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A case report of angioleiomyoma of uterus.

Jeong A HONG ; Gyeong Eun HEO ; Jeong Ja KWAK ; Soo Ho CHUNG

Obstetrics & Gynecology Science.2017;60(5):494-497. doi:10.5468/ogs.2017.60.5.494

Angioleiomyoma (AL) is a very rare benign tumor that originates from smooth muscle cells and has thick walled vessels. It may be found throughout the body but more frequently occurs in the lower extremities and rarely develops in the head and other parts of the body. This paper presents a case report of giant AL detected in a 33-year-old woman who complained of severe anemia, menorrhagia, and palpable lower abdominal mass. The patient underwent myomectomy and was diagnosed with AL based on the pathological report of mass. The effective treatment for AL is either simple hysterectomy or angiomyomectomy depending on the patient's desire to preserve fertility and symptom.
Adult ; Anemia ; Angiomyoma* ; Female ; Fertility ; Head ; Humans ; Hysterectomy ; Immunohistochemistry ; Leiomyoma ; Lower Extremity ; Menorrhagia ; Myocytes, Smooth Muscle ; Uterus*

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Delayed intestinal perforation and vertebral osteomyelitis after high-intensity focused ultrasound treatment for uterine leiomyoma.

Dong Won HWANG ; Hyun Suk SONG ; Hee Sun KIM ; Kyoung Chul CHUN ; Jae Whoan KOH ; Young Ah KIM

Obstetrics & Gynecology Science.2017;60(5):490-493. doi:10.5468/ogs.2017.60.5.490

High-intensity focused ultrasound (HIFU) is a non-invasive uterine fibroid treatment option for patients who want to preserve fertility. However, according to several reports regarding ablation of solid tumors by HIFU, there are rare complications in patients with uterine leiomyomas, and overall data are still insufficient. Here, we report rare and major complications of HIFU, such as delayed intestinal perforation, uterine perforation with recto-uterine fistula, and osteomyelitis 29 days after the HIFU procedure to treat multiple myomas. Thus, we present a very serious case resulting from HIFU treatment of uterine fibroids and a review of the literature.
Fertility ; Fistula ; Humans ; Intestinal Perforation* ; Leiomyoma* ; Myoma ; Osteomyelitis* ; Ultrasonography* ; Uterine Perforation

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Estrogen-induced acute pancreatitis: A case report and literature review.

Dajeong SEO ; Hyojin SUH ; Jun Kyu LEE ; Dong Kee JANG ; Ha Yan KWON ; Chae Hyeong LEE ; Sang Ho YOON ; Ju Won ROH ; Hyun Soo PARK

Obstetrics & Gynecology Science.2017;60(5):485-489. doi:10.5468/ogs.2017.60.5.485

Estrogens are commonly used in gynecologic area, such as oral contraception, hormone replacement therapy, and in vitro fertilization-embryo transfer. Although estrogen is a common cause of acute drug-induced pancreatitis, there has been paucity of report in Korea. Clinical course of estrogen-induced acute pancreatitis is usually mild to moderate, but fetal case can occur. In addition, there can be a latency from the first administration to the symptom. Therefore, physicians should consider the possibility of the disease when a woman taking estrogen or previous history of taking estrogen presents with acute abdominal pain. Here, we report a case of estrogen-induced acute pancreatitis that occurred during the preparation for embryo transfer.
Abdominal Pain ; Contraception ; Embryo Transfer ; Estrogens ; Female ; Hormone Replacement Therapy ; Humans ; In Vitro Techniques ; Korea ; Pancreatitis*

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Metastatic uterine cancer looking as cervical fibroid in recurrent breast cancer woman: a case report.

So Young SEO ; Jin Yong SHIN ; Yong Il JI

Obstetrics & Gynecology Science.2017;60(5):481-484. doi:10.5468/ogs.2017.60.5.481

Metastasis to the female genital tract from extragenital primary cancer is uncommon. In this case, a 46-year-old woman was diagnosed with invasive lobular carcinoma of the left breast in 2011. She had left breast conserving surgery, chemotherapy, radiation, and hormonal therapy (gosereline and tamoxifen). However, she developed menorrhagia after interruption of hormonal therapy and incidentally, the ultrasonogram of her pelvis showed a solid, large mass in the cervix. It looked like leiomyoma. Because of massive vaginal bleeding requiring multiple blood transfusions, she underwent total hysterectomy with bilateral salpingo-oophorectomy. Unexpectedly, however, histopathological examination revealed metastatic carcinoma, consistent with breast origin.The metastatic tumor involved the uterine corpus with spreading to the endocervix, left ovary, and multiple lymphovascular invasion was present. We described the rarity and risk of metastatic uterine cancer in patient with history of malignant tumor treatment.
Blood Transfusion ; Breast Neoplasms* ; Breast* ; Carcinoma, Lobular ; Cervix Uteri ; Drug Therapy ; Female ; Humans ; Hysterectomy ; Leiomyoma* ; Mastectomy, Segmental ; Menorrhagia ; Middle Aged ; Neoplasm Metastasis ; Ovary ; Pelvis ; Ultrasonography ; Uterine Cervical Neoplasms ; Uterine Hemorrhage ; Uterine Neoplasms*

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BRCA1-mutated ovarian cancer with skin metastasis: a case report.

So Ra OH ; Jung Woo PARK ; Hyun Young KWON ; Seo Hee RHA

Obstetrics & Gynecology Science.2017;60(5):477-480. doi:10.5468/ogs.2017.60.5.477

The major risk factor for ovarian cancer (OC) is mutation of the BRCA1 or BRCA2 DNA mismatch repair genes, which occurs in approximately 10% of OC cases. Most previous studies have demonstrated that BRCA1- and BRCA2-mutated OCs are associated with better prognosis than sporadic OCs. However, information about the patterns and clinical course of the metastatic spread of BRCA-mutated OCs is limited. Herein, we describe a case of OC with a BRCA1 mutation and skin metastases in a 49-year-old patient, which to the best of our knowledge has not been reported previously.
DNA Mismatch Repair ; Humans ; Middle Aged ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Prognosis ; Risk Factors ; Skin*

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Genital tract cavernous hemangioma as a rare cause of postpartum hemorrhage.

Bo Ram YU ; Ga Eul LEE ; Dong Hyu CHO ; Young Ju JEONG ; Jeong Heon LEE

Obstetrics & Gynecology Science.2017;60(5):473-476. doi:10.5468/ogs.2017.60.5.473

Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.
Adult ; Arteries ; Episiotomy ; Female ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Postpartum Hemorrhage* ; Postpartum Period* ; Rupture ; Vagina ; Vascular Malformations ; Vulva

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Epithelial ovarian tumors in a premenarchal girl: a rare case report.

Pushpanjali OJHA ; Jitendra Singh NIGAM ; Archana Hemant DESHPANDE ; Chitrawati Bal GARGADE

Obstetrics & Gynecology Science.2017;60(5):469-472. doi:10.5468/ogs.2017.60.5.469

Ovarian tumors are relatively uncommon in paediatric age group and mostly occur in the period after menarche and are extremely rare prior to menarche. However, in children and adolescent, the epithelial ovarian tumors account approximately 10% to 28% of all ovarian tumors. In the present case, the patient was presented with abdominal pain for 1 day and no mass was felt on physical examination. Contrast-enhance computed tomography abdomen and pelvis showed a left ovarian cystic mass measuring 7.3×5.1 cm in size and unilateral oophorectomy was done. Tumor shows multiloculated cysts of varying sizes filled with mucinous fluid. Cysts were lined by tall columnar epithelial cells and show predominantly periodic acid-Schiff positive neutral mucin favouring benign nature of lesion. We present this case due to its uncommon age of presentation and the patient was premenarchal girl.
Abdomen ; Abdominal Pain ; Adolescent ; Alcian Blue ; Child ; Epithelial Cells ; Female* ; Fertility ; Humans ; Menarche ; Mucins ; Neoplasms, Glandular and Epithelial ; Ovarian Cysts ; Ovarian Neoplasms ; Ovariectomy ; Pelvis ; Periodic Acid-Schiff Reaction ; Physical Examination

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Preoperative diagnostic clues to ovarian pregnancy: retrospective chart review of women with ovarian and tubal pregnancy.

Mi Rang SEO ; Joong Sub CHOI ; Jaeman BAE ; Won Moo LEE ; Jeong Min EOM ; Eunhyun LEE ; Jihyun KEUM

Obstetrics & Gynecology Science.2017;60(5):462-468. doi:10.5468/ogs.2017.60.5.462

OBJECTIVE: To analyze the preoperative diagnostic clues to ovarian pregnancy (OP). METHODS: This study conducted a retrospective chart review of 23 patients with OP and 46 patients with tubal pregnancy (TP) from October 1, 2003 to September 31, 2016 in Hanyang University Hospital. RESULTS: There were no significant differences in demographic and clinical characteristics between the two groups. The presence of an ectopic gestational sac and hemoperitoneum was significantly higher in the TP group (13.0% vs. 95.7%, P=0.000; 13.0% vs. 54.3%, P=0.001, respectively) in preoperative ultrasonogram. The OP group had more ruptured ectopic gestational sacs than the TP group (73.9% vs. 45.7%, P=0.039) in surgical findings. CONCLUSION: For the patients in whom a gestational sac is not detected in the uterus or the fallopian tubes, it is important to be aware of the possibility of OP and rupture of an ovarian gestational sac to promote early diagnosis and surgical intervention.
Early Diagnosis ; Fallopian Tubes ; Female ; Gestational Sac ; Hemoperitoneum ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ovarian* ; Pregnancy, Tubal* ; Retrospective Studies* ; Rupture ; Ultrasonography ; Uterus

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Port site infiltration of local anesthetic after laparoendoscopic single site surgery for benign adnexal disease.

Jung Eun KIM ; Seung Hyuk SHIM ; Meari DONG ; Hyojin LEE ; Han Sung HWANG ; Han Sung KWON ; Sun Joo LEE ; Ji Young LEE ; In Sook SOHN ; Soo Nyung KIM ; Soon Beom KANG

Obstetrics & Gynecology Science.2017;60(5):455-461. doi:10.5468/ogs.2017.60.5.455

OBJECTIVE: To determine whether local bupivacaine injection into the incision site after gynecologic laparoendoscopic single site surgery (LESS) improves postoperative pain. METHODS: This prospective cohort study included consecutive 158 patients who had LESS for benign adnexal disease from March 2013 to December 2015. Chronologically, 82 patients (March 2013 to August 2014) received no bupivacaine (group 1) and 76 (August 2014 to December 2015) received a bupivacaine block (group 2). For group 2, 10 mL 0.25% bupivacaine was injected into the 20 mm-incision site through all preperitoneal layers after LESS completion. Primary outcome is postoperative pain score using the visual analog scale (VAS). RESULTS: There was no difference in clinicopathological characteristics between the groups. Operating time (expressed as median [range], 92 [55–222] vs. 100 [50–185] minutes, P=0.137) and estimated blood loss (50 [30–1,500] vs. 125 [30–1,000] mL, P=0.482) were similar between the groups. Post-surgical VAS pain scores after 3 hours (3.5 [2–6] vs. 3.5 [2–5], P=0.478), 6 to 8 hours (3.5 [2–6] vs. 3 [1–8], P=0.478), and 16 to 24 hours (3 [2–4] vs. 3 [1–7], P=0.664) did not differ between groups. CONCLUSION: Bupivacaine injection into the trocar site did not improve postoperative pain after LESS. Randomized trials are needed to evaluate the benefits of local bupivacaine anesthetic for postoperative pain reduction.
Adnexal Diseases* ; Anesthesia, Local ; Bupivacaine ; Cohort Studies ; Female ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Prospective Studies ; Surgical Instruments ; Visual Analog Scale

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Gonadotropin releasing hormone antagonist administration for treatment of early type severe ovarian hyperstimulation syndrome: a case series.

Dayong LEE ; Se Jeong KIM ; Yeon Hee HONG ; Seul Ki KIM ; Byung Chul JEE

Obstetrics & Gynecology Science.2017;60(5):449-454. doi:10.5468/ogs.2017.60.5.449

OBJECTIVE: To report an efficacy of gonadotropin releasing hormone (GnRH) antagonist administration after freezing of all embryos for treatment of early type ovarian hyperstimulation syndrome (OHSS). METHODS: In 10 women who developed fulminant early type OHSS after freezing of all embryos, GnRH antagonist (cetrorelix 0.25 mg per day) was started at the time of hospitalization and continued for 2 to 4 days. Fluid therapy and drainage of ascites was performed as usual. RESULTS: Early type OHSS was successfully treated without any complication. At hospitalization, the median (95% confidence interval [CI]) of the right and the left ovarian diameter was 10.0 cm (7.6 to 12.9 cm) and 8.5 cm (7.5 to 12.6 cm). After completion of GnRH antagonist administration, it was decreased to 7.4 cm (6.2 to 10.7 cm) (P=0.028) and 7.8 cm (5.7 to 12.2 cm) (P=0.116), respectively. The median duration of hospital stay was 6 days (3 to 11 days). Trans-abdominal drainage of ascites was performed in 2 women and drainage of ascites by percutaneous indwelling catheter was performed in 4 women. No side effect of GnRH antagonist was noted. CONCLUSION: GnRH antagonist administration appears to be safe and effective for women with fulminant early type OHSS after freezing all embryos. Optimal dose or duration of GnRH antagonist should be further determined.
Ascites ; Catheters, Indwelling ; Drainage ; Embryonic Structures ; Female ; Fluid Therapy ; Freezing ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Hospitalization ; Humans ; Length of Stay ; Ovarian Hyperstimulation Syndrome*

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