Jong-In Kim

Endometrial histology and predictable clinical factors for endometrial disease in women with polycystic ovary syndrome

Objective This study was aimed to investigate endometrial histology and to find predictable clinical factors for endometrial disease (hyperplasia or cancer) in women with polycystic ovary syndrome (PCOS). Methods We investigated the endometrial histology and analyzed the relationship between endometrial histology and clinical parameters, such as LH, FSH, estradiol, testosterone, fasting and 2 hours postprandial glucose and insulin, insulin resistance, body mass index, endometrial thickness, menstrual status from 117 women with PCOS. Statistical analysis was performed with chi square and t-test, p-value<0.05 was considered as statistically significant. And receiver operating characteristic curve was used to find predictable clinical factors for endometrial disease and to decide the cuff off values. Results In 117 women with PCOS, endometrial histologic profiles are as follows: proliferative phase in 90 women (76.9%), endometrial hyperplasia in 25 women (21.4%), and endometrial cancer in 2 women (1.7%). Of 25 women with endometrial hyperplasia, simple hyperplasia without atypia, complex hyperplasia without atypia and complex hyperplasia with atypia were diagnosed in 15 (12.8%), 6 (5.1%), 4 (3.4%) women, respectively. Age and endometrial thickness were significantly related with endometrial disease, p=0.013 and p=0.001, respectively. At the cut off level of 25.5 years in age, sensitivity and specificity predicting for endometrial disease were 70.4% and 55.6%, respectively (p=0.023). At the cut off level of 8.5 mm in endometrial thickness, sensitivity and specificity were 77.8% and 56.7%, respectively (p=0.000). Conclusion In women with PCOS, the incidence of endometrial hyperplasia and cancer were 21.4% and 1.7%. The age and endometrial thickness may be used as clinical determining factors for endometrial biopsy.

Pulmonary and retroperitoneal benign metastasizing leiomyoma.

Benign metastasizing leiomyoma (BML) is a rare disease, which usually occurs in women with a history of a prior hysterectomy or myomectomy for benign uterine leiomyoma, and has the potential to metastasize to distant sites, such as the lung, lymph nodes, muscular tissue, heart, or retroperitoneum. These lesions are slow-growing, asymptomatic, and usually found incidentally. The prognosis of BML is also excellent. However, there has been debate on the origin and the correct classification of BML, and there are no guidelines for the treatment of BML. We report here on a rare case of BML in both the retroperitoneal cavity and lung in a 48-year-old woman with a history of hysterectomy due to histologically benign uterine leiomyoma. The patient underwent retroperitoneal mass excision and bilateral salpingo-oophorectomy, and then wedge biopsy of two pulmonary nodules was performed additionally 9 days later. Until now, there has been no sign of recurrence and the patient remains asymptomatic. To our knowledge, pulmonary BML is rare and the co-existence of the retroperitoneal metastases after previous hysterectomy is even rarer.

Isolated torsion of bilateral fallopian tubes combined with tubal endometriosis: A case report

Torsion of the fallopian tube is less frequent. Indeed, isolated bilateral fallopian tube torsion is rare and often diffi cult t o diagnose. The etiology of fallopian tube torsion is still uncertain, especially when this is not associated with torsion of the ovary. We present a case of the torsion of isolated bilateral fallopian tube combined with tubal endometriosis. A 30-year-old woman presented with chronic abdominal pain of 5-month duration and severe dysmenorrhea. Presumptive diagnosis by ultrasound and magnetic resonance imaging was both adnexal endometriosis. At laparoscopy, the fi mbrial ends of both tubes were dilated, twisted and necrotic changes with adhesion to omentum, which subsequently led to terminal obstruction of that tube. However, both ovaries and uterus were normal. Laparoscopic bilateral salpingectomy was performed. The postoperative histological report confi rmed hematosalpinx with tubal endometriosis. To our knowledge, this is the fi case of isolated and bilateral fallopian tubes tors ion combined with tubal endometriosis.

An orbital hemangioendothelioma of fetus detected by prenatal ultrasonography

Most orbital tumors of infants include retinoblastoma, dermoid cyst (teratoma), optic nerve glioma and nevus, and hemangioendothelioma is found in rare cases. Hemangioendothelioma, the tumor of intermediate malignancy between angiosarcoma and hemangioma, is commonly recognized in soft tissue of extremities, skin, lung and liver with symptoms of ulceration and hepatomegaly in neonates and infants. However it seldom localizes in the orbit. Although there have been two case reports of orbital hemangioendothelioma in neonate and adult in Korea, there was no case report of prenatally diagnosed orbital hemangioendothelioma in fetus. We found hemangioma-like orbital tumor in a fetus at 36 weeks of gestation by prenatal ultrasonography and confirmed hemangioendothelioma by microscopic examination after birth. This is the first case of orbital hemangioendothelioma in fetus.

An ectopic ureterocele diagnosed in interlabial mass

Interlabial mass in infant is not common. Because of similarity of symptoms and signs of those mass and less experience of gynecologist due to those rarity, differential diagnosis is not easy. In infant, there are fi ve common interlabial masses which are prolapsed ectopic ureterocele, urethral prolapse, paraurethral cyst, hydrocolpos and rhabdomyosarcoma. Ureterocele with duplex ureter might be diagnosed, however prolapsed ureterocele through urethra is extremely rare. We found 18 months old girl with interlabial mass and diagnosed as prolapsed ectopic ureterocele by ultrasonography, magnetic resonance imaging and voiding cystourethrography. We managed by endoscopic incision of ureterocele successfully. So we report this case with a brief review of associated literatures.