ADVANCES IN OBSTETRICS AND GYNECOLOGY
Online ISSN : 1347-6742
Print ISSN : 0370-8446
ISSN-L : 0370-8446
Current issue
ADVANCES IN OBSTETRICS AND GYNECOLOGY Vol.76 No.1
Displaying 1-14 of 14 articles from this issue
CASE REPORT
  • Yukiko SUZUKI, Ai KOGIKU, Takahiro NATSUYAMA, Satoko MORIKAMI, Eri K ...
    2024 Volume 76 Issue 1 Pages 1-7
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    Mesonephric carcinomas (MC) are rare malignant tumors in the mesonephric remnant of the uterine cervix. Recently, mesonephric-like adenocarcinomas (MLA), which share similar characteristics with MCs, have been classified in the 5th edition of WHO Classification of Tumors. The exact origin of MLA remains unclear, as they may either arise from the mesonephric tissue or represent Müllerian tumors that closely resemble MC. In this study, we present the case of a 28-year-old pregnant woman with an ovarian cyst. While we could not dismiss the possibility of malignancy, our primary suspicion was that the tumor was an endometriotic cyst exhibiting decidualization based on the MRI image. Following consultation, we made the decision to carefully proceed with the pregnancy without resorting to surgery. During the caesarian section, we performed an ovarian cystectomy, revealing that the cyst was, in fact, an MLA coexisting with seromucinous borderline tumors located on the posterior aspect of the endometriotic cyst. This particular case provides further evidence supporting the notion that MLA represents a Müllerian adenocarcinoma demonstrating mesonephric differentiation. Differentiating between a malignant tumor and an endometriotic cyst with decidualization, during the gestational period poses a challenge. Moreover, the coexistence of MLA and seromucinous borderline tumors likely contributed to the difficulty in distinguishing between benign and malignant conditions. 〔Adv Obstet Gynecol, 76(1): 1-7, 2024(R6.2)〕
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  • Jiao SHEN, Anna UMEDA, Azusa OTANI, Minako NISHIZAWA, Yuri YASUI, ...
    2024 Volume 76 Issue 1 Pages 8-15
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    Fitz-Hugh-Curtis syndrome (FHCS) is an extra-pelvic complication of pelvic inflammatory disease (PID). It complicates approximately 12% to 13.8% of cases with PID. FHCS is typically develops secondary to genital tract infections including Chlamydia trachomatis and Neisseria gonorrhoeae. Here we describe a 37-year-old woman with no sexual experience who had laparoscopic surgery for a benign ovarian tumor and was diagnosed with FHCS on perihepatic violin string fibrinous strands. Several months before this surgery, she had experienced abdominal pain around the navel, and the right side quadrant pain due to appendicitis. Based on her clinical course, FHCS was suggested to occur concurrently or secondary to non-sexually transmitted PID and/or appendicitis. 〔Adv Obstet Gynecol, 76(1): 8-15, 2024(R6.2)〕
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  • Sachi TAKAOKA, Mizuki HATTORI, Hajime UDA, Tatsuya MATSUYAMA, Tomo ...
    2024 Volume 76 Issue 1 Pages 16-24
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    Antiphospholipid syndrome (APS) is associated with obstetric complications such as pregnancy loss. Previous research has indicated that heparin and aspirin could potentially increase the likelihood of live births in individuals with APS. However, when experiencing genital bleeding during pregnancy, the decision to discontinue anticoagulant therapy in patients with APS can be challenging. Here, we report a case of APS with a massive subchorionic hematoma (SCH), possibly due to anticoagulation. A 37-year-old woman with APS, receiving heparin and aspirin, experienced excessive bleeding at 18 weeks of gestation. Transvaginal ultrasonography and magnetic resonance imaging revealed a massive SCH. The patient had a history of five previous miscarriages and one ectopic pregnancy, yet she was determined to continue the current pregnancy, even if it meant risking her life. Thus, we decided to discontinue aspirin while continuing heparin, considering that aspirin may increase the risk of SCH and heparin may enhance the likelihood of achieving a successful live birth. After stopping aspirin, the bleeding gradually subsided, allowing the woman to carry the pregnancy to term. She eventually gave birth at 38 weeks of gestation. In APS-complicated pregnancies, even with heavy bleeding or massive SCH, continuation of anticoagulation therapy may lead to live births. 〔Adv Obstet Gynecol, 76(1):16-24, 2024(R6.2)〕
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  • Yu TOKUSHIGE, Shuichiro IWAMI, Eriko NAKAGAWA, Takahito ASHIHARA, ...
    2024 Volume 76 Issue 1 Pages 25-31
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    Surgical techniques for adnexal mass resection during pregnancy include laparoscopic and open surgery. At our hospital gasless laparoscopy assisted surgery (GLLA) under lumbar anesthesia is used for ovarian tumor resection during pregnancy, and minimally invasive surgery is performed without general anesthesia or carbon dioxide pneumoperitoneum. We retrospectively investigated nine patients who underwent adnexal tumor surgery during pregnancy at our hospital. GLLA was associated with many advantages such as a smaller surgical incision and shorter operation time in women with <27 weeks’gestation. Laparotomy is often necessary after the 27th week of pregnancy in cases of uterine enlargement and ovarian tumors located on the dorsal aspect of the uterus and in women who undergo emergency surgery, which is associated with intestinal tract dilatation. In such cases, initial GLLA followed by minimally invasive surgery may be a useful option. 〔Adv Obstet Gynecol, 76(1): 25-31, 2024(R6.2)〕
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  • Yoshihiro KURITANI, Satoshi KUBOTA, Masaaki SAWADA, Tetsuya TAKAO, ...
    2024 Volume 76 Issue 1 Pages 32-37
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    Premature ovarian insufficiency (POI) is diagnosed based on amenorrhea (≥4 months) and elevated follicle-stimulating hormone levels (FSH; >25 IU/L). Ovarian dysfunction, characterized by low estradiol and high gonadotropin levels, may cause health problems, including a low spontaneous pregnancy rate and treatment-refractory infertility. Estrogen therapy suppresses serum FSH levels and sensitizes the remaining follicles to exogenous stimulation. Herein, we present the results from a data analysis undertaken to evaluate the rate of follicle development and pregnancy from 36 cycles in three patients with iatrogenic infertility (associated with ovarian surgeries, n=2, and chemotherapy, n=1). Follicle development occurred in two patients (on each with ovarian surgery and post-chemotherapy) within seven cycles, which led to timed intercourse (one cycle), intrauterine insemination (five cycles), and oocyte retrieval (one cycle). The overall rate of follicle development and pregnancy was 19.4% (in 36 cycles) and 0%, respectively. Earlier initiation of estrogen therapy tended to increase the rate of follicle development. Assisted reproductive technology could be recommended for the patients with POI. 〔Adv Obstet Gynecol, 76(1):32-37, 2024(R6.2)〕
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  • Sachiko KITAMURA, Masafumi UEDA, Yasufumi HOSHINO, Kohei FUJITA
    2024 Volume 76 Issue 1 Pages 38-44
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    Screening methods for ovarian, fallopian tube, and peritoneal cancer have not been established and there are sometimes difficulties in dealing with patients only with a high CA125 levels. In this report, we experienced two cases in which it took more than half a year from the time the patient visited a gynecologist because of a high CA125 level to the time the diagnosis of malignancy was confirmed. Case 1: 53 years old woman with a high CA125 level and her sister had ovarian cancer at the age of 45; was diagnosed as high grade serous carcinoma about six months after the first visit to our department. Case 2: 70 years old woman with a history of breast cancer and a high CA125 level was diagnosed as tubal high grade serous carcinoma one year later of the first visit. Genetic tests revealed they are BRCA2 pathological variant carriers. Although the significance of screening tests based on CA125 levels in the general population has not been established, a visit to a gynecologist because of an elevated CA125 level provides an opportunity to pick up high-risk patients for ovarian cancer by asking about medical and family history. 〔Adv Obstet Gynecol, 76(1): 38-44, 2024(R6.2)〕
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  • Ayako BEKKU, Miho MASUDA, Yukiko ANDO, Hiroshi SATO, Nao TAGUCHI, ...
    2024 Volume 76 Issue 1 Pages 45-53
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    We report three cases of giant ovarian tumors. In all cases, we initially performed slow aspiration of the tumor content through a small abdominal incision made under local anesthesia, and general anesthesia was administered after confirmation of circulatory stability. Case one was a 52-year-old woman who presented with abdominal fullness and generalized weakness, and was intubated. Following aspiration of 20 L of ovarian tumor content, right salpingo-oophorectomy was performed. Postoperatively, she was extubated, but was unable to expectorate; thus, tracheostomy was performed. She developed disuse syndrome. Case two was a 44-year-old woman with right ovarian tumor. After aspiration of 20 L of tumor content, radical surgery was performed without complications. Case three was an 86-year-old woman who presented with abdominal fullness and anorexia, and was diagnosed with pneumonia, right ovarian tumor, and deep vein thrombosis. After inferior vena cava filter was inserted, 10 L of tumor content was aspirated, and bilateral salpingo-oophorectomy was performed. This study reiterates the importance of careful perioperative management for giant ovarian tumors. These cases require preoperative evaluation for deep vein thrombosis, circulatory monitoring during surgery, and management of reexpansion pulmonary edema and disuse syndrome in the postoperative period. 〔Adv Obstet Gynecol, 76(1): 45-53, 2024(R6.2)〕
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  • Masashi AKADA, Mariko TANIGUCHI, Mie TANAKA, Naoya SHIGETA, Yumiko ...
    2024 Volume 76 Issue 1 Pages 54-59
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    Umbilical artery aneurysm is a rare and potentially fatal condition that can lead to fetal demise. We present a case in which an umbilical artery aneurysm was identified in association with intrauterine fetal de- mise. A 30-year-old primigravida received prenatal care at our hospital starting at 35 weeks of gestation. Fetal ultrasound examinations revealed no obvious abnormalities. She went into labor at 39 weeks and 1 day of pregnancy, but the fetus had already died. The umbilical cord consisted of two umbilical arteries and one umbilical vein, with a 1.8 cm mass observed in one of the umbilical arteries. Both the placenta and the baby exhibited no anomalies. Pathological examination of the umbilical cord revealed an aneurysm in one of the umbilical arteries, accompanied by intraluminal thrombosis. Thrombosis was also noted within the adjacent umbilical vein. These findings suggest that the umbilical artery aneurysm likely disrupted normal blood flow within the adjacent umbilical vein, ultimately resulting in intrauterine fetal demise. Umbilical artery aneu- rysm is a lethal condition, only few cases had reported result in a favorable fetal prognosis. When an umbili-cal artery aneurysm is recognized during pregnancy, careful management is required, including timing and mode of delivery.〔Adv Obstet Gynecol, 76(1): 54-59, 2024(R6.2)〕
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  • Yusaku SHIMIZU, Takashi MIYATAKE, Takako MATSUKI, Akihiko YOSHIMUR ...
    2024 Volume 76 Issue 1 Pages 60-68
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
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    We report a case of mature cystic teratoma with malignant transformation to papillary carcinoma of the thyroid gland.A 26-year-old woman (null gravida, unmarried) was referred to a physician for lower abdominal pain, and bilateral ovarian tumors were detected. On MRI, the high-signal area of the ovarian tumors disappeared with fat suppression, and bilateral mature cystic teratomas were detected. Laparoscopic bilateral ovarian tumor resection was performed. Intraoperative rupture of the ovarian cyst was observed bilaterally. Histopathological examination revealed squamous epithelium in the left ovarian tumor and an enlarged thyroid follicular-like structure with sporadic papillary structures. The follicular epithelium contained enlarged nuclei with nuclear grooves and intranuclear inclusion bodies, and a diagnosis of malignant transformation of mature cystic teratoma to papillary thyroid carcinoma was made. Considering her age and aims to reserve fertility, left salpingo-oophorectomy was additionally performed, and there was no residual tumor found in the additionally resected specimen. The postoperative staging was stage IC1 pT1cN0M0.No adjuvant chemotherapy was given. The patient has displayed no signs of recurrence for 17 months after surgery. Malignant transformation of mature cystic teratoma to papillary thyroid carcinoma is extremely rare, and there is no established treatment plan.〔Adv Obstet Gynecol, 76(1): 60-68, 2024(R6.2)〕
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  • Mayu ASAI, Yumiko YOSHIOKA, Yuka MIZUTA, Yuki KOZONO, Akiko OKADA ...
    2024 Volume 76 Issue 1 Pages 69-78
    Published: February 01, 2024
    Released on J-STAGE: January 29, 2024
    JOURNAL RESTRICTED ACCESS
    Myxoinflammatory fibroblastic sarcoma (MIFS) is a slow-growing sarcoma with most occurring in the distal extremities of middle-aged adults. We report here a case of MIFS occurred in the vulva of a woman in her 60s. The patient was referred to our hospital because of a vulvar mass that had gradually increased in size with pain, over the past five years. A solid mass less than five cm was observed on the right temporal side of the clitoris. A benign soft tissue tumor was suspected on contrast-enhanced MRI.Vulvar tumorectomy was performed to confirm the diagnosis, and the histopathological diagnosis was MIFS. The surgical margin was positive, so we planned to resect the remaining tumor additionally. The remaining mass was resected along with the clitoris, and reconstructive surgery was performed using a genital femoral flap for the vulvar defect. The histopathological diagnosis was MIFS as in the initial surgery. In this case, no local recurrence or distant metastasis was observed 18 months after the reoperation. A high local recurrence rate, and late recurrence of MIFS has been reported. Although rare, lymph node metastasis and lung metastasis have also been reported. Long-term and strict follow-up, including imaging studies is necessary. 〔Adv Obdtet Gynecol, 76(1): 69-78, 2024(R6.2)〕
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