PURPOSE: To investigate whether preoperative serum anti-mullerian hormone (AMH) levels are lower in women with ovarian endometrioma and in women with mature cystic teratoma of the ovaries. MATERIALS AND METHODS: In a tertiary university hospital, a retrospective case-control study was performed. Serum AMH levels between an advanced (stage III and IV) endometrioma group (n=102) and an age- and body mass index (BMI)-matched control group were compared. Serum AMH levels between an ovarian mature cystic teratoma group (n=48) and age- and BMI-matched controls were also compared. RESULTS: Absolute serum AMH and multiples of the median for AMH (AMH-MoM) relevant to Korean standards were lower in the endometrioma group than controls, but this was not statistically significant (mean+/-SEM, 2.9+/-0.3 ng/mL vs. 3.3+/-0.3 ng/mL, p=0.28 and 1.3+/-0.1 vs. 1.6+/-0.1, p=0.29, respectively). Specifically, the stage IV endometriosis group (n=51) exhibited significantly lower serum AMH and AMH-MoM (2.1+/-0.3 vs. 3.1+/-0.4 ng/mL, p=0.02 and 1.1+/-0.1 vs. 1.7+/-0.2, p=0.03, respectively). Serum AMH and AMH-MoM levels were similar between stage III endometriosis and controls (3.7+/-0.5 vs. 3.4+/-0.5 ng/mL and 1.6+/-0.2 vs. 1.5+/-0.2, respectively), as well as between the mature cystic teratoma group and controls (4.0+/-0.5 ng/mL vs. 4.0+/-0.5 ng/mL and 1.6+/-0.2 vs. 1.6+/-0.3, respectively). Interestingly, AMH-MoM level was negatively correlated with endometriosis score with statistical significance (r2=0.13, p<0.01). CONCLUSION: In women with advanced ovarian endometrioma, preoperative serum AMH values tended to be lower than those for age and BMI-matched controls. Notably, stage IV endometrioma appeared to be closely associated with decreased ovarian reserve, even before operation. Clinicians should keep this information in mind before undertaking surgery of ovarian endometrioma.
Adult ; Anti-Mullerian Hormone/*blood ; Body Mass Index ; Case-Control Studies ; Endometriosis/blood/*surgery ; Female ; Humans ; Ovarian Neoplasms/blood/pathology/*surgery ; Ovary/pathology/*physiology/surgery ; Preoperative Period ; Retrospective Studies ; Teratoma/blood/*surgery

Autoimmune hemolytic anemia associated with an ovarian teratoma is a very rare disease. However, treating teratoma is the only method to cure the hemolytic anemia, so it is necessary to include ovarian teratoma in the differential diagnosis of autoimmune hemolytic anemia. We report herein on a case of a young adult patient who had severe autoimmune hemolytic anemia that was induced by an ovarian teratoma. A 25-yr-old woman complained of general weakness and dizziness for 1 week. The hemoglobin level was 4.2 g/dL, and the direct and indirect antiglobulin tests were all positive. The abdominal computed tomography scan revealed a huge left ovarian mass, and this indicated a teratoma. She was refractory to corticosteroid therapy; however, after surgical resection of the ovarian mass, the hemoglobin level and the reticulocyte count were gradually normalized. The mass was well encapsulated and contained hair and teeth. She was diagnosed as having autoimmune hemolytic anemia associated with an ovarian teratoma. To the best of our knowledge, this is the first such a case to be reported in Korea.
Teratoma/*complications/diagnosis/surgery ; Ovarian Neoplasms/*complications/diagnosis/surgery ; Humans ; Female ; Diagnosis, Differential ; Blood Transfusion ; Anemia, Hemolytic, Autoimmune/diagnosis/*etiology/therapy ; Adult ; Adrenal Cortex Hormones/therapeutic use

OBJECTIVETo study the clinical characteristics, diagnosis and surgical treatment of malignant intracranial teratomas.

METHODSThirty-four patients with intracranial teratoma proved by histopathology were treated by operation. The growth pattern of this tumor, assessed by its clinical manifestations and neuroimaging together with surgical treatment and results were analyzed retrospectively.

RESULTSOnly 6 lesions had been correctly suspected as teratoma before surgery. Total removal was achieved in 14 patients with a operative mortality of 32.4%. The survival of 23 patients with lesions showing aggressive growth was significantly different from those without (P < 0.05). Nineteen of these patients did not survive beyond the sixth month after surgery.

CONCLUSIONAccurate preoperative diagnosis is difficult in malignant intracranial teratoma, especially for patients with the tumor in the sella region. The invasive biological behavior of the tumor is proved to be the main cause of surgery being dwarfed. Protection of the hypothalamus and brainstem, relief of hydrocephalus are the crucial points in surgical treatment. Comprehensive histopathologic examination combined with serum and CSF tumor marker detection is necessary for correct diagnosis and treatment.

Adolescent ; Adult ; Biomarkers, Tumor ; blood ; cerebrospinal fluid ; Brain Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Child ; Female ; Humans ; Male ; Neoplasm Invasiveness ; Prognosis ; Teratoma ; diagnosis ; mortality ; pathology ; surgery

OBJECTIVETo explore a better operative approach to resect complicated pelvic retroperitoneal tumors.

METHODSA total of 28 patients with complicated pelvic retroperitoneal tumors who received surgical resection in our hospital from 2006 to 2010 were included in this study. The surgical operation was assisted with an arc-shaped transperineal incision in front of the apex of coccyx. The operation time, intraoperative blood loss, death toll and length of hospital stay of the patients were retrospectively analyzed.

RESULTSThe median operation time was 122.5 minutes. The median blood loss was 420 ml, and the median length of hospital stay of the patients was 17.5 days. There was no postoperative death in this group of patients.

CONCLUSIONWith the assistance of this arc-shaped transperineal incision in front of the apex of coccyx, the resection of pelvic retroperitoneal tumors can be effectively improved and the surgery risk is reduced.

Adult ; Aged ; Blood Loss, Surgical ; Coccyx ; surgery ; Epidermal Cyst ; pathology ; surgery ; Female ; Gastrointestinal Stromal Tumors ; pathology ; surgery ; Humans ; Length of Stay ; Male ; Middle Aged ; Neurilemmoma ; pathology ; surgery ; Pelvic Neoplasms ; pathology ; surgery ; Retroperitoneal Space ; Retrospective Studies ; Teratoma ; pathology ; surgery

OBJECTIVETo investigate the clinical value of combination of human epididymis protein 4 (HE4), CA125 and the Risk of Ovarian Malignancy Algorithm (ROMA) in diagnosis of ovarian carcinoma.

METHODSTo detect the serum concentration of HE4 using ELISA and CA125 using ECL in patients of ovarian carcinoma group (n = 119), borderline ovarian tumor group (n = 36), benign ovarian neoplasm group (n = 96) and female healthy control group (n = 53). The ROMA based on the serum level of CA125, HE4 and a woman's menopausal status was used to calculate the predicted probability (PP) and diagnostic results of ovarian cancers.

RESULTSThe receiver operating characteristic (ROC) analysis showed the cut-off value was 67.3 pmol/L (the AUC was 0.906, the sensitivity was 80.7% and specificity was 94.6%). The serum levels of HE4 and CA125 in the ovarian carcinoma group were significantly higher than that in the borderline ovarian tumor group, benign ovarian neoplasm group and female healthy control group (P < 0.01). The serum levels of CA125 and HE4 showed statistically no significant difference between the borderline ovarian tumor group and benign ovarian neoplasm group (P > 0.05). The levels of HE4 and CA125 were reduced significantly in ovarian patients after surgery therapy (P < 0.01). The sensitivity and specificity of HE4 + CA125 combination was 92.7% and 72.5%. The ROMA that can classify patients into high and low risk groups was established as 9.3% in premenopausal and 27.3% in postmenopausal women.

CONCLUSIONSHE4 is a helpful biomarker for ovarian carcinoma diagnosis. Biomarker combination of HE4 and CA125, and applying of the ROMA are helpful to improve the accuracy in diagnosis of ovarian cancers.

Adenocarcinoma, Mucinous ; blood ; diagnosis ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor ; blood ; CA-125 Antigen ; blood ; Cystadenocarcinoma, Serous ; blood ; diagnosis ; surgery ; Cystadenoma, Serous ; blood ; diagnosis ; surgery ; Endometriosis ; blood ; diagnosis ; Female ; Humans ; Menopause ; Middle Aged ; Ovarian Neoplasms ; blood ; diagnosis ; surgery ; Proteins ; metabolism ; ROC Curve ; Sensitivity and Specificity ; Teratoma ; blood ; diagnosis ; surgery ; Young Adult

Biomarkers ; blood ; Child ; Chorionic Gonadotropin ; blood ; Follicle Stimulating Hormone ; blood ; Growth Disorders ; etiology ; Humans ; Klinefelter Syndrome ; complications ; diagnosis ; genetics ; Magnetic Resonance Imaging ; Male ; Mediastinal Neoplasms ; complications ; diagnosis ; surgery ; Puberty, Precocious ; diagnosis ; etiology ; Teratoma ; complications ; diagnosis ; surgery ; Testis ; pathology