Masahiko Umemoto

Preoperative diagnosis of ovarian tumors, focusing on the solid area based on diagnostic imaging

Aim:  The objectives were to attempt to differentiate between benignancy and malignancy by focusing not on macroscopic finding of tumor sections, but on the solid areas by diagnostic imaging. To investigate the usefulness of diagnostic imaging for ovarian tumors, we examined the solid areas in the tumor and their shape and analyzed the relationship between these factors and the malignant potential.

Cytopathologic and clinicopathologic features of ovarian hepatoid carcinoma. A case report.

BACKGROUND Hepatoid carcinoma is a rare ovarian tumor and is thought to be a different histopathologic subtype from hepatoid-type yolk sac tumor based upon its pathologic features. However, the cytopathologic characteristics of ovarian hepatoid carcinoma (OHC) have not been reported previously. We report the clinicopathologic and cytopathologic features and immunoreactivity of a case of OHC. CASE A 36-year-old woman presented to our department with lower abdominal pain. A left ovarian tumor was found on pelvic examination, magnetic resonance imaging and computed tomography. The tumor was diagnosed as a hepatoid carcinoma of the left ovary based upon the histopathology of the surgically resected specimen. Cytopathologic specimens from a tumor touch preparation of the tumor exhibited pleomorphic tumor cells with abundant cytoplasm. The nuclei contained rough, granular chromatin and large, prominent nucleoli. Several tumor cells were multinucleated. Tumor cells were immunoreactive for alpha-fetoprotein (AFP). Hematoxylin and eosin staining revealed that the tumor cells were in a sinusoidal pattern resembling hepatocellular carcinoma without any glandular formation. The tumor cells were negative for human chorionic gonadotropin while positive for AFP, alpha-1-antitripsin, CA-125 and carcinoembryonic antigen. CONCLUSION Cytopathologic examination is of considerable aid in the diagnosis of OHC since cytopathologic preparations highlight the characteristic cell pleomorphism.

Total abdominal hysterectomy versus laparoscopically-assisted vaginal hysterectomy versus total vaginal hysterectomy

Introduction: While total abdominal hysterectomy (TAH) and total vaginal hysterectomy (TVH) are conventional procedures, we have actively introduced laparoscopically‐assisted vaginal hysterectomy (LAVH) since its advent. This study was the first attempt to retrospectively compare the surgical results, including invasiveness, among the three methods of performing a hysterectomy.

Study of the correlation between tumor size and cyst rupture in laparotomy and laparoscopy for benign ovarian tumor: is 10 cm the limit for laparoscopy?

Aim:  Laparoscopy is the gold standard for treatment of benign ovarian cysts, although there is a risk of intraoperative cyst rupture if the lesion is cancerous. This study is aimed at comparing the incidence of cyst rupture to tumor size in both laparotomy and laparoscopy in order to select the optimum surgical procedure for ovarian cysts.

Indication for laparoscopically assisted vaginal hysterectomy.

When uterine weight is greater than 800 grams, total abdominal hysterectomy is more appropriate than laparoscopic-assisted vaginal hysterectomy.

Carbamyl phosphate synthetase deficiency and postpartum hyperammonemia

Carbamyl phosphate synthetase (CPS) is an enzyme that converts ammonia to carbamyl phosphate in the urea cycle. CPS deficiency is a genetic disorder that causes hyperammonemia because of enzyme activity deficiency. It is primarily diagnosed in neonates and infants and has a poor prognosis. We report an adult woman with CPS deficiency who developed hyperammonemia postpartum.

Preoperative differentiation between tumor‐related ovarian torsion and rupture of ovarian cyst preoperatively diagnosed as benign: A retrospective study

Introduction:  Patients with ovarian cyst sometimes present with acute abdomen caused by ovarian torsion or rupture, which are difficult to differentiate preoperatively. The purpose of this study was to determine preoperative features of patients with ovarian cyst that could be used in differentiation.

Estimation of preoperative uterine weight in uterine myoma and uterine adenomyosis

Uterine myoma and uterine adenomyosis frequently occur in sexually mature women. Total hysterectomy is the treatment of choice when the symptoms are severe. To select an operative procedure from abdominal, vaginal, and laparoscopic methods, precise estimation of the preoperative uterine weight is desired. In this study, we estimated the preoperative uterine weight with preoperative images in cases of uterine myoma and uterine adenomyosis.

Case of acquired hemophilia with factor VIII inhibitor in a mother and newborn

We report a mother and newborn in the puerperium with hemorrhage secondary to factor VIII inhibitor. A 31‐year‐old gravida 1 para 1 delivered at a local clinic with a massive postpartum hemorrhage. The activated partial thromboplastin time was prolonged and factor VIII inhibitor was detected. The persistent hemorrhage improved following treatment, including transfusion, steroid therapy, and bypass therapy with factor VII formulations. After hysteroscopic removal of the retained placenta, the hemorrhage decreased. The newborn developed significant swelling of the hands after routine blood sampling and factor VIII inhibitor was detected. The inhibitor disappeared without any special treatment in the 5th month postpartum in the mother and the 4th month postpartum in the newborn. Factor VIII inhibitor may be transferred via the placenta from the mother to the fetus. Therefore, the newborn should also be carefully observed in a case of massive hemorrhage after delivery.

Uterus-sparing myomectomy for uterine pyomyoma following cesarean section

Uterine myoma complicates approximately 1% of pregnancies [1,2]. Pregnancy complicated by uterine myoma presents various problems throughout the perinatal period, including repeated spontaneous abortions, premature delivery, and disorders at delivery. In recent years, the rate of pregnancies complicated by uterine myoma is thought to have increased, because of the increase in late marriages, or because of an increase in diagnoses as a result of advances in imaging technology, including ultrasound. Some studies have reported patients with uterine myoma complicated by infection. However, among these patients, cases of pyomyoma in which the myoma was filled with ichorous pus, were rare. Since 1945, only 13 patients with pyomyoma that occurred during pregnancy and the puerperium were reported [3]. Among these patients, four underwent Cesarean section (C-section) [3e5]. Moreover, for most of these cases, the only option was total abdominal hysterectomy. Here, we report a patient with an infected uterine myoma that developed after a C-section that was indicated for a pregnancy complicated by uterine myoma. After the pyomyoma was discovered during open surgery, myomectomy was performed to conserve the uterus. The patient was a 36-year-old nulligravida, with no significant past or family history. At week 6 of her pregnancy, a transvaginal ultrasound revealed a 13 cm uterine myoma involving the muscle layer and the fetal sac in the uterine cavity. The rest of the pregnancy was uneventful, and the myoma did not increase in size. At week 37 day 6, the patient underwent abdominal C-section at the pelvic level. A baby girl was delivered through a low transverse incision of the uterus. The infant’s weight was 2512 g, the 1-minute Apgar score was 9, and the 5-minute Apgar score was 10. The volume of intraoperative blood loss was 690 mL, which included