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VSIG4, a newly identified co-inhibitory molecule belonging to the B7-related family, is exclusively expressed on tissue-resident macrophages and is involved in the suppression of T cell proliferation and cytokine production. We sought to characterize the role of VSIG4 in anti-tumor immunity in the tumor microenvironment, focusing on VSIG4-expressing tumor-associated macrophages (TAMs). We found that VSIG4-expressing TAMs negatively regulated antigen-specific T cell proliferation and cytokine production through direct inhibition via cell cycle arrest, but not apoptosis, as well as through their arginase 1 activity. Furthermore, VSIG4-expressing TAMs suppress tumor-specific CD8

Placenta previa (PP) is one such complication related to several adverse pregnancy outcomes. Adverse outcomes are likely greater if PP coexists with antepartum hemorrhage (APH). This study aims to evaluate the risk factors and pregnancy outcomes of APH in women with PP. This retrospective case–control study included 125 singleton pregnancies with PP who delivered between 2017 and 2019. Women with PP were divided into two groups: PP without APH (n = 59) and PP with APH (n = 66). We investigated the risk factors associated with APH and compared the differences between both groups in placental histopathology lesions due to APH and the resulting maternal and neonatal outcomes. Women with APH had more frequent antepartum uterine contractions (33.3% vs. 10.2%, P = .002) and short cervical length (P = .003). The placentas from the APH group had lower weight (442.9 ± 110.1 vs. 488.3 ± 117.7 g, P = .03) in the gross findings, and a higher rate of villous agglutination lesions (42.4% vs. 22.0%, P = .01) in the histopathologic findings. Women with APH in PP had higher rates of composite adverse pregnancy outcomes (83.3% vs. 49.2%, P = .0001). Neonates born to women with APH in PP had worse neonatal outcomes (59.1% vs. 23.9%, P = .0001). Preterm uterine contractions and short cervical length were the most significant risk factors for APH in PP.

Objective This study aimed to examine the diagnostic performance of F-18 fluorodeoxyglucose positron emission tomography with computed tomography (F-18 FDG PET/CT) compared with cancer antigen 125 (CA125), human epididymis protein 4 (HE4), and risk of ovarian malignancy algorithm (ROMA) score to distinguish epithelial ovarian cancer from benign tumors. Methods A total of 46 patients with pelvic masses, who underwent F-18 FDG PET/CT, CA125, and HE4 before surgery between January 2015 and December 2018, were included in this retrospective study. The diagnostic performance of CA125, HE4, ROMA score, and maximum standardized uptake value (SUVmax) to differentiate epithelial ovarian cancer from benign pelvic tumors was examined by receiver operating characteristic curve analysis. Results Among the 46 patients, 28 were cases of ovarian cancers and 18 were of benign. The mean values of CA125, HE4, ROMA score, and SUVmax were significantly higher in the ovarian cancer group than the benign group. In early cancer stages (stages I and II), Area under the curve for SUVmax was significantly higher than CA125 and ROMA score (0.778 for CA125, 0.753 for HE4, 0.682 for ROMA score, and 0.922 for SUVmax). Conclusion SUVmax using F-18 FDG PET/CT showed a high diagnostic accuracy for differentiating epithelial ovarian cancer from benign pelvic tumors, including early stage ovarian cancer. F-18 FDG PET/CT can be a useful modality for the assessment of pelvic mass. .

Müllerian anomalies are rare deformities in women, and only a few cases concerning gynecologic malignancies arising in patients with congenital uterine malformations have been reported. Herein, we present the case of a 34-year-old woman with dysgerminoma with a Müllerian anomaly (uterus didelphys). She had secondary amenorrhea, and an ovarian mass and uterus didelphys were discovered during examination. After right salpingo-oophorectomy, the tumor was confirmed as dysgerminoma, and a chromosome study revealed a normal female karyotype (46, XX). The patient completely responded to 6 cycles of chemotherapy. To our knowledge, this is the first reported case of dysgerminoma with uterus didelphys. Although gynecologic malignancies in patients with Müllerian anomalies are very rare, clinicians should be aware of the coexistence of gynecologic malignancies and uterine malformations.

Purpose We investigated the clinical relevance and spectrum of BRCA1/2 mutations in Korean ovarian cancer (KoOC) patients. Materials and Methods Two hundred seventy-nine KoOC patients were enrolled from three university hospitals between 2012 and 2017. Their peripheral blood samples were obtained for BRCA1/2 mutation analysis by direct sequencing. Clinicopathological characteristics were retrospectively reviewed, and spectrum analyses of BRCA1/2 mutation were assessed by systematic literature review. Results Frequency of BRCA1/2 mutations was 16.5% in KoOC patients. BRCA1/2 mutations were significantly associated with family history of breast/ovarian cancer (pT of BRCA2 in KoBC). Conclusion The clinical relevance of BRCA1/2 mutations in KoOC patients was confirmed but that of early age-of-onset was not. Possible inconsistency in the ratio of BRCA1-to-BRCA2 mutations and the most common mutation between KoOC and KoBC may probably suggest presence of mutation sequence-associated penetrance tendency in hereditary Korean breast and ovarian cancer. These data may provide insights for optimal genetic counseling and prophylactic treatment for at-risk relatives of KoOC patients.

The Silva system is a pattern-based classification system that stratifies endocervical adenocarcinomas (AC) into 3 categories to assess the risk of lymph node (LN) metastasis. This study aimed to evaluate whether this novel risk stratification system is applicable to all endocervical AC, including usual and variant, and to suggest a suitable management plan for cervical AC. We retrospectively retrieved consecutive pathology cases with a final diagnosis of endocervical AC treated via radical hysterectomy and pelvic lymphadenectomy. Specimens were classified by consensus according to the Silva system based on “pattern of invasion” as A, B, or C, further clinical/pathologic features were assessed according to pattern-based classification. A total of 76 cases of invasive cervical AC were evaluated. Of these, 63 (82.9%) were categorized as usual-type endocervical AC and 13 (17.1%) as special types. Among those with usual and variants, all patients with pattern A tumor had no LN metastasis and did not develop recurrence. Likewise, multivariate analysis revealed that LN metastasis and pattern C or B tumors are significant independent predictors of disease-free survival (DFS). Although pattern A tumors had no LN metastasis, they also developed complications after surgery, similar to pattern B or C tumors. Regardless of histologic subtypes, pattern A tumors had no LN metastasis and no recurrence. Thus, the Silva classification system can influence the clinical management of all types of endocervical AC. Conservative management is reasonable in all patients with endocervical AC with pattern A tumors.

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.

Objective: To evaluate the pathological changes of the placenta to determine the mechanism underlying placenta-derived fetal growth restriction (FGR) and investigate its influence on neonatal outco...

Objective: The aim of the present study was to determine the prognostic significances of markers of preoperative systemic inflammatory response (SIR) in patients with ovarian clear cell carcinoma (OCCC). Methods: A total of 109 patients diagnosed with OCCC that underwent primary cytoreductive surgery and adjuvant platinum-based chemotherapy from 2009 to 2012 were enrolled in this retrospective study. SIR markers were calculated from complete blood cell counts determined before surgery. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR). Prognostic significances with respect to overall survival (OS) and progression-free survival (PFS) were determined by Kaplan-Meier curve and multivariate Cox regression analysis. Results: The optimized NLR, LMR and PLR cut-off values as determined by ROC curve analysis for PFS and OS were 2.3, 4.2, and 123.6, respectively. When the cohort was divided using these optimized cut-offs, NLR and LMR were found to be significantly associated with clinicopathologic factors, NLR with FIGO stage, the presence of malignant ascites, and platinum response, and LMR with FIGO stage, lymph node metastasis, malignant ascites, and platinum response. Kaplan-Meier analysis revealed a high NLR (> 2.3) was significantly associated with low 5-year PFS and OS rates and that a high LMR was significantly associated with high 5-year PFS and OS rates. Multivariate analysis identified FIGO stage, residual mass, and platinum response as independent prognostic factors of PFS, and FIGO stage, residual mass, platinum response, and LMR as independent prognostic factors of OS. Conclusions: Markers of systemic inflammatory response provide useful prognostic information and lymphocyte-to-monocyte ratio is the most reliable independent prognostic factor of overall survival in patients with ovarian clear cell carcinoma.

Objective: Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune and paraneoplastic encephalitis caused by the N-methyl-d-aspartate receptor antibody which is related to tumors, such as teratomas of the ovaries. To our knowledge, this is the first reported case of Anti-NMDAR encephalitis associated with ovarian mucinous cystadenoma. Case report: A 23-year-old woman with a flu-like illness, confused mental status, and behavioral changes presented to the hospital. A right-sided ovarian tumor was detected during the work-up and was suspected to be a teratoma that might have caused the encephalitis. A laparoscopic right salpingo-oophorectomy (RSO) was performed. Histopathological examination revealed a mucinous cystadenoma. She recovered gradually and had complete resolution of symptoms after surgical removal of the mucinous cystadenoma and immunotherapy. Conclusion: Even though anti-NMDAR encephalitis is caused by ovarian teratoma because it contains various types of tissues, ovarian tumors in anti-NMDAR encephalitis may not be limited to ovarian teratomas. Keywords: Anti-NMDAR encephalitis, Ovarian tumor, Mucinous cystadenoma

To date, epidemiological evidence has consistently supported a link between ovarian cancer risk and menopause. However, little is known about how menopause status affects the risk of specific histological subtypes of ovarian tumors. We aimed to analyze the differences in various histopathological subtypes of ovarian tumors between pre- and postmenopausal women.We reviewed the medical records of women who underwent surgery for ovarian tumors and received histopathological confirmation at the Busan Paik Hospital between January 1997 and October 2016. Pathological findings were regrouped according to 2014 World Health Organization (WHO) classification and subdivided into the following five main categories: epithelial, germ cell, sex cord-stromal, tumor-like lesions, and secondary tumors.A total of 4,683 cases (3,404 premenopausal and 1,279 postmenopausal) were included in this study. Among the 4,683 neoplasms, epithelial tumors accounted for 52.6%, germ cell tumors for 27.1%, sex cord-stromal tumors (SCSTs) for 4.1%, tumor-like lesions for 14.0%, and secondary tumors for 0.8%. Among the epithelial tumors, malignant epithelial tumors were significantly associated with postmenopausal women (5.4% vs 22.1%, P 0.0001), whereas benign epithelial tumors were significantly associated with premenopausal women (40.5% vs 31.9%, P 0.0001). Among the 1,271 cases of germ cell tumors, most (97.6%) were benign mature teratoma and 2.4% were malignant germ cell tumors. Germ cell tumors were noted more frequently in premenopausal women than in postmenopausal women (31.3% vs 16.1%, P 0.0001). Among the 194 cases of SCSTs, fibrothecoma was the most common (71.6%) followed by adult granulosa cell tumor (12.9%). The majority of SCSTs occurred in postmenopausal women (2.1% vs 9.5%, P 0.0001). Among the 656 cases of tumor-like ovarian lesions, corpus luteum cyst was the most common (31.9%) followed by tubo-ovarian abscess (27.6%). Tumor-like ovarian lesions were significantly associated with premenopausal women (15.2% vs 10.7%, P = 0.0001). Among the 36 cases of secondary tumors, 66.7% of the metastatic ovarian tumors were Krukenberg tumors. There was no significant difference in the incidence of secondary tumors between the groups.We demonstrated the differences in diverse histological subtypes of ovarian tumors according to the menopause status based on the new WHO classification for Korean women.

Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly of the urogenital tract, which is characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It usually presents at puberty with pelvic pain, dysmenorrhea, and a vaginal or pelvic mass. Although rare, it may present with purulent vaginal discharge due to secondary infection of the obstructed hemivagina, making diagnosis difficult. A careful pelvic examination to identify the cervix and vagina is the key to the diagnosis of Mullerian duct anomalies and magnetic resonance imaging can provide additional useful information. The optimal treatment is full excision and marsupialization of the obstructing vaginal septum so that both uteri can drain through the patent vagina. The authors report a case of a 22-year-old female with an unusual presentation of Herlyn-Werner-Wunderlich syndrome complicated by pyocolpos, which was successfully managed by vaginal septum resection and drainage of pus.

Objective: We aimed to assess the impact of antenatal MgSO4 therapy given to women with PPROM before 32 weeks’ gestation on latency, maternal outcomes, perinatal outcomes, and neurodevelopmental outcomes.Methods: We undertook a retrospective cohort observational study of 184 singleton pregnancies complicated by PPROM at 23°–316 weeks who were hospitalized and received magnesium therapy for tocolysis (MgSO4 group) or did not receive tocolytic therapy (no MgSO4 group) between 2005 and 2013. Furthermore, patients were subdivided into two groups based on the gestational age at the onset of PPROM (23°–276 weeks’ gestation and 28°–316 weeks’ gestation).Results: We included 184 women, of whom 143 received magnesium therapy and 41 did not. The latency period was significantly longer in the MgSO4 group compared with no MgSO4 group (7.9 ± 9.0 versus 4.0 ± 6.0 days, p = .0017). Antenatal magnesium therapy was significantly associated with decreased stillbirth (1.4% versus 14.6%, p = .0012) and perinatal mort...

Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor that usually occurs in soft tissues of the extremity and rarely in the retroperitoneum. We report a unique case of isolated massive fetal ascites attributed to KHE, involving the retroperitoneum and multiple visceral organs, along with the Kasabach–Merritt phenomenon. We suspect that retroperitoneal KHE might have caused massive fetal ascites because of its high potential to invade the lymphatic vessels aggressively in the retroperitoneal space, which possibly permits intestinal lymph leakage into the peritoneal cavities.

This study aimed to compare obstetrical complications and neonatal outcomes between monochorionic and dichorionic discordant twin pregnancies.We enrolled 296 patients with twin pregnancy who delivered at Busan Paik Hospital between January 2014 and December 2017. The prevalence of obstetrical complications, neonatal mortality between monochorionic and dichorionic twins was compared. We also investigated whether there is a difference in neonatal outcome and neonatal morbidity between monochorionic discordant twins without monochorionic-specific complications and dichorionic discordant twins.The risk of fetal deathRisk of birth weight discordance is higher in monochorionic twin but no significant difference was observed in maternal outcomes, neonatal mortality and morbidity between noncomplicated monochorionic and dichorionic discordant twins.

Background: Arsenic compounds (As2O3 and As4O6) have demonstrated anticancer effects in various malignancies. In this study, the cytotoxicity of arsenic compounds on ovarian cancer cell lines and the anticancer activity of the combination of arsenic compounds and cisplatin IN chemoresistant ovarian cancer cells were investigated. Methods: We investigated the cytotoxicity of As2O3 and As4O6 and their combinations with cisplatin in the paclitaxel-sensitive ovarian cancer cell lines SKOV3ip1 and HeyA8 and paclitaxel-resistant ovarian cancer cell lines SKOV3TRip2 and HeyA8-MDR. Growth and apoptosis were evaluated by MTT assay and annexin V assay using flow cytometry, respectively. For detection of apoptotic cells, immunofluorescence was performed using a cleaved caspase-3 antibody. Cell-cycle distribution was determined by propidium iodide staining and flow cytometry. Results: Treatment of each cell line with As2O3 or As4O6 led to a marked dose-dependent inhibition of cell growth. As2O3 and As4O6 treatment induced caspase-3-dependent apoptosis in all cell lines compared to the respective control groups (p 2O3 and As4O6 induced apoptosis of paclitaxel-sensitive and -resistant cancer cell lines following G2/M cell cycle arrest (p 2O3 or As4O6 in the paclitaxel-resistant ovarian cancer cell lines. Conclusions: As2O3 and As4O6 can inhibit cell growth and induce apoptosis in paclitaxel-sensitive and -resistant ovarian cancer cell lines. Their combination with cisplatin resulted in a synergistic effect in paclitaxel-resistant cancer cell lines. These results suggest that arsenic compounds may be given in monotherapy or combination therapy with cisplatin for treating paclitaxel-resistant ovarian cancer.

Dural sinus malformations, which are characterized by massively dilated dural sinuses, are one of the etiologies of an intracranial fetal cystic mass. Thrombi within these dural sinus malformations can develop while in-utero, and can be visualized by ultrasound in fetal life. Definitive postnatal diagnosis requires an autopsy.We report two thrombosed fetal dural sinus malformations which are prenatally suspected during the second trimester with ultrasonography and postnatally confirmed with autopsy.Prenatal ultrasound images and fetal autopsy findings can be useful to establish the prenatal diagnosis of thrombosed dural sinus malformation.

Study Objective VSIG4 has been identified as a potent negative regulator of T cell responses and is suggested to regulate anti-tumor immunity. This study investigates whether VSIG4 is significantly expressed in endometriosis patients and its potential as an endometriosis biomarker. Design Cross-sectional study. Setting University hospital. Patients or Participants 42 endometriosis and 21 non-endometriotic tumor patients. Interventions None. Measurements and Main Results Tumor tissues and peripheral blood samples were obtained during surgery from patients with endometriosis and non-endometriotic tumors. The levels of VSIG4 mRNA, VSIG4 protein expression in tumor tissue, and serum soluble VSIG4 concentration were compared between the endometriosis and control group. In addition, receiver operating characteristic (ROC) curve analysis was used to obtain optimal VSIG4 cut-off values for endometriosis prediction. After dividing the cohort using these optimized cut-off values, we examined the association between VSIG4 levels and the factors indicating endometriosis severity, VSIG4 levels and serum cancer antigen (CA)-125 levels. The expressions of VSIG4 mRNA, VSIG4 protein, and serum VSIG4 concentration were significantly increased in the endometriosis group compared with the control group (P= 0.001, 0.002, and 0.049, respectively). The optimized VSIG4 mRNA, VSIG4 protein, and serum VSIG4 concentration cut-off values as determined by ROC curve analysis were 0.71, 0.32, and 144.37 pg/mL, respectively. After cohort division using these values, the proportion of women with increased VSIG4 levels was significantly greater in the higher CA-125 (≥ 24.88 U/mL) group compared with the lower CA-125 ( Conclusion The expression of VSIG4 in endometriosis patients is increased compared with non-endometriotic tumor patients, and higher VSIG4 levels are significantly associated with higher serum CA-125 levels. This finding supports that VSIG4′s possible usefulness as a diagnostic biomarker for endometriosis.

Endometrial cancer is the sixth most common cancer in women worldwide. Peroxiredoxins (PRDXs) are antioxidant enzymes that serve important roles in cell differentiation, proliferation, and apoptosis. In the present study, the potential associations between PRDX expression and endometrial cancer were investigated. The expression levels of various PRDX mRNAs were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) in endometrial cancer tissues (n=26) and normal endometrial tissues (n=10). Additionally, the expression of PRDX isoforms was immunohistochemically examined in endometrial cancer tissues and adjacent normal endometrial tissues from 42 patients. Finally, the associations between high PRDX expression levels and clinicopathological features were examined in patients with endometrial cancer. Analysis of PRDX expression in endometrial cancer tissues and normal endometrial tissues by semi-quantitative RT-PCR showed that all PRDX isoforms had increased expression in the endometrial cancer tissues compared with that in the normal endometrium, and the differences in the expression levels of PRDX1 and PRDX3 between cancer and normal tissues were statistically significant (P=0.0015 and P=0.0134, respectively). Additionally, analysis of PRDX expression in endometrial cancer and paired normal endometrial tissues by immunohistochemistry showed strong cytoplasmic staining of PRDX3 and PRDX5 in cancer tissues, with high PRDX3 (25/42, 59.5%) and PRDX5 (32/42, 76.2%) appearing more frequently in endometrial cancer than in normal endometrial tissues (P=0.0001 and P=0.0023, respectively). Furthermore, high expression of PRDX5 was associated with advanced-stage endometrial cancer (P=0.0399). Although the 5-year survival rate was marginally higher in patients with low expression of PRDX3 and PRDX5, this result was not statistically significant. In summary, PRDX3 and PRDX5 are highly expressed in endometrial cancer and could be associated with advanced stage and poor prognosis. Therefore, these proteins may potentially be used as prognostic markers for endometrial cancer.

1 Introduction Placenta previa is a condition in which the placenta implants in the poorly vascularized lower uterine segment, which may result in inadequate uteroplacental perfusion, in turn, adversely affect the neonatal outcome. Abnormal placentation may also lead to severe postpartum hemorrhage as placenta separation proceeds. We aimed to evaluate the differences in placental histopathology and perinatal outcomes in pregnancies complicated with placenta previa and controls. Method We undertook a retrospective case-control study of 93 pregnancies with placenta previa and 81 controls between 2011 and 2017. Results Gross findings of the placenta showed that the placentas in placenta previa had significantly higher mean large chorionic plate diameters (18.5 ± 3.2 vs 17.5 ± 2.6 cm, P = .0298), chorionic plate areas (218.4 ± 62.9 cm2 vs 198.7 ± 56.0 cm2, P = .0344), and marginal cord insertion (19.8% vs 8.6%, P = .0411) than control groups. Placental histopathological findings showed that placentas in placenta previa was significantly associated with maternal underperfusion, including villous infarction (50.5% vs 25.9%, P = .0009) and increased intervillous fibrin deposition (38.7% vs 7.4%, P Discussion Abnormal placentation into the poorly vascularized lower uterine segment induces compensatory placental growth and increased surface area in response to reduced placental perfusion, which was consistent with the histopathological findings of coagulative necrosis of chorionic villi and fibrin deposition in the intervillous space. The morphological changes occurring in placenta previa may have important roles in maintaining adequate uteroplacental-fetal perfusion, which may prevent adverse neonatal outcomes.

Objective The purpose of this study was to evaluate the group B streptococcus (GBS) colonization rate in pregnant Korean women using selective culture media for GBS and to identify obstetrical complications and GBS-induced early-onset neonatal sepsis. Methods We evaluated 1,014 pregnant women who delivered at Busan Paik Hospital between January 2015 and December 2016. GBS colonization was assessed using chromID Strepto B agar. We evaluated GBS colonization in pregnant women, as well as the obstetrical complication and GBS-induced neonatal sepsis rates. Results The total GBS colonization rate was 11.6% (117/1,014). No significant increase was observed in the rate of pregnancy-related complications between the GBS-positive and the GBS-negative groups. Among the 134 neonates born to colonized mothers, early neonatal sepsis was reported in 2 neonates (1.5%); however, these were cases of non-GBS-induced sepsis. Conclusion The GBS colonization rate (using selective culture media) in this study involving pregnant Korean women showed a higher colonization rate than that previously reported in Korea. Therefore, based on this study, we recommend GBS screening and the administration of intrapartum antibiotic prophylaxis in pregnant Korean women.

// In-Sung Song 1 , Yu Jeong Jeong 1 , Young Jin Seo 2 , Jung Mi Byun 2 , Young Nanm Kim 2 , Dae Hoon Jeong 2 , Jin Han 3 , Ki Tae Kim 2, * and Sung-Wuk Jang 1, * 1 Department of Biomedical Sciences, College of Medicine, Ulsan University, Asan Medical Center, Seoul, Republic of Korea 2 Department of Obstetrics & Gynecology, Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan, Republic of Korea 3 National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Republic of Korea * These authors have contributed equally to this work Correspondence to: Ki Tae Kim, email: obgynkkt@inje.ac.kr Sung-Wuk Jang, email: swjang@amc.seoul.kr Keywords: peroxiredoxin 3, endometrial cancer, cancer stem cells, oxidative stress, mitochondria Received: June 23, 2017 Accepted: September 08, 2017 Published: October 06, 2017 ABSTRACT Cancer stem cell (CSC)-targeted therapy could reduce tumor growth, recurrence, and metastasis in endometrial cancer (EC). The mitochondria of CSCs have been recently found to be an important target for cancer treatment, but the mitochondrial features of CSCs and their regulators, which maintain mitochondrial function, remain unclear. Here, we investigated the mitochondrial properties of CSCs, and identified specific targets for eliminating CSCs in EC. We found that endometrial CSCs displayed higher mitochondrial membrane potential, Ca 2+ , reactive oxygen species, ATP levels, and oxygen consumption rates than non-CSCs. Further, we also verified that mitochondrial peroxiredoxin 3 (Prx3) was upregulated, and that it contributed to the survival of CSCs in EC. The knockdown of the Prx3 gene resulted not only in decreased sphere formation, but also reduced the viability of endometrial CSCs, by causing mitochondrial dysfunction. Furthermore, we found that the forkhead box protein M1 (FoxM1), an important transcriptional factor, is overexpressed in patients with EC. FoxM1 expression correlates with elevated Prx3 expression levels, in agreement with the tumorigenic ability of Prx3 in endometrial CSCs. Taken together, our findings indicate that human endometrial CSCs have enhanced mitochondrial function compared to that of endometrial tumor cells. Endometrial CSCs show increased expression of the mitochondrial Prx3, which is required for the maintenance of mitochondrial function and survival, and is induced by FoxM1. Based on our findings, we believe that these proteins might represent valuable therapeutic targets and could provide new insights into the development of new therapeutic strategies for patients with endometrial cancer.

ObjectiveWe aimed to analyze the differences in prognosis and the pattern of recurrence between squamous cell carcinoma (SCC) and adenocarcinoma (ADC) in patients with cervical cancer.MethodsWe retrospectively reviewed the medical records of 969 patients with SCC and 144 patients with ADC who underwent radical hysterectomy and pelvic lymph node dissection at the Busan Paik Hospital between January 1988 and December 2010.ResultsAdenocarcinoma was associated with poorer disease-free survival (P = 0.0515) and overall survival (OS) (P = 0.0156) compared with SCC, and that this was more apparent for patients with International Federation of Gynecology and Obstetrics stages IIA to IIB disease. Subgroup analysis by prognostic factors for recurrence showed significant differences in the OS in the intermediate-risk subgroup (P = 0.0266), but not in the high-risk subgroup (P = 0.1674). Based on the metastatic pattern in patients with recurrence, ADC was associated with an increased risk for distant recurrence resulting from hematogenous spread compared with SCC (P < 0.0001), and patients with distant recurrence showed a worse OS (P = 0.0481) and survival after recurrence (P = 0.0016) than patients with locoregional or lymphatic recurrence. Multivariate analysis showed that ADC was a significant independent factor for poor disease-free survival (P = 0.0034) and OS (P = 0.0001).ConclusionsAdenocarcinoma is associated with a poorer prognosis and a greater probability of distanat recurrence compared with SCC. Different therapeutic strategies for ADC need to be developed, and when considering the greater tendency for distant recurrence in patients with ADC, systemic chemotherapy may have a role in reducing the risk of hematogenous spread.

Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are a rare group of stromal neoplasms containing prominent sex cord-like elements. Since they were first described in 1945 by Morehead and Bowman [1], no more than 100 such tumors have been reported [2]. In a report by Clement and Scully [3], these neoplasms were divided into 2 groups on the basis of clinical and histologic patterns. The first group (group I) included endometrial stromal tumors with less than 50 % sex cord-like elements, and the second group (group II) included UTROSCTs exhibiting sex cord-like differentiation of more than 50 %. In the latest, according to the World Health Organization classification of uterine neoplasms, UTROSCTs were placed in a miscellaneous category of tumors of the uterine corpus because of their different morphology and benign clinical behaviors [4]. More recently, UTROSCTs have been suggested to be unusual neoplasms of uncertain malignancy with polyphenotypic immunohistochemical expression, characterized by positivity for sex cord, epithelial, and myoid markers [5, 6]. These tumors usually occur in premenopausal or menopausal women. Most patients have symptoms such as abnormal vaginal bleeding, abdominal pain, and enlarged uterus or a palpable uterine mass on physical examination [7]. In most cases, UTROSCT is diagnosed incidentally after hysterectomy for a clinical diagnosis of an endometrial polyp [8, 9] or sometimes leiomyoma [10]. We report a case of UTROSCT in a postmenopausal woman with vaginal bleeding who was diagnosed with uterine sarcoma at a local clinic.

Late postpartum eclampsia is defined as the onset of a seizure more than 48 hours after delivery. Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by clinical manifestations such as seizures, headaches, visual disturbances, altered mental status, and characteristic magnetic resonance imaging findings, including sub-cortical vasogenic edema at the bilateral parietal and occipital lobes. Late postpartum eclampsia concurrent with PRES is rare, and not always preceded by preeclampsia before delivery. We report the case of a 26-year-old woman who developed PRES with late postpartum eclampsia 5 days after cesarean delivery but did not have hypertensive disease during pregnancy.

Background Choriocarcinoma is a highly malignant tumor of gestational trophoblastic neoplasia that characteristically spreads via the bloodstream. Small bowel metastasis is very rare, and a small number of cases of choriocarcinoma metastasis to small bowel have been reported. Methods We report a case of a 40-year-old woman presenting with acute abdominal pain and vaginal bleeding due to small bowel perforation secondary to jejunal metastasis. In our case, metastatic choriocarcinoma was present in the small bowel, lung, and liver, but no primary lesion was apparent. Results After resection and anastomosis of the perforated small bowel, chemotherapy was performed. The patient began chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) for 9 cycles. When the 4th cycle of chemotherapy was finished, β-human chorionic gonadotropin (hCG) level was normalized and follow-up computed tomography scans showed regression of the liver metastasis and small bowel lesion and significantly decreased lung metastasis. After 9 cycles of chemotherapy were completed, the patient showed complete response. Conclusions If patients have high β-hCG of unknown origin and suspected panperitonitis, which are suspicious of choriocarcinoma metastasis to small bowel, the pathologic findings are important. It is essential to confirm the histopathologic diagnosis postoperatively. Choriocarcinoma can spread to various organs and show aggressive manifestations. Therefore, we should be aware of possible metastatic sites and remain alert to its diagnosis.

Objective There are no universally successful guidelines for the treatment of metronidazole-resistant vaginal trichomoniasis. This is distressing for patients and frustrating for physicians. We therefore decided to evaluate whether zinc sulfate douche is effective in treating vaginal trichomoniasis, because the compound is a natural antimicrobial chemical defense in humans. Case reports In our retrospective case review, eight cases of metronidazole-resistant trichomoniasis were treated with 1% zinc sulfate douche with or without tinidazole between 2005 and 2012. Except for one patient who was pregnant, seven patients were successfully treated and were negative for microscopic findings with no clinical symptoms at follow up. Conclusion Although the exact role of zinc sulfate in metronidazole-resistant trichomoniasis is not clear, our patients experienced a therapeutic effect with zinc sulfate douche treatment. We therefore recommend zinc sulfate douche as an option for the treatment of metronidazole-resistant vaginal trichomoniasis.

Vulvovaginal sequelae in Stevens–Johnson syndrome have been widely described in published literature, however, there is no consensus regarding effective preventive treatments. Labial minora synechiae as sequelae of Stevens–Johnson syndrome are rare, but can reduce patients' quality of life as a result of dysuria, urinary tract infection, and sexual dysfunction. Occasionally, sequelae can induce adenosis, and subsequently result in malignancy. Therefore, biopsy of the affected tissue in Stevens–Johnson syndrome patients with genital involvement should be considered after the acute phase has been resolved. Here, we report Stevens–Johnson syndrome with labial involvement in a 24-year-old woman who was treated with labial adhesiolysis. We recommend genital examination for all women with Stevens–Johnson syndrome to diagnose genital disease and avoid urinary tract infections and other sexual complications.

Objective The aim of this study was to investigate whether massive proteinuria in preeclampsia is associated with maternal and fetal complications. Methods We retrospectively analyzed the clinical records of 233 patients who were diagnosed with preeclampsia. We divided the preeclamptic patients into three groups based on the amount of proteinuria: massive (≥5 g/24 hr), moderate (2 to 5 g/24 hr) and mild (

An indirect inguinal hernia containing the fallopian tube alone is extremely rare in reproductive-aged women without any genital tract anomalies. Despite this rarity, early diagnosis and adequate management is important to prevent strangulation and recurrence. We present a case of an indirect inguinal hernia containing only the fallopian tube in the hernia sac, which was successfully reduced by using a laparoscopic total extraperitoneal approach and repaired with a polypropylene mesh.