Masumi Takeda

Etiology of Ascites and Pleural Effusion Associated with Ovarian Tumors: Literature Review and Case Reports of Three Ovarian Tumors Presenting with Massive Ascites, but without Peritoneal Dissemination

Borderline ovarian tumors are benign but relatively large tumors that are often initially mistaken as ovarian cancers. We report three cases of stage I borderline ovarian tumors having massive ascites that we (preoperatively) suspected of being advanced ovarian cancer. The three patients (35, 47, and 73 years old) reported feeling fullness of the abdomen before consulting their gynecologist. By CT scan, they were diagnosed with a pelvic tumor accompanied by massive ascites, the diameters of which were 11, 20, and 11 cm, respectively. Postsurgical pathology showed all were stage I borderline ovarian tumors without dissemination; two were mucinous and one was serous. The amount of ascites was 6,300, 2,600, and 3,600 mL, respectively, and was serous in all. Cytodiagnosis of the ascites found that one was positive for tumor cells and two were negative. After resection of the mass, the ascites disappeared in all three cases. No pleural effusion was present at any time. The literature is reviewed concerning ascites and pleural effusions linked to ovarian tumors, and a supposition is forwarded of why pleural effusion presents sporadically in these cases.

Can Triclosan-Coated Sutures and the Use of Double Gloves Reduce the Incidence of Surgical Site Infections?

Background: Postoperative surgical site infections (SSIs) are one of the most frequent complications after open abdominal surgery. Triclosan-coated sutures were said to be able to reduce its occurrence. In gynecologic surgery, SSIs of the vaginal stump are a frequent cause of postoperative fever. Double gloving is also said to contribute to the prevention of SSIs. We performed abdominal hysterectomy with double gloving and sutured the vagina stump with VICRYL PLUS ® , a Polyglactin 910 suture coated with triclosan, to prevent SSIs. We investigated whether triclosan-coated sutures coupled with double gloving could indeed reduce the incidence of SSIs following abdominal hysterectomy. Methods: We retrospectively reviewed 384 cases of abdominal hysterectomies operated in our department between April 2013 and March 2015. In the first period (from April 2013 to March 2014), we performed 195 operations with single gloving and sutured the vaginal stump with VICRYL ® (Polyglactin 910 suture without triclosan coat). In the second period (from April 2014 to March 2015), we performed 189 operations with double gloving and sutured the vaginal stump with VICRYL PLUS ® (Polyglactin 910 suture with triclosan coat). The primary outcome is the incidence of SSIs. Results: The two groups were comparable with respect to risk factors for SSIs. The incidences of SSIs in the first and second groups were 17 of 195 patients (8.7%) and eight of 189 patients (4.2%), respectively. The difference in the incidence of SSIs was not significant between the two groups (P = 0.097). The numbers of cases requiring postoperative antibiotic therapy in the first and second groups were 13 (6.7%) and 4 (2.1%). The incidence was higher in the control group (P = 0.045). None of the 189 cases needed drainage therapy or a re-operation. Conclusion: It is possible that triclosan-coated sutures coupled with double gloving are able to reduce SSIs and prevent SSI aggravation. J Clin Gynecol Obstet. 2017;6(1):1-5 doi: https://doi.org/10.14740/jcgo429w

Case report of a rare pure uterine lipoma treated by laparoscopic hysterectomy

We herein present a case of a pure lipoma, arising from the uterine fundus, coincidental with an ovarian tumor. Both masses were successfully resected with laparoscopy. A 60-year-old woman (gravida 3, para 2) was referred to our hospital with both an ovarian and a uterine tumor, which were found by her physician during a routine physical checkup. Her past medical history contained nothing particular to this event. Importantly, she did not present with any related symptoms, such as abdominal pain or abnormal genital bleeding. The patients serum tumor markers for CA125, carcinoembryonic antigen (CEA), and CA19-9 were all in the normal range, and her uterine cervical cytology was negative. Transvaginal ultrasonography revealed a hyperechogenic tumor (25 mm in diameter) in the fundus of the uterus (Figure 1). Transvaginal ultrasonography showed a second mass (55 mm in diameter), containing both hyperechogenic and isoechogenic regions, in the right ovary. Magnetic resonance imaging (MRI) was applied to investigate the ovarian tumor; it also described the tumor in the uterine myometrium, with a high intensity pattern in both the T1/T2 weighted sequences, and the MRI signal dropped out in the fat suppression series. The tumor of the uterus was preoperatively suspected of being a lipoleiomyoma, lipoma, or some other neoplastic malignancy. The contents of the right ovarian tumor were suppressed in the MRI fat suppression series. This suggested that the ovarian tumor was a mature cystic teratoma (Figure 2). Laparoscopy-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy were performed. The gross weight of the combined uterus and left adnexa was 118 g. The gross findings for the posterior uterine wall showed a yellow-colored soft tumor of 25 mm in diameter (Figure 3). The contents of the right ovarian tumor were hair and fatty tissue (figures not shown). Microscopic examination of the posterior uterine wall showed atrophic endometrium with an intramural tumor composed of benign mature adipose tissue. The tumor was clearly delineated from the normal myometrium and no smooth muscle cells or fibrous elements were seen within the tumor (Figure 4). The final histopathology confirmed a diagnosis of a pure lipoma of the uterus, and of a mature cystic teratoma of the right ovary. The patient has since recovered, without any complications, and she was discharged on the 8th postoperative day.

Rare hydrosalpinx in a sexually inactive adolescent successfully treated with laparoscopy

The majority of cases of symptomatic hydrosalpinx needing treatment are caused by sexually transmitted diseases. However, here, we present a rare case of a hydrosalpinx occurring in a sexually-inactive adolescent girl successfully treated with laparoscopy. A 17-year-old girl presenting with lower abdominai symptoms had a surgical history for an inguinal hernia at infancy. Transabdominal ultrasonography revealed a multicystic lesion in the pelvis, and magnetic resonance imaging suggested hydrosalpinx. Due to the abdominal pain and a suspicion of torsion, laparoscopic surgery was performed. After aspiration and resection of a cystic tumor, we confirmed that the left ovary was normal and that the tumor involved the left fallopian tube, which was twisted at the isthmus. Although relatively rare in postmenarchal sexually inactive adolescents, clinicians and surgeons must still consider hydrosalpinx as a possible diagnosis when encountering an adolescent patient with lower abdominal pain.

Gemella morbillorum bacteremia following total laparoscopic hysterectomy for uterine corpus cancer

Gemella morbillorum, a Gram-positive coccus facultative anaerobe, is part of the normal flora of the mucous membranes of the oropharynx, upper respiratory, gastrointestinal, and female genital tracts. However, this species can also cause serious infection. We herein report on a case of bacteremia, accompanied by peritonitis and pleuritis, in a 46-year-old immunocompetent female following a total laparoscopic hysterectomy for endometrial cancer. The case was successfully treated with antibacterial and antifungal agents.

Rare Primary Adenocarcinoma of the Broad Ligament: Report of Two Cases and a Literature Review.

Malignant primary tumors arising in the uterine broad ligament are extremely rare, and only 26 cases have been reported to date. We describe 2 new cases of primary adenocarcinoma of the broad ligament, and we review the previous literature on such rare tumors. In Case 1, a 71-year-old woman presented with a 2-month history of increased yellow vaginal discharge and lower abdominal pain during bowel movement. Transvaginal sonography revealed a 6.5 cm mass located on the dorsum of the uterus and a 7.0 cm mass (with cystic and solid parts) near the right adnexa. We postoperatively diagnosed the mass as a high-grade serous carcinoma of the broad ligament (pT3cNXM0). The patient is currently receiving adjuvant chemotherapy with paclitaxel and carboplatin. In Case 2, during a complete medical checkup a 43-year-old woman was found to have a pelvic mass indicative of leiomyoma. Transvaginal sonography revealed a 3.8 cm mass located on the dorsum of the uterus. Following surgery, we diagnosed the mass as a clear cell adenocarcinoma of the broad ligament (pT2bN1M0). This patient is also now receiving adjuvant chemotherapy with paclitaxel and carboplatin.