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Thanasa A, Thanasa E, Antoniou IR, Kontogeorgis G, Gerokostas EE, Kamaretsos E, Paraoulakis I, Simopoulou E, Mousia M, Thanasas I. Abdominal Wall Endometriosis: Early Diagnosis of a Rare Iatrogenic Complication Following Cesarean Section. Cureus 2024; 16:e56284. [PMID: 38623122 PMCID: PMC11018261 DOI: 10.7759/cureus.56284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
Abdominal wall endometriosis is a rare form of extrapelvic endometriosis, frequently diagnosed with delay in most cases. It is typically iatrogenic and primarily associated with procedures such as cesarean sections or other gynecological surgeries. In our patient, endometriosis at the laparotomy scar was diagnosed relatively early, approximately two months after the onset of symptoms, which manifested 10 months after the last cesarean section. The patient, who had an obstetric history of three cesarean sections, presented at the Gynecology outpatient clinic of the General Hospital of Trikala, complaining of pain associated with menstruation located in the lower abdomen, near the surgical scar. Based on clinical and imaging findings, abdominal wall endometriosis was suspected, leading to a decision for wide excision of the endometriotic lesion. Histological examination of the surgical specimen confirmed the diagnosis. The postoperative course was uneventful, and three months after the surgery, the patient reported complete resolution of symptoms. This case report emphasizes the importance of integrating advanced diagnostic methods alongside classic clinical findings for the accurate diagnosis of abdominal wall endometriosis. It also highlights the contribution of surgical treatment through wide excision of the endometriotic lesion, in facilitating early diagnosis, achieving cure, and minimizing the risk of disease recurrence in the future.
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Affiliation(s)
- Anna Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Efthymia Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | | | | | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | | | - Maria Mousia
- Department of Pathology, General Hospital Trikala, Trikala, GRC
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
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2
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Ning L, Lang J, Long B, Wu L. Diagnostic value of circN4BP2L2 in type I and type II epithelial ovarian cancer. BMC Cancer 2022; 22:1210. [PMID: 36434559 PMCID: PMC9694909 DOI: 10.1186/s12885-022-10138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND CircN4BP2L2 was previously identified to be significantly decreased in epithelial ovarian cancer (EOC) and was associated with disease progression. The aim of this study was to evaluate the diagnostic value of plasma circN4BP2L2 using the unifying model of type I and type II EOC. METHODS A total of 540 plasma samples were obtained from 180 EOC patients, 180 benign ovarian cyst patients, and 180 healthy volunteers. CircN4BP2L2 was assessed using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) were assessed using enzyme-linked immunosorbent assay (ELISA). Receiver operating curve (ROC), the area under the curve (AUC), sensitivity and specificity were estimated. RESULTS Low level of circN4BP2L2 was associated with advanced tumor stage (p < 0.01) in type I EOC. Decreased circN4BP2L2 was associated with lymph node metastasis (LNM) (p = 0.04) in type II EOC. The expression level of circN4BP2L2 in type I was similar to that in type II. CircN4BP2L2 could significantly separate type I or type II from benign or normal cohort (p < 0.01). Early-stage type I or type II EOC vs. benign or normal cohort could also be distinguished by circN4BP2L2 (p < 0.01). CONCLUSION CircN4BP2L2 might serve as a promising diagnostic biomarker for both type I and type II EOC. The diagnostic safety for circN4BP2L2 in early-stage type I or type II EOC is also acceptable. Further large-scale well-designed studies are warranted to investigate whether circN4BP2L2 is specific for all histologic subgroups.
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Affiliation(s)
- Li Ning
- grid.506261.60000 0001 0706 7839Department of gynecologic oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021 Beijing, China
| | - Jinghe Lang
- grid.506261.60000 0001 0706 7839Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730 Beijing, China
| | - Bo Long
- grid.506261.60000 0001 0706 7839Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730 Beijing, China
| | - Lingying Wu
- grid.506261.60000 0001 0706 7839Department of gynecologic oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021 Beijing, China
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3
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Yadav N, Podder AR. Utility of CA 125 in Determining the Response to Neoadjuvant Chemotherapy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Feeney L, Harley IJG, McCluggage WG, Mullan PB, Beirne JP. Liquid biopsy in ovarian cancer: Catching the silent killer before it strikes. World J Clin Oncol 2020; 11:868-889. [PMID: 33312883 PMCID: PMC7701910 DOI: 10.5306/wjco.v11.i11.868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/29/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
Epithelial ovarian cancer (EOC) is the most lethal gynaecological malignancy in the western world. The majority of women presenting with the disease are asymptomatic and it has been dubbed the "silent killer". To date there is no effective minimally invasive method of stratifying those with the disease or screening for the disease in the general population. Recent molecular and pathological discoveries, along with the advancement of scientific technology, means there is a real possibility of having disease-specific liquid biopsies available within the clinical environment in the near future. In this review we discuss these discoveries, particularly in relation to the most common and aggressive form of EOC, and their role in making this possibility a reality.
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Affiliation(s)
- Laura Feeney
- Patrick G Johnston Centre for Cancer Research, Queens University, Belfast BT9 7AE, United Kingdom
| | - Ian JG Harley
- Northern Ireland Gynaecological Cancer Centre, Belfast Health and Social Care Trust, Belfast BT9 7AB, United Kingdom
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast BT12 6BL, United Kingdom
| | - Paul B Mullan
- Patrick G Johnston Centre for Cancer Research, Queens University, Belfast BT9 7AE, United Kingdom
| | - James P Beirne
- Trinity St James Cancer Institute, St. James’ Hospital, Dublin 8, Ireland
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5
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Severe adenomyosis with unexpectedly high CA-125: report of a rare case. MENOPAUSE REVIEW 2020; 19:144-146. [PMID: 33100951 PMCID: PMC7573337 DOI: 10.5114/pm.2020.99610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
A 46-year-old woman presented to the emergency department with abdominal pain and abnormal uterine bleeding over the last year. She had a history of failed cyclic progesterone with tranexamic acid over the last 3 months to control her bleeding attacks. She had a tender pelvi-abdominal mass of 28 weeks’ gestation size. Therapeutic curettage was performed, followed by correction of her iron deficiency anemia with intravenous iron. The trans-abdominal ultrasound of the pelvi-abdominal mass showed asymmetrical myometrial thickening, predominantly its anterior wall, with myometrial hyperechoic regions surrounded by hypoechoic areas suggestive of adenomyosis uterus for magnetic resonance imaging (MRI) evaluation. The MRI evaluation confirmed the diagnosis of adenomyosis uterus and showed diffuse asymmetrical uterine adenomyosis, predominantly its anterior myometrial wall, with an ill-defined endo-myometrial junction. Total abdominal hysterectomy with bilateral salpingectomy and bilateral ovarian conservation was performed after departmental approval and the patient’s consent. The routine pre-operative investigations were completely normal except the cancer antigen (CA-125) which was unexpectedly high (1658 and 1046 IU/ml repeated twice two days apart). The histological examination of the surgical removed uterus confirmed the diagnosis of adenomyosis uterus and the pre-operative high CA-125 decreased to 22 IU/ml (normal range 0-35 IU/ml) one week after surgery.
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Minimally Invasive Excision of a Giant Paratubal Cyst: Case Report and Management Review. Case Rep Obstet Gynecol 2019; 2019:3458230. [PMID: 31934473 PMCID: PMC6942751 DOI: 10.1155/2019/3458230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/06/2019] [Indexed: 11/17/2022] Open
Abstract
Paratubal cysts are usually incidentally found due to being small and asymptomatic adnexal structures. Enlargement to more than 15 cm concurrent with late presentation in an adult is rare. We present the case of a 36 cm diameter cyst in a 31-year-old female whose symptoms involved overactive bladder, abdominal bloating, and pressure. Radiologic findings suggested that it extended from the xiphoid and pubic symphysis. Removal was through a minimally invasive technique.
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7
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Yao T, Cao R, Xiao W, Pan F, Li X. An optical study of drug resistance detection in endometrial cancer cells by dynamic and quantitative phase imaging. JOURNAL OF BIOPHOTONICS 2019; 12:e201800443. [PMID: 30767401 PMCID: PMC7065625 DOI: 10.1002/jbio.201800443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 05/15/2023]
Abstract
Platinum chemosensitivity detection plays a vital role during endometrial cancer treatment because chemotherapy responses have profound influences on patient's prognosis. Although several methods can be used to detect drug resistance characteristics, studies on detecting drug sensitivity based on dynamic and quantitative phase imaging of cancer cells are rare. In this study, digital holographic microscopy was applied to distinguish drug-resistant and nondrug-resistant endometrial cancer cells. Based on the reconstructed phase images, temporal evolutions of cell height (CH), cell projected area (CPA) and cell volume were quantitatively measured. The results show that change rates of CH and CPA were significantly different between drug-resistant and nondrug-resistant endometrial cancer cells. Furthermore, the results demonstrate that morphological characteristics have the potential to be utilized to distinguish the drug sensitivity of endometrial cancer cells, and it may provide new perspectives to establish optical methods to detect drug sensitivity and guide chemotherapy in endometrial cancer.
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Affiliation(s)
- Tian Yao
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingChina
| | - Runyu Cao
- Key Laboratory of Precision Opto‐Mechatronics Technology of Ministry of Education, School of Instrumentation Science & Optoelectronics EngineeringBeihang UniversityBeijingChina
| | - Wen Xiao
- Key Laboratory of Precision Opto‐Mechatronics Technology of Ministry of Education, School of Instrumentation Science & Optoelectronics EngineeringBeihang UniversityBeijingChina
| | - Feng Pan
- Key Laboratory of Precision Opto‐Mechatronics Technology of Ministry of Education, School of Instrumentation Science & Optoelectronics EngineeringBeihang UniversityBeijingChina
| | - Xiaoping Li
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingChina
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8
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Huang C, Hong MK, Chu TY, Ding DC. A retrospective study of surgical treatment and outcome among women with adnexal torsion in eastern Taiwan from 2010 to 2015. PeerJ 2018; 6:e5995. [PMID: 30533300 PMCID: PMC6284449 DOI: 10.7717/peerj.5995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/24/2018] [Indexed: 12/22/2022] Open
Abstract
Background Adnexal torsion is a gynecologic emergency that requires surgical treatment. In this study, we reviewed the surgical outcomes of women with adnexal torsion in eastern Taiwan (Hualien county, area 4,629 km2, 330,000 residents). Methods This retrospective study included 42 women diagnosed with surgically-proven adnexal torsion from January 1, 2010, to September 31, 2015. We compared the symptoms, objective findings, and surgical outcomes of patients who underwent laparotomy or laparoscopy. Results The laparoscopy and laparotomy groups included 27 and 15 patients, respectively. The most common symptom and sign was abdominal pain, followed by nausea and vomiting. In all patients, an adnexal tumor was detected through ultrasound. The median and range of time from admission to surgery was 1.5 (1–11.5) and 1.0 (1–11) hours in the laparotomy and laparoscopy groups, respectively. Compared with those undergoing laparotomy, the smaller tumor size [7 (4.2–10) vs. 10 (7–17) cm] and shorter hospital stay [4 (2–8) vs. 6 (3–9) days] in patients undergoing laparoscopy were significantly noted, respectively (P < 0.01). No differences were observed in age, operative time, and blood loss between both groups. The surgeries performed were mostly detorsion with cystectomy and adnexectomy. The most common pathology was a simple ovarian cyst, followed by teratoma. Regarding the surgical types, older age is the only risk factor for radical surgery. Discussion Acute onset of abdominal pain with a presenting ovarian tumor is the most common feature of adnexal torsion. Laparoscopic surgical group showed a small tumor size and a short ER hospital stay than laparotomy. Older age is the risk factor for radical surgery.
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Affiliation(s)
- Ci Huang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Mun-Kun Hong
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Tawian, Taiwan
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9
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Chatterjee M, Hurley LC, Levin NK, Stack M, Tainsky MA. Utility of paraneoplastic antigens as biomarkers for surveillance and prediction of recurrence in ovarian cancer. Cancer Biomark 2018; 20:369-387. [PMID: 29125478 DOI: 10.3233/cbm-170652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ovarian cancer is frequently diagnosed at an advanced stage and 70% of patients experience recurrence months to years from initial diagnosis. The expression of paraneoplastic antigens can result in the occurrence of onconeural autoantibodies in ovarian cancer that may be associated with neurological disorders that are clinically manifested in patients before diagnosis of ovarian cancer. These paraneoplastic antigens can serve as excellent biomarkers not only for early detection but also for monitoring ovarian cancer recurrence. OBJECTIVE To assess the immunoreactivity of our previous 3 biomarkers along with 3 paraneoplastic antigens, HARS, Ro52 and CDR2 for the evaluation of their sensitivity in predicting recurrence before the clinical relapse of the ovarian cancer. METHODS Western blot immunoassays were performed to assess the immunoreactivity of 6 antigens with 21 recurrent ovarian cancer patients. RESULTS The results indicated that antibodies to HARS, Ro52, CDR2 and 5H6 antigens predicted ovarian cancer recurrence 5.03 months before the clinical or symptomatic relapse in 21 ovarian cancer patients with a sensitivity of 90.5% when CA125 levels were below the standard cutoff (35 U/ml). CONCLUSION Our study suggests that appearance of onconeural antibodies prior to the rise in CA125 during post treatment surveillance can be a useful diagnostic to predict ovarian cancer recurrence.
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Affiliation(s)
- Madhumita Chatterjee
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Laura C Hurley
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Nancy K Levin
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Matthew Stack
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Michael A Tainsky
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Molecular Therapeutics Program, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI 48201, USA
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10
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Abstract
Adnexal masses (ie, masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetrician-gynecologists and often present diagnostic and management dilemmas. Most adnexal masses are detected incidentally on physical examination or at the time of pelvic imaging. Less commonly, a mass may present with symptoms of acute or intermittent pain. Management decisions often are influenced by the age and family history of the patient. Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy. The purpose of this document is to provide guidelines for the evaluation and management of adnexal masses in adolescents, pregnant women, and nonpregnant women and to outline criteria for the identification of adnexal masses that are likely to be malignant and may warrant referral to or consultation with a gynecologic oncologist.
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11
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Kurosaki A, Hasegawa K, Kato T, Abe K, Hanaoka T, Miyara A, O'Shannessy DJ, Somers EB, Yasuda M, Sekino T, Fujiwara K. Serum folate receptor alpha as a biomarker for ovarian cancer: Implications for diagnosis, prognosis and predicting its local tumor expression. Int J Cancer 2015; 138:1994-2002. [PMID: 26595060 DOI: 10.1002/ijc.29937] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/14/2015] [Accepted: 10/26/2015] [Indexed: 11/11/2022]
Abstract
Folate receptor alpha (FRA) is a GPI-anchored glycoprotein and encoded by the FOLR1 gene. High expression of FRA is observed in specific malignant tumors of epithelial origin, including ovarian cancer, but exhibits very limited normal tissue expression, making it as an attractive target for the ovarian cancer therapy. FRA is known to shed from the cell surface into the circulation which allows for its measurement in the serum of patients. Recently, methods to detect the soluble form of FRA have been developed and serum FRA (sFRA) is considered a highly promising biomarker for ovarian cancer. We prospectively investigated the levels of sFRA in patients clinically suspected of having malignant ovarian tumors. A total of 231 patients were enrolled in this study and analyzed for sFRA as well as tumor expression of FRA by immunohistochemistry. High sFRA was predominantly observed in epithelial ovarian cancer patients, but not in patients with benign or borderline gynecological disease or metastatic ovarian tumors from advanced colorectal cancers. Levels of sFRA were highly correlated to clinical stage, tumor grade and histological type and demonstrated superior accuracy for the detection of ovarian cancer than did serum CA125. High sFRA was significantly associated with shorter progression-free survival in both early and advanced ovarian cancer patients. Finally, tumor FRA expression status was strongly correlated with sFRA levels. Taken together, these data suggest that sFRA might be a useful noninvasive serum biomarkers for future clinical trials assessing FRA-targeted therapy.
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Affiliation(s)
- Akira Kurosaki
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.,Gynecologic Oncology Translational Research Unit, Project Research Division, Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.,Gynecologic Oncology Translational Research Unit, Project Research Division, Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Japan
| | - Tomomi Kato
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kenji Abe
- Department of Research and Development, EIDIA Co. Ltd, Inashiki, Japan
| | - Tatsuya Hanaoka
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.,Gynecologic Oncology Translational Research Unit, Project Research Division, Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Japan
| | - Akiko Miyara
- Gynecologic Oncology Translational Research Unit, Project Research Division, Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Japan
| | | | - Elizabeth B Somers
- Department of Translation Medicine and Diagnostics, Morphotek, Inc, Exton, PA
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Tetsuo Sekino
- Department of Research and Development, EIDIA Co. Ltd, Inashiki, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.,Gynecologic Oncology Translational Research Unit, Project Research Division, Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Japan
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Holbrook J, Schneller C, Lapping-Carr G, Hageman JR, Lo A. A 3-year-old female with abdominal pain, vomiting, and an abdominal mass. Pediatr Ann 2015; 44:e6-9. [PMID: 25621630 DOI: 10.3928/00904481-20151226-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of a 3-year-old female with a 10-day history of lower abdominal pain, distention, and vomiting, as well as fatigue, low-grade fever, and subjective weight loss who was found to have utero-ovarian torsion with pathology revealing hemorrhagic and infarcted tissue. While the literature is limited, it suggests that utero-adnexal torsion in children may be more common than previously recognized. A missed, or even delayed, diagnosis of utero-adnexal torsion has the potential to result in irreversible ischemic damage. Utero-adnexal torsion should therefore be included in the differential diagnosis for girls presenting with acute abdominopelvic pain. Pelvic ultrasound to evaluate the uterus and adnexae is an important non-invasive first step in establishing the diagnosis. Computed tomography scan or magnetic resonance imaging can be considered in the case of indeterminate ultrasound. The diagnosis of utero-adnexal torsion must be made early, and surgical intervention must be timely in order to preserve fertility.
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13
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Nishioka K, Tanaka R, Tsutsumi S, Yamashiro K, Nakahara M, Shimura H, Hattori N, Urabe T. Cerebral Dural Sinus Thrombosis Associated with Adenomyosis: A Case Report. J Stroke Cerebrovasc Dis 2014; 23:1985-7. [PMID: 24794947 DOI: 10.1016/j.jstrokecerebrovasdis.2014.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/25/2014] [Accepted: 01/30/2014] [Indexed: 11/25/2022] Open
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14
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Macciò A, Madeddu C, Kotsonis P, Pietrangeli M, Paoletti AM. Large twisted ovarian fibroma associated with Meigs' syndrome, abdominal pain and severe anemia treated by laparoscopic surgery. BMC Surg 2014; 14:38. [PMID: 24962423 PMCID: PMC4074309 DOI: 10.1186/1471-2482-14-38] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 06/11/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Meigs' syndrome is a rare but well-known syndrome defined as the triad of benign solid ovarian tumor, ascites, and pleural effusion. Meigs' syndrome always requires surgical treatment. However, the optimal approach for its management has not been sufficiently investigated. CASE PRESENTATION We report a patient with a large twisted ovarian fibroma associated with Meigs' syndrome, abdominal pain and severe hemolytic anemia that was treated by laparoscopic surgery. This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach and the adverse impact that Meigs' syndrome can have on the patient's condition, especially if it is associated with acute pain and severe anemia. Considering the patient's serious clinical condition and assuming that she had Meigs' syndrome with a twisted large ovarian mass and possible hemolytic anemia, we first concentrated on effective medical management of our patient and chose the most appropriate surgical treatment after laparoscopic examination. The main aim of our initial approach was preoperative management of the anemia. Blood transfusions and glucocorticoid therapy resulted in stabilization of the hemoglobin level and normalization of the bilirubin levels, which confirmed the appropriateness of this approach. Laparoscopic surgery 4 days after admission enabled definitive diagnosis of the tumor, confirmed torsion and removed the bulky ovarian fibroma, resulting in timely resolution of symptoms, short hospitalization, relatively low morbidity and a rapid return to her social and professional life. CONCLUSIONS This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach, and the adverse impact that Meigs' syndrome can have on the patient's condition, especially if it is associated with acute pain and severe anemia. The present case suggests that laparoscopic surgery for potentially large malignant tumors is feasible and safe, but requires an appropriate medical and gynecological oncology expertise.
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Affiliation(s)
- Antonio Macciò
- Department of Gynecologic Oncology, Businco Hospital, Regional Referral Center for Cancer Disease, via Edward Jenner, Cagliari 09121, Italy.
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15
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Tolman CJ, Vaid T, Schreuder HWR. Extremely elevated CA-125 in benign ovarian disease due to stretch of the peritoneum. BMJ Case Rep 2012; 2012:bcr2012006664. [PMID: 23188839 PMCID: PMC4543764 DOI: 10.1136/bcr-2012-006664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Serum concentrations of CA-125 are rarely elevated beyond 1000 U/ml in benign conditions of the ovary in postmenopausal women. In this report, the authors present an unusual case of a 78-year-old woman with an extremely elevated CA-125 concentration of 2897 U/ml without the presence of a malignancy, ascites or pleural effusion. Imaging revealed a large intra-abdominal cystic mass with irregular solid deviations on CT scan, most likely arising from an ovary. Exploratory laparotomy was performed with suspicion of ovarian cancer but histopathological analysis revealed benign serous cystic adenofibroma. This case report highlights the diagnostic challenge of extremely increased levels of CA-125 in postmenopausal women. A possible explanation for this CA-125 elevation could be the mechanical stretch of the peritoneum.
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Affiliation(s)
- Christine J Tolman
- Division of Women and Baby, Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Tejasvini Vaid
- Department of Obstetrics and Gynaecology, Kasturba Hospital, Kasturba Medical College, Manipal, India
| | - Henk W R Schreuder
- Division of Women and Baby, Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, Netherlands
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16
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Cho FN, Liu CB, Li JY, Chen SN, Yu KJ. Dramatic changes of CA 125 levels in a pregnant woman with a degenerated subserosal myoma. Taiwan J Obstet Gynecol 2012; 51:117-8. [DOI: 10.1016/j.tjog.2012.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2011] [Indexed: 10/28/2022] Open
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Spinelli C, Pucci V, Buti I, Liserre J, Messineo A, Bianco F, Ugolini C. The Role of Tumor Markers in the Surgical Approach of Ovarian Masses in Pediatric Age: A 10-Year Study and a Literature Review. Ann Surg Oncol 2012; 19:1766-73. [DOI: 10.1245/s10434-012-2249-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Indexed: 01/27/2023]
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Luna Ramos IMD, Podgaec S, Abrão MS, Oliveira RD, Baracat EC. Evaluation of CA-125 and soluble CD-23 in patients with pelvic endometriosis: a case-control study. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ramos IMDL, Podgaec S, Abrão MS, Oliveira RD, Baracat EC. Evaluation of CA-125 and soluble CD-23 in patients with pelvic endometriosis: a case-control study. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s2255-4823(12)70151-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ramos IMDL, Podgaec S, Abrão MS, Oliveira RD, Baracat EC. Evaluation of CA-125 and soluble CD-23 in patients with pelvic endometriosis: a case-control study. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70151-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Identification of anti-syntaxin 5 autoantibody as a novel serum marker of endometriosis. J Reprod Immunol 2011; 91:48-55. [DOI: 10.1016/j.jri.2011.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/11/2011] [Accepted: 04/18/2011] [Indexed: 01/07/2023]
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Lee TC, Ho HC. Effects of prostaglandin E2 and vascular endothelial growth factor on sperm might lead to endometriosis-associated infertility. Fertil Steril 2011; 95:360-2. [PMID: 20864099 DOI: 10.1016/j.fertnstert.2010.08.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/11/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
Abstract
Significantly higher levels of prostaglandin E2 and vascular endothelial growth factor were associated with the severity of endometriosis. In this study, pathologic concentrations of prostaglandin E2 and vascular endothelial growth factor found in endometriotic women significantly inhibited sperm motility, acrosome reaction, and sperm-oocyte interaction, which might result in endometriosis-associated subfertility/infertility.
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Affiliation(s)
- Te-Ching Lee
- Institute of Physiological and Anatomical Medicine, Department of Anatomy, Tzu Chi University, and Department of Obstetrics and Gynecology, Yuli Veterans Hospital, Hualien, Taiwan
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He RH, Yao WM, Wu LY, Mao YY. Highly elevated serum CA-125 levels in patients with non-malignant gynecological diseases. Arch Gynecol Obstet 2010; 283 Suppl 1:107-10. [PMID: 21069368 DOI: 10.1007/s00404-010-1717-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 10/13/2010] [Indexed: 12/24/2022]
Abstract
PURPOSES To identify patients with highly elevated serum CA-125 levels and analyze their clinical characteristics. METHODS Patients with non-malignant gynecologic disease (NMGDs, n = 41), in whom serum CA-125 levels were over 1,000 IU/ml were retrospectively enrolled in the study. Seventy-one patients with epithelial ovarian cancer (EOC), in whom, serum CA-125 levels were over 1,000 IU/ml were included as the comparison group. Clinical parameters were compared between the two groups. RESULTS In NMGDs group, 43.90% of the patients had endometriosis. The median of serum CA-125 level in NMGDs was much lower than that of EOC subjects (P < 0.001). Compared to EOC group, the patients in NMGDs group were much younger (P < 0.001) and had fewer histories of pelvic masses (P < 0.001) but had more clinical complaints such as acute abdominal symptoms (P < 0.001) and/or abnormal vaginal bleeding (P = 0.022). Clinical progresses of these two groups were correlated with changes of serum CA-125 levels by follow-up for up to 386 days. CONCLUSIONS High levels of serum CA-125 were found not only in the EOC, but also in some NMGDs, especially in the reproductive patients with complaints of acute abdomen symptoms or abnormal vaginal bleeding.
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Affiliation(s)
- Rong-Huan He
- Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, People's Republic of China
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Ross A, Sardi A, Nieroda C, Merriman B, Gushchin V. Clinical utility of elevated tumor markers in patients with disseminated appendiceal malignancies treated by cytoreductive surgery and HIPEC. Eur J Surg Oncol 2010; 36:772-6. [DOI: 10.1016/j.ejso.2010.05.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 12/30/2009] [Accepted: 05/17/2010] [Indexed: 11/27/2022] Open
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The role of serum CA-125 levels and CA-125 tissue expression positivity in the prediction of the recurrence of stage III and IV epithelial ovarian tumors (CA-125 levels and tissue CA-125 in ovarian tumors). Arch Gynecol Obstet 2010; 283:1397-402. [DOI: 10.1007/s00404-010-1589-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 07/05/2010] [Indexed: 01/24/2023]
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McCarthy JD, Erickson KM, Smith YR, Quint EH. Premenarchal ovarian torsion and elevated CA-125. J Pediatr Adolesc Gynecol 2010; 23:e47-50. [PMID: 19589703 PMCID: PMC2818042 DOI: 10.1016/j.jpag.2009.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 04/03/2009] [Accepted: 04/03/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ovarian tumors are the most common gynecologic malignancy occurring in childhood, with germ cell tumors being most frequent. This contrasts with adults where epithelial tumors account for most ovarian neoplasms. Tumor markers are an integral part of the work-up and may guide management. CASE A 6-year-old girl with a persistent adnexal mass was found to have a highly elevated CA-125. Other tumor markers were normal. Laparoscopy revealed an enlarged, adherent ovary. A minilaparotomy revealed an ovary filled with necrotic material. This necrotic material was excised and the ovary was spared. The pathology was consistent with necrosis. Follow-up ultrasonography and CA-125 were normal. SUMMARY AND CONCLUSIONS This case demonstrates for the first time the association of an elevated CA-125 and ovarian torsion in a pediatric patient. This benign finding allowed attempting a conservative ovary-sparing approach during the surgery even in the presence of a highly elevated CA-125. However, in general, for children CA-125 is of limited utility, as it will not affect the indication for surgical exploration of persistent masses and elevations in CA-125 may discourage ovarian conservation.
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Affiliation(s)
- Jenifer D McCarthy
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
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Nabeta M, Abe Y, Kagawa L, Haraguchi R, Kito K, Ueda N, Sugita A, Yokoyama M, Kusanagi Y, Ito M. Identification of anti-α-enolase autoantibody as a novel serum marker for endometriosis. Proteomics Clin Appl 2009; 3:1201-10. [PMID: 21136944 DOI: 10.1002/prca.200900055] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 06/18/2009] [Accepted: 06/29/2009] [Indexed: 01/07/2023]
Abstract
Diagnosis of endometriosis needs invasive maneuvers. New serum marker that possesses both high sensitivity and high specificity has long been desired. To establish novel serum marker for endometriosis, serum autoantibodies (autoAbs) were investigated using proteomic approach. AutoAbs in sera of endometriotic patients and healthy controls were analyzed using a mesothelial cell line, 2-DE and Western blotting. Proteins in reacted spots were identified using MALDI TOF-MS with MASCOT analysis. ELISAs were established using recombinant proteins and autoAb-titers were estimated in sera of endometriotic patients, disease and healthy controls. Several autoAbs were identified. Anti-α-enolase (Eno1)-autoAb levels in endometriotic patients were significantly elevated compared with both healthy and disease controls. Sensitivity and specificity of serum anti-Eno1-autoAb was nearly comparable to serum CA125. When anti-Eno1-autoAb and CA125 assays were combined, diagnostic sensitivity and accuracy improved. Serum anti-Eno1-autoAb can be a new serum endometriotic marker and it is useful as a supplement assay for CA125. This study validates further clinical evaluation of this novel marker.
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Affiliation(s)
- Motowo Nabeta
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Toh-on, Ehime, Japan; Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toh-on, Ehime, Japan
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Kim HS, Kim JW, Kim MK, Chung HH, Lee TS, Jeon YT, Kim YB, Jeon HW, Yun YH, Park NH, Song YS, Kang SB. A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design. Trials 2009; 10:8. [PMID: 19178748 PMCID: PMC2645389 DOI: 10.1186/1745-6215-10-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 01/29/2009] [Indexed: 11/12/2022] Open
Abstract
Background Laparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by uterine fibroids in place of hysterectomy. The current study was designed to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to evaluate the efficacy of laparoscopic uterine artery ligation which can treat symptomatic uterine fibroids with the preservation of uterus. Methods and design Patients enrolled the current study are randomized to laparoscopic uterine artery ligation or laparoscopy-assisted vaginal hysterectomy. The primary outcome is to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer patients version 3.0. Secondary outcomes are to evaluate the volume reduction of uterus, uterine fibroids and ovaries by the 2 treatments, to compare the improvement of subjective symptoms using 11-point symptom score and postoperative clinical outcomes between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to investigate the improvement of postoperative vaginal bleeding by laparoscopic uterine artery ligation. Discussion Among treatment methods for symptomatic uterine fibroids with the preservation of uterus, laparoscopic uterine artery ligation is expected to have the efficacy like uterine artery embolization, which appeared to be safe for routine use with symptomatic relief. The current study fully recruited in June 2008 and the results will be available in June 2009. If there is no difference of postoperative QOL between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids, the comparison of quality of life between laparoscopic uterine artery ligation and uterine artery embolization will be also needed as a surgical treatment for preserving uterus. Trial registration Current Controlled Trials ISRCTN76790866
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Affiliation(s)
- Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 110-744, Republic of Korea.
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