Anaplastic carcinoma in ovarian seromucinous cystic tumor of borderline malignancy

Background

The mortality rate of ovarian cancer is the highest among all gynecological malignancies in Japan. Ovarian tumors are classified as benign, borderline malignant, or malignant. Anticipating the histological subtype with imaging only is often difficult because of several histological subtypes of epithelial ovarian tumors (such as serous, mucinous, endometrioid, clear cell, and Brenner tumors). In addition, the majority of mucinous tumors in the ovary are metastatic. Furthermore, mucinous tumors belong to one of the two different subclasses (i.e., intestinal and seromucinous types). Ovarian seromucinous cystic tumors of borderline malignancy are infrequent and only rarely coexist with other malignant tumors.

Case presentation

We have reported a 53-year-old Japanese woman with anaplastic carcinoma in an ovarian seromucinous cystic tumor of borderline malignancy. Her MRI and CT analysis revealed an ovarian tumor with a mural nodule, ascites, and peritoneal dissemination. Enhanced MRI revealed that the mural nodule was enhanced. Enhanced CT analysis revealed that the lymph nodes were not swollen. Intriguingly, the mural nodule crossed the cyst wall into the cavity and onto the surface. Her laboratory data revealed high serum CA 125 level. Cumulatively, these results suggested ovarian malignancy. The patient underwent hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and resection of the disseminated lesions. Lymph node biopsy was omitted because of the suggestion of enhanced CT image findings and palpation during surgery. Her postoperative specimen examination determined FIGO at least stage IIIB, and accordingly, adjuvant chemotherapy was prescribed. After 3 years of the operation, the patient is presently alive without clinical tumor recurrences.

Conclusion

Imaging studies with pathognomonic findings contributed to ovarian cancer diagnosis in this case. To the best of our knowledge, this is the first study in English literature to report detailed classification of mucinous borderline malignancy, seromucinous cystic, and anaplastic carcinoma in an ovarian seromucinous cystic tumor of borderline malignancy.

A case of pregnancy in a woman with cloacal dysgenesis and a rudimentary uterine horn

Cloacal dysgenesis is frequently associated with uterine anomalies. We report a case of pregnancy which resulted in an abortion in a woman with a persistent cloaca. Presumptive diagnosis before operation was ectopic pregnancy of the left tube. Postoperatively, the site of implantation of the conceptus was found to be the cavity of a unicornuate uterus in association with a rudimentary horn, the presence of which misled us to diagnose an ectopic pregnancy.

Development of extrauterine fetal incubation system using extracorporeal membrane oxygenator

Despite the recent progress in perinatal medicine, it is still difficult to manage the extremely immature newborn. A new extrauterine incubation system has been developed using 14 goat fetuses. The goat fetus is surrounded by artificial amniotic fluid and is connected to an extracorporeal membrane oxygenator. The blood is drained from the umbilical arteries and returned to the umbilical vein. The perfused blood is recirculated and ventilated with a mixture of O2, N2, and CO2 gases to obtain a PO2 of 30-35 mm Hg and a PCO2 of 30-35 mm Hg in the umbilical venous blood. Fetal heart rate, blood pressure, electroencephalogram, and several movement parameters are continuously recorded by the polygraph. With this system, the fetuses can be kept under fairly stable physiological conditions for periods up to 165 h. This improved system might therefore become a useful method to manage the ill fetuses and newborns.

[Laboratory and clinical studies on latamoxef in the field of obstetrics and gynecology]

Latamoxef (LMOX) is a new antibiotic synthesized by Shionogi Research Laboratory. Chemically LMOX is especially unique with a sulfur atom replacing the oxygen atom in the 1 position of the conventional cephalosporin nucleus, and in addition, this antibiotic has a cephamycin-like structure. The antibacterial activity of LMOX shows high potency against Gram-negative bacteria, but tends to be weak against Gram-positive bacteria. The tissue levels of LMOX in humans after intravenous injection of 1 g were examined. The levels in uterine and adnexa uteri tissue at 1 hour after administration were 25.4 and 27.4 micrograms/g respectively. LMOX was administered to 147 cases in infections of obstetric and gynecological field. The clinical effect according to disease was 94.6% for intrauterine infections, 95.0% for adnexitis, 87.0% intrapelvic infections, and 100% for external genital organ infections, making a total of 92.5%. The rate of occurrence of side effects or abnormal laboratory findings was similar to or slightly less than that seen with other beta-lactam antibiotics.

[Clinical application of 6059-S in the field of obstetrics and gynecology. Effects on gynecological infection and infection of trimester of pregnancy (author's transl)]

6059-S, a new oxacephem antibiotic was applied in the clinical use of gynecological and obstetrical infection. 1. In obstetrical field, attention should be paid on choice of antibiotics in the case of maternal infection. Especially in the trimester of pregnancy, such drugs as ampicillin (ABPC) has been reported apparent unfavourable effects by decreasing the estriol (E3) level. 2. The comparative study between 6059-S, SBPC and ABPC was performed by various hormone level, including E3 (blood and urine), blood progesterone, alpha-fetoprotein, human chorionic gonadotropin (HCG), cortisol and human placental lactogen (HPL). 9 cases of intrauterine fetal growth retardation (IUGR) (ranging from 28 approximately 36 weeks of pregnancy) was selected, including toxemia of pregnancy or complicated pregnancy of myoma of uterus and diabetes mellitus. The determination of hormone level, one drug (2g) out of three test drug was chosen at random and administered by intravenous infusion on 3 approximately 4 days after admission. After 5 days of interval, another test dose was given, and the evaluation between the drug effects was performed on the hormonal level. 3. Following the single administration of ABPC (2 g) by intravenous infusion, the decrease of urinary E3 reached 26% on the 2 days after injection. As for SBPC the decrease was 21%, while in cases 6059-S, no apparent change was determined. Statistical difference between 6059-S and ABPC 5% by chi 2 determination was found. On the other hormonal level, there was relatively great individual difference, and the apparent day by day change was undeterminable. 4. Clinical estimation of 6095-S on the gynecological infection was also performed on the 7 cases of patients. The overall efficacy rate was 85.7%. No adverse reaction was observed except one case elevation of S-GPT.