Natsuko Makihara

Large cell neuroendocrine carcinoma originating from the uterine endometrium: a report on magnetic resonance features of 2 cases with very rare and aggressive tumor.

Neuroendocrine carcinomas (NEC) of the female genital tract are aggressive and uncommon tumors, which usually involve the uterine cervix and ovary, and are seen very rarely in the endometrium. Only less than 10 cases of large cell NEC (LCNEC) of the endometrium have been reported in the literature and their radiological findings are not well described. We report here two cases of pathologically proven LCNEC of the uterine endometrium. In both cases, the uterine body was enlarged and the tumor occupied part of the uterine cavity. Endometrial mass exhibited heterogeneous high intensity on T2-weighted magnetic resonance (MR) images, and diffusion-weighted MR images revealed high intensity throughout the tumor, consistent with malignancy. LCNEC is a highly malignant neoplasm without particular findings in terms of diagnostic imaging and pathology, so its preoperative definitive diagnosis is very difficult. However, when laboratory test, pathologic diagnosis and MR imaging suggest a poorly differentiated uterine malignancy, positron emission tomography-computed tomography scan should be performed as a general assessment to help with diagnosis.

In vitro fertilization-embryo transfer pregnancy was a risk factor for hemorrhagic shock in women with placental polyp

Abstract Objective: The aim of this study was to determine the risk factors for hemorrhagic shock in women with placental polyp. Materials and methods: Twelve women (group A) developed hemorrhagic shock (shock index < 1.5) and received uterine artery embolization (UAE). The other 25 women (group B) had shock index < 1.5 and did not receive UAE. All women underwent transcervical resection (TCR). The risk factors for the development of hemorrhagic shock, including the age, conception mode, numbers of previous abortion, gestational weeks at termination of pregnancy (TOP), blood loss weights at TOP and at TCR, were analyzed. Results: When compared with group B, group A had higher in vitro fertilization-embryo transfer (IVF-ET) pregnancy rate (58.3 versus 12.0%, p < 0.01), number of previous abortion (median 1.58 versus 0.68, p < 0.05), gestational weeks at TOP (median 36.5 versus 17.0 weeks, p < 0.05), and blood loss weight at TOP (median 2151 versus 40 g, p < 0.05). A logistic regression analysis reveled that IVF-ET (OR 41, 95% CI 1.3–1264) and blood loss weight at TOP (1.0025, 1.0006–1.0044) were independent risk factors for hemorrhagic shock. Conclusions: For the first time, IVF-ET pregnancy was found to be a risk factor for the development of hemorrhagic shock in women with placental polyp.

A Case of Endometrioid Adenocarcinoma Originating from the Serous Surface of the Small Intestine

Malignant transformation of endometriosis has been extensively described in the literature. However, extragonadal endometrioid adenocarcinoma, either de novo or arising from malignant transformation of endometriosis, is rare. The present case report describes a patient with endometrioid adenocarcinoma on the serous surface of the small intestine. A 25-year-old female with no history of endometriosis was referred to our hospital with an intrapelvic tumor. An internal examination, ultrasound, and magnetic resonance imaging revealed a round mass approximately 80 mm in diameter; however, identification of the affected organ was difficult. Because we could not rule out malignancy based on the non-specific radiologic findings, laparotomy was performed. A mass with ileal adhesions was detected intraoperatively. In addition, the uterus and bilateral adnexa appeared normal. The tumor was resected with part of the ileum. Histopathology confirmed a diagnosis of endometrioid adenocarcinoma originating from the serous surface of the small intestine.

PP094. A comparison of gestational changes in urinary excretion of magnesium with those of calcium.

INTRODUCTION Magnesium is one of the essential minerals required in various cellular functions. Some investigators have postulated that some aspects of pathophysiology in preeclampsia could be associated with alteration in regulatory mechanisms of the mineral. However, gestational changes in absorption, excretion and blood concentration of magnesium have remained less elucidated compared with those of calcium, which is another important mineral forming a divalent cation. OBJECTIVES The purpose of this study was to clarify if urinary excretion of magnesium during pregnancy might be altered compared with those of calcium. METHODS Sixty specimens of 24h urine and 586 samples of spot urine were collected from healthy pregnant women who gave consent. Determination of the minerals were according to Orthocresol-phthalein complexone method for calcium, and xylidyl blue method for magnesium. Urinary creatinine was determined by Jaffe Method. RESULTS Daily excretions of magnesium determined with 24h samples were 60, 70, 81, 65, and 102mg in 1st, 2nd, and early 3rd trimesters, term, and postpartum 4weeks, respectively. There were no statistical differences among the values. Those of calcium were 174, 186, 139, 52, and 40mg, respectively. The values in term and in postpartum were significantly lower than those in 1st through early 3rd trimesters. The Mg/Cr ratios (mg/mg Cr) determined with spot urine samples were 0.064, 0.071, 0.066, 0.067, and 0.086, in 1st, 2nd, and early 3rd trimesters, term, and postpartum 4weeks, respectively. The value of Mg/Cr in postpartum was significantly higher than the values in pregnant period. The Ca/Cr ratios (mg/mg Cr) were 0.164, 0.163, 0.135, 0.118, and 0.090, respectively. There was a trend of decreasing pattern in changes of Ca/Cr from 2nd trimester to postpartum. CONCLUSION It is suggested that there is a mechanism of preservation of calcium in the late phase of pregnancy or puerperal period by reducing urinary excretion of the mineral. However, human pregnancy does not seem to show such a function controlling magnesium metabolism.