Kwan-Young Joo

Ovarian leiomyoma as a potential cause of compromised fertility

OBJECTIVE To analyze cases of ovarian leiomyomas and to discuss the proper surgical management. DESIGN A case series and discussion. SETTING General university hospital and healthcare center. PATIENT(S) Nine patients who were diagnosed with ovarian leiomyomas after surgery between 1993 and 2009. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) A preoperative diagnosis that was matched to the postoperative diagnosis and the type of surgery. RESULT(S) In all cases, ovarian leiomyoma was misdiagnosed preoperatively as pedunculated uterine myoma, ovarian fibroma, or even ovarian endometrioma. Seven (77.8%) of the nine patients underwent a salpingo-oophorectomy or an oophorectomy with or without hysterectomy, and only two (22.2%) patients were submitted to an ovary-preserving surgery (i.e., a cystectomy or ovarian wedge resection). CONCLUSION(S) Because of their extreme rarity, ovarian leiomyomas are seldom suspected intraoperatively or preoperatively. However, most of these tumors appear at reproductive age and have a benign nature, similar to uterine myomas. Therefore, surgeons should perform ovary-preserving management, especially in young patients.

Laparoscopic cervical myomectomy: Five years of experience

Uterine myoma is the most common benign tumor in women of reproductive age [1]. Leiomyoma affects 25% to 50% of women of reproductive age, and at least 50% of patients have significant symptoms [2]. Common symptoms of myoma include menorrhagia, metrorrhagia, dysmenorrhea, and pressure symptoms. The process of myoma development is not well understood and can continue until menopause. Indications for surgery include abnormal uterine bleeding, unresponsiveness to medical therapy, pain or pressure symptoms, urinary signs or symptoms, a high level of malignancy, growth after menopause, infertility with endometrial distortion, and recurrent pregnancy loss [1]. For preservation of fertility, myomectomy is carried out in women of reproductive age with symptomatic uterine myoma. With the development of laparoscopic equipment and establishment of laparoscopic surgical settings, the indications for gynecologic laparoscopy have been extended. Nowadays, laparoscopic operation is generally preferred because of its good cosmetic results, reduced pain levels, short hospitalization time, quick recovery time, and similar outcomes as those of laparotomy [3]. LAPAROSCOPIC CERVICAL MYOMECTOMY: FIVE YEARS OF EXPERIENCE Soo-Yoon Lee, MD, Hee-Suk Lee, MD, Yeon-Jean Cho, MD, Kwan-Young Joo, MD, Joo-Myung Kim, MD Department of Obstetrics and Gynecology, Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine, Seoul; Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea