the RCS (2.4%, P<0.001) group. Operation time was significantly longer in the RCS group (median 69 minutes) as compared to the NS (58 minutes, P=0.0014) and LM (57 minutes, P<0.001) groups. Perioperative hemorrhage occurrence was significantly more frequent in the LM (median 810 mL) as compared with the RCS (704 mL, P=0.04) group. Patients and physicians should be aware of increased risk of perioperative hemorrhage during a cesarean section performed after a laparoscopic myomectomy. [Adv Obstet Gynecol, 74 (3) : 318-323, 2022 (R4.8)]

The management of ovarian cancer with peritoneal dissemination requires a multidisciplinary approach, including surgery and chemotherapy. Despite its proven efficacy, intraperitoneal (IP) chemotherapy is not a standard treatment because of its toxicity or cumbersome procedure. In this study, we investigated the efficacy and feasibility of using IP chemotherapy to treat ovarian cancer. We retrospectively analyzed the background, treatment details, and adverse effects in patients with ovarian cancer who underwent treatment from 2001 to 2015. We performed IP chemotherapy in 23 patients. The regimen consisted of intravenous paclitaxel and intraperitoneal carboplatin. Eighteen patients (82%) responded on initial treatment (17 complete responses [CRs] and 1 partial response); 10 of the 17 patients who had CRs relapsed, five had intraperitoneal recurrence, and five had distant or lymph node metastasis. The three-year progression-free survival (PFS) rate was 48%, and median PFS was 37 months. Notably, >grade 3 neutropenia occurred in 12 patients (52%), with catheter-related adverse events in 6 patients (26%). One patient died of anaphylaxis by paclitaxel. Conclusion: Despite the higher risk of adverse effects associated with IP chemotherapy, it may be an effective therapeutic strategy against ovarian cancer with peritoneal dissemination with great caution. [Adv Obstet Gynecol, 74 (3) : 324-329, 2022 (R4.8)]

Microwave endometrial ablation (MEA), a minimally invasive and easy treatment for menorrhagia, is expected to become a widely accepted therapeutic option in the future. We summarize our learning experience in 18 patients who underwent MEA performed by an obstetrician and gynecologist without any experience with MEA. The study included 15 patients who refused hysterectomy for management of menorrhagia and anemia associated with uterine fibroids, adenomyosis, and endometrial hyperplasia, among other disorders and 3 patients who underwent emergency MEA for severe genital bleeding. MEA successfully controlled menorrhagia and anemia in all 18 women, without any complications. Our study highlights the following features associated with our learning experience of MEA technology : (i) Application of MEA requires technical ingenuity to accurately estimate the direction of the fallopian tube ostium from outside the uterus using a hysteroscope, followed by gentle manipulation of the instrument into the angle of the fallopian tube with a twist of the sounding applicator. (ii) Women with a small uterus tend to experience severe post-MEA pain. (iii) Operators should follow specific precautions when learning MEA skills. We summarized the ideas of MEA learning skills for MEA inexperience doctor. [Adv Obstet Gynecol, 74 (3) : 330-337, 2022 (R4.8)]

Fulminant type 1 diabetes mellitus (FT1DM) is characterized by the acute onset of diabetic ketoacidosis and poor prognosis. We report two cases of FT1DM associated with pregnancy. Case 1 : A 30-year-old gravida 1 para 0 observed reduced fetal movements and visited a previous hospital at 36 weeks of gestation. Diagnosis of fetal distress necessitated emergency cesarean section; however, the neonate died despite resuscitation. She developed difficulty in breathing on the first postoperative day and was transported to our hospital for further evaluation. Initial laboratory test results revealed hyperglycemia, metabolic acidosis, and ketonuria. Case 2 : A 42-years-old gravida 4 para 1 underwent a normal delivery at 39 weeks of pregnancy. She was discharged five days later without any complications in pregnancy progression. She observed excessive thirst seven days after delivery and visited our hospital for further evaluation. Initial laboratory test results revealed hyperglycemia, metabolic acidosis, and ketonuria. Based on these findings, we diagnosed diabetic ketoacidosis in both patients. Additional laboratory tests showed glycated hemoglobin (National Glycohemoglobin Standardization Program) levels within the normal range, low levels of serum C-peptide, and unresponsiveness to glucagon stimulating test for C-peptide, which led to the diagnosis of FT1DM. Clinicians should consider FT1DM in the differential diagnosis in pregnant or postpartum women with normal progression, who present with sudden onset of dyspnea, acute circulatory failure, or severe metabolic disorder. Early diagnosis and treatment are essential for optimal treatment of FT1DM associated with pregnancy. [Adv Obstet Gynecol, 74 (3) : 338-342, 2022 (R4.8)]

Laparoscopic total hysterectomy (TLH) has a predominantly higher frequency of ureteral injury than with abdominal surgery. In the present study, we experienced two cases in which drip infusion pyelography (DIP) was performed and ureteral stenting was performed preoperatively in patients with bilateral duplicate pyelonephric ureters and ureteral injury was avoided. Case 1 was a case 49-year-old female. She was referred to our clinic for uterine fibroids, excessive menstruation, and enlarged myomas, and the plan was to operate. She had a pregnancy history of one pregnancy and one birth (one cesarean section). Preoperative DIP showed two left ureters, which were fused at the level of the iliac bone and the following were fused at the level of the iliac bone, so we suspected an incomplete duplicate left pyelic ureter. A ureteral stent was placed and surgery was performed. We confirmed one left and one right ureter on cystoscopy and incomplete duplicate left pyelic ureter. Case 2 is a 45-year-old woman. After five courses of GnRH analogue, she was referred to our hospital for surgical treatment of uterine fibroids. She had a history of three pregnancies and three deliveries (three cesarean sections). The patient underwent a preoperative DIP examination, and a bilateral pyelogram and ureteral stent were placed, as in case 1. Both cases were confirmed no bladder damage and the outflow of indigo carmine administered intravenously through all ureteral orifice after the stent was removed. Preoperative DIP can confirm the presence or absence of a urinary tract malformation, and implantation of a ureteral stent can reduce intraoperative complications. Preoperative DIP can confirm the presence of urinary tract malformations and implantation of a ureteral stent was considered important to prevent intraoperative ureteral injury. [Adv Obstet Gynecol, 74 (3) : 343-350, 2022 (R4.8)]

Hepatic endometriosis is a particularly rare form of extrapelvic endometriosis. It has no characteristic imaging findings and its preoperative diagnosis is difficult. The current authors encountered a case of hepatic endometriosis that was identified preoperatively, as reported here. The case involved a 42-year-old nulligravida. The woman underwent a laparoscopic left adnexectomy and removal of an endometrial cyst in the right ovary by a previous physician for bilateral ovarian endometrioma at the age of 39. The woman had no upper abdominal symptoms prior to surgery. The contents of the peritoneal cavity were examined intraoperatively, but there were no abnormalities in the upper abdomen. Two years later, the woman developed worsening dysmenorrhea and periodic right upper quadrant pain during menstruation, so she underwent abdominal pelvic contrasting magnetic resonance imaging (MRI). MRI revealed findings suggesting the recurrence of endometriosis and a cystic lesion of the liver, so a GnRH agonist was administered and then she started taking dienogest. MRI while the woman was taking dienogest revealed shrinkage of the lesion, and right upper quadrant pain was alleviated. Based on these findings, the woman was presumed to have hepatic endometriosis. After taking dienogest for two months, dysmenorrhea worsened, so the woman was also administered a GnRH agonist at this hospital, and this is where she eventually underwent surgery. The patient had no desire to bear children in the future, and she fervently wished to reduce the risk of recurrence and prevent a progression to malignancy. The surgical strategy was to remove the uterus and right adnexa. A laparoscopic partial resection of the liver, total hysterectomy, and right adnexectomy was performed. The postoperative course was uneventful, and the patient was discharged. A postoperative pathological examination of the liver lesion revealed signs of endometriosis. But a postoperative pathological examination of the right adnexa revealed signs of endometriosis. Since Gn-RH agonist treatment was successful, ectopic endometrial tissue was found around the right adnexa, and there was a previous surgical history of endometriosis, it was diagnosed that the hepatic capsular endometriosis caused by dissemination of endometriosis to the liver. At the current point in time, she has not developed any climacteric symptoms or symptoms of recurrence. We review the literature of hepatic endometriosis. [Adv Obstet Gynecol, 74 (3) : 351-359, 2022 (R4.8)]

Bevacizumab has antitumor effects and acts synergistically with concomitant medications. The adverse events of bevacizumab include hypertension, proteinuria, bleeding, and delayed wound healing. We report a case of rupture of a pseudoaneurysm of the inferior mesenteric artery, with resultant melena and hemorrhagic shock, that occurred during weekly paclitaxel-bevacizumab therapy in a 39-year-old nongravid, nulliparous, unmarried woman with stage IIIc serous ovarian cancer. A total of seven courses of docetaxel-carboplatin therapy as well as interval debulking surgery were initially undertaken, followed by various chemotherapy regimens for cancer recurrence. Subsequently, weekly paclitaxel-bevacizumab therapy was initiated, and tumor shrinkage was observed after three courses of this regimen. On the day of the schedule fifth course, the patient suddenly fell while walking, had massive melena, and experienced hemorrhagic shock. Contrast-enhanced computed tomography revealed a ruptured pseudoaneurysm of the inferior mesenteric artery that continued to bleed into the colon, and the patient underwent microcoil embolism to achieve hemostasis. Massive bleeding following a pseudoaneurysm rupture during bevacizumab administration is rare, but caution should be exercised when administering bevacizumab to patients with advanced lesions. Interventional radiology was useful to achieve hemostasis. [Adv Obstet Gynecol, 74 (3) : 360-365, 2022 (R4.8)]

Benign metastasizing leiomyoma (BML) is a rare disease, and although it is histopathologically benign, it can metastasize to the lungs and other organs. Here, we report a case of BML with multiple lung metastases after hysterectomy for uterine myoma that required multidisciplinary treatment because its size gradually increased and it extended into the pulmonary vein. A 71-year-old woman underwent hysterectomy for a leiomyoma at 63 years of age. Seven years later, multiple lung nodules were detected. Thus, diagnostic thoracoscopic partial left lung resection was performed, although positron emission tomography/computed tomography (CT) showed no fluorodeoxyglucose accumulation. A leiomyoma, suggesting BML, was histopathologically diagnosed. Four years later, as the residual lung tumor showed a tendency to gradually increase in size, radiofrequency ablation and intensity-modulated radiotherapy were performed. Three years later, CT revealed lung metastatic lesions extending into the left upper pulmonary veins. Although chemotherapy(Doc etaxel+Gemcitabine) was ineffective, considering the possibility of sudden changes, left upper lobectomy and pulmonary angioplasty were performed. No obvious malignant findings were found on histopathological examination. The patient is still being followed up for BML. Although BML is pathologically benign, it should be considered a low-grade leiomyosarcoma because it can become malignant and metastasize and have intravenous extensions. [Adv Obstet Gynecol, 74 (3) : 366-375, 2022 (R4.8)]

Spontaneous hemoperitoneum in pregnancy (SHiP) is infrequent and has serious consequences such as high maternal and fetal mortality. Herein, we report two cases of SHiP developed in the 8th month of pregnancy.The first case was a woman at 29 weeks of gestation, transferred to our hospital due to lower abdominal pain and difficulty in suppressing uterine contractions. Acute appendicitis was suspected by MRI, and an emergency surgery was performed. The uterine vein was distended from the right side of the uterine floor to the right ovarian ridge, and bleeding was observed from the anterior wall of the uterus and the right ovarian vein. As the baby's condition was stable, the patient continued the pregnancy and achieved vaginal delivery.The second case was a woman at 30 weeks of gestation. An emergency cesarean section was performed due to decreased maternal consciousness and fetal distress. An aneurysm on the right dorsal side of the uterus was ruptured and bleeding, and the baby suffered severe neonatal asphyxia.When determining the causes of acute abdomen in pregnancy, it is believed that early detection of SHiP will lead to improvement in the prognosis of mothers and infants. [Adv Obstet Gynecol, 74 (3) : 376-382, 2022 (R4.8)]

The patient was a 48-year-old woman, referred to our department for further treatment for recurrent uterine cancer. The patient was diagnosed with endometrial cancer stage IVB. Postoperative chemotherapy was administered, but the disease worsened. The Microsatellite instability test was positive, and the patient showed complete response to pembrolizumab administration. On day 15 of the 20th cycle, upper respiratory tract inflammation was observed, and the patient was diagnosed with COVID-19 by PCR test. Low-grade fever persisted, and 33 days later, she developed a high-grade fever and lymph node swelling. The repeat COVID-19 PCR test was positive. Computed tomography (CT) showed linear shadows in the subpleural regions, multiple ground-glass opacities and granular shadows in the upper lobes of both lungs, and enlarged cervical lymph nodes. The patient was treated with dexamethasone. Her fever promptly subsided. CT scan showed that all the lymph nodes had shrunk. The 21st cycle of pembrolizumab was resumed, and the patient was well thereafter.The main cause of COVID-19 pneumonia is autoimmune alveolar damage triggered by viral infection. Pembrolizumab administration may exacerbate COVID pneumonia by activating immune cells. If COVID-19 pneumonia is found in patients under pembrolizumab treatment, early administration of steroids may be effective. [Adv Obstet Gynecol, 74 (3) : 383-390, 2022 (R4.8)]

Adenomyomectomy has been increasingly performed for fertility preservation treatment. We experienced a case of silent uterine rupture at 32 weeks’ gestation identified using serial magnetic resonance imaging (MRI). A 35-year-old primigravida underwent adenomyomectomy, myomectomy, and endometriosis ablation by laparotomy for fertility preservation treatment. She conceived through intracytoplasmic sperm injection one year and four months later. MRI was performed at 16, 25, and 32 weeks’ gestation to evaluate the myometrium. At 16 and 25 weeks’ gestation, myometrial thinning was observed at the uterine fundus; this coincided with the adenomyomectomy scar. At 32 weeks’ gestation, the thinning progressed, and the fetal membranes bulged into the abdominal cavity. We suspected a silent uterine rupture and performed an emergency cesarean section. Uterine rupture was noted at the site of the adenomyomectomy scar, and the uterine serosa adhered to the intestines; however, no defect was found. A diagnosis of incomplete uterine rupture was made, the rupture site was cut and repaired with sutures after adhesiolysis. The puerperal and neonatal courses were uneventful. MRI performed three months postoperatively revealed no myometrial thinning. The present case suggests that serial MRI is beneficial in diagnosing threatened or silent uterine rupture during pregnancy after adenomyomectomy. [Adv Obstet Gynecol, 74 (3) : 391-398, 2022 (R4.8)]

We report the case of a pregnant woman infected with syphilis who was treated with acetylspiramycin because of drug eruption caused by penicillin antibiotics. The patient was a 19-year-old nulliparous woman. At 10 weeks of gestation, both the rapid plasma reagin test (RPR) and Treponema pallidum hemagglutination test (TPHA) were positive. A quantitative test for syphilis at 12 weeks of gestation revealed high levels of RPR (64-fold) and TPHA (20,480-fold). The diagnosis of asymptomatic syphilis was made. The time of infection was unknown. Amoxicillin at 1500 mg/day was started at 12 weeks of gestation. She developed drug rash eight days after starting the medication. Acetylspiramycin was administered for eight weeks starting at 15 weeks of gestation. After oral administration, the RPR titer decreased and she was considered cured. She delivered a healthy male baby at 41 weeks of gestation. The newborn had no signs of congenital syphilis. In this case, acetylspiramicyn was effective in preventing congenital syphilis. However, data are insufficient to recommend acetylspiramycin for the treatment of maternal infection and prevention of congenital syphilis. Therefore, further studies are necessary to determine alternative treatments to penicillin for pregnant women with syphilis in the case of penicillin allergy. [Adv Obstet Gynecol, 74 (3) : 399-403, 2022 (R4.8)]

Aortic dissections rarely occur in young women. However, during pregnancy, the aortic wall and the blood flow undergo various hemodynamic changes. This increases the risk of aortic dissection especially in women with Marfan syndrome or Loeys–Dietz syndrome. Herein, we describe two cases of type-A aortic dissection that occurred in the perinatal period and required surgery. The first patient was a 43-year-old woman, two gravida zero para who presented to our hospital after experiencing sudden chest and back pain in the 31st week of gestation (30W3D). Transthoracic echocardiography demonstrated type-A aortic dissection. Emergency cesarean-section and aortic repair surgeries were performed. She was diagnosed with Loeys–Dietz syndrome. The second patient was a 28-year-old woman, 1 gravida 0 para. She experienced sudden backpain during pregnancy but her symptom resolved without a clinical visit. She delivered a baby in the 41st gestational week (40W3D) after having shortness of breath two days after delivery with palpitations. She visited a maternity hospital six days after delivery and was transferred to our hospital where she was diagnosed with type-A aortic dissection and underwent aortic-root replacement and mitral-valve replacement on the seventh day of hospitalization after treatment of heart failure. She was diagnosed with Marfan syndrome. [Adv Obstet Gynecol, 74 (3) : 404-411, 2022 (R4.8)]

Malignant transformation from adenomyosis of the uterus is rare, with only a few reported cases. We report a case of endometrial carcinoma arising from adenomyosis of the uterus and do a review of the existing literature. A 57-year-old woman came to our hospital due to a high CA19-9 level in her medical checkup results. MRI showed a cystic mass on the dorsal side of the uterus, and PET-CT showed FDG accumulation in the cervix and Douglas fossa. There were no obvious malignant findings in the cervical and endometrial cytology results, nor in the uterine cervical and endometrial histology report. There were no obvious abnormal findings, as well, in the colposcopy results. The only significant findings were in images. Thereafter, the patient underwent laparoscopic surgery for suspected cervical cancer. The intraoperative findings were that the Douglas fossa was closed, the posterior wall of the uterus and rectum were firmly adherent, and some tumor components were exposed at the time of the adhesion detachment. The patient underwent a semi-radical hysterectomy, bilateral adnexal resection, combined rectal resection, pelvic and para-aortic lymph node dissection, rectal end-to-end anastomosis. The histopathological examination revealed no tumors in the endometrium, no endometrioid carcinoma in the myometrium, and no endometrioid carcinoma G1 tumors in the adenomyosis. The tumor was exposed on the serosal surface of the uterus, but no infiltration into the mesentery was observed. There was no ovarian metastasis, and lymph node metastasis was found in the right para-aortic and right closed segments. Since the tumor was the main tumor from the uterine body to the cervix, endometrial cancer IIIC2 pT3bN2M0 was diagnosed. PET-CT can help in the early diagnosis of endometrial carcinoma arising from adenomyosis. Ultimately, however, a surgical histopathological diagnosis is essential, so laparoscopic surgery is considered useful due to its minimally invasive nature. [Adv Obstet Gynecol, 74 (3) : 412-417, 2022 (R4.8)]

We report a case of total laparoscopic hysterectomy in a 47-year-old nulligravida woman with a uterus bicornis bicollis and vaginal septum. The patient was prescribed dienogest at a previous clinic to treat adenomyosis. However, because of continuous abnormal bleeding, she selected surgical treatment and was referred to our hospital. Local speculum examination revealed a vaginal septum, but only one of her uterine cervices was visible. Transvaginal ultrasonography revealed adenomyosis, but it did not lead to the diagnosis of uterine malformation. A preoperative exploratory pelvic MRI scan revealed a uterus bicornis bicollis. Total abdominal contrast CT examination confirmed no urinary tract malformations. During the operation, the vaginal septum was first removed and parts of the two cervices were visually recognized. We confirmed that the combined size of the two cervices did not exceed the colpotomy cup, and inserted the uterine manipulator into the right uterus and performed laparoscopic hysterectomy and bilateral salpingo-oophorectomy without any adverse event. In vaginal septum cases, it is important to evaluate preoperative uterine and urinary tract malformations. [Adv Obstet Gynecol, 74 (3) : 418-424, 2022 (R4.8)]

Malignant transformation of an ovarian teratoma into intestinal adenocarcinoma is extremely rare and to date, only 15 cases are described in the literature. We report a case of malignant transformation of a mature ovarian teratoma into intestinal adenocarcinoma in a 22-year-old woman. She underwent pelvic magnetic resonance imaging, which revealed a right ovarian polycystic mass with a solid component and positron emission tomography-computed tomography, which revealed abnormal fluorodeoxyglucose uptake in the same area. Based on these findings, we suspected a borderline malignant or malignant ovarian tumor and performed fertility-preserving right adnexal resection. Histopathological evaluation of the resected specimen showed ductal adenocarcinoma; the background sac wall showed completely mature non-keratinized stratified squamous epithelium and sebaceous glands, which typically represent the features of a mature teratoma. Therefore, the patient was diagnosed with malignant transformation of a mature teratoma. Owing to the advanced-stage malignancy, we performed surgery for ovarian malignancy. The patient was diagnosed with pT1c2N0M0 stage IC2. She received four cycles of TC therapy as postoperative adjuvant chemotherapy. Few studies have reported this condition in young patients, and further investigations are warranted to gain a deeper understanding of the prognosis and the possibility of fertility-preserving surgery in this patient population. [Adv Obstet Gynecol, 74 (3) : 425-432, 2022 (R4.8)]

Postoperative infection with Mycoplasma hominis has been reported in the field of gynecology. Mycoplasma hominis is the smallest prokaryote. Because it has no cell walls, gram staining is not useful; additionally, Mycoplasma hominis is resistant to β-lactam antibiotics. We often use cephem antibiotics before and after surgery to prevent postoperative infections, but these are not effective against Mycoplasma hominis. Because it takes a long time to culture Mycoplasma hominis and gram staining is not useful, DNA analysis or detailed inspections are needed to identify Mycoplasma hominis. Attempts to identify M. hominis in routine bacterial cultures can result in false-negative results. This report describes two young women who developed abdominal pain and a fever after radical hysterectomy for cervical cancer. β-lactam antibiotic therapy was initiated, but the patients’ symptoms did not improve after several days. Therefore, Mycoplasma hominis infection was suspected, and pelvic infection was diagnosed by proper culture. The patients had been treated with 14- and 15-member macrolide antibiotics (erythromycin and azithromycin), and we changed these antibiotics to clindamycin after obtaining the culture results. The abdominal pain and fever improved thereafter. [Adv Obstet Gynecol, 74 (3) : 433-439, 2022 (R4.8)]

Anemia is a common complication in pregnancy and is frequently secondary to iron deficiency. We report a case of anemia caused by folic acid deficiency during the third trimester of pregnancy. A 31-year-old woman (gravida 2, para 1) presented for regular prenatal checkup at 34 weeks’ gestation. Blood test results at 36 weeks’ gestation showed serum hemoglobin (Hb) 9.7 g/dL, mean corpuscular volume (MCV) 101.0 fL, and platelets (Plt) 132,000/μL. She underwent spontaneous vaginal delivery at 38 weeks and 2 days. Blood loss at delivery was 376 g, and her postpartum course was stable. Blood test results revealed severe anemia and thrombocytopenia (Hb 6.9 g/dL, MCV 101.5 fL, and Plt 57,000/μL) on the 3^rd postpartum day. Additional blood tests revealed that the blood folic acid level was below the measurement sensitivity. She was diagnosed with megaloblastic anemia due to folic acid deficiency. Oral folic acid (15 mg/day) and mecobalamin (1500 μg/day) treatment was initiated on the 5^th postpartum day, and anemia and thrombocytopenia improved on the 40^th postpartum day. Clinicians should monitor both the serum Hb and MCV levels during evaluation of anemia. Folic acid deficiency should be considered in the differential diagnosis in pregnant women with thrombocytopenia. [Adv Obstet Gynecol, 74 (3) : 440-446, 2022 (R4.8)]

Recently, uterine artery embolization (UAE) has been increasingly used as a conservative treatment approach for postpartum hemorrhage. However, post-UAE effects on menstruation are not fully evaluated. This study retrospectively examined the post-UAE effects on menstruation in 11 obstetric cases, followed between January 2010 and December 2020. A gelatin sponge was used as the embolizing substance, and the embolizing site was applied only to the bilateral uterine arteries in all cases. UAE was performed for obstetric hemorrhage in seven cases and for Retained Products of Conception (RPOC) in four cases, and all cases resumed menstruation. Out of these cases, two cases got pregnant and gave birth. In this study, menstruation was found to resume in all cases. Therefore, UAE appeared to have no deleterious effects on menstruation. [Adv Obstet Gynecol, 74 (3) : 447-453, 2022 (R4.8)]

Cellular angiofibroma (CAF)is a benign disease that was proposed by Nucci et al. in 1997 as a condition presenting with histological images of both angiomyofibroblastoma and spindle cell lipoma. Although there have been a few cases of recurrence even after resection, the risks of recurrence and treatment remain unclear. The present case is of a 47-year-old woman who was diagnosed with a left Bartholin’s gland cyst at another hospital seven years earlier and underwent marsupialization. Two years later, she experienced recurrence at the same site; resection was performed at our department, and CAF was diagnosed based on postoperative pathology. The resected margins were partially positive, but since there are reports that CAF does not recur even when the margins are positive, we consulted with the patient and decided to place her on follow-up observation. Five years later, the mass reappeared and was diagnosed as CAF on biopsy. Although the mass was close to the anus and rectum on magnetic resonance imaging, we performed collaborative surgery to achieve complete resection and preservation of function and resected a portion of the levatorani muscle and the intrinsic rectal muscle layer with negative margins. In this paper, we report the preoperative differential diagnosis of CAF and the surgical method, including a discussion of the literature. [Adv Obstet Gynecol, 74 (3) : 454-460, 2022 (R4.8)]