GO-12 : Primary squamous cell carcinoma of the endometrium; A case report

( Sang Gap Kim ),( Gun Sik Park ),( Byeung Jum Kim ),( Sang Kook Kim ),( Soo Jin Song ),( Sang Chill Kwon ),( Ja Seong Koo,),( Hyun Sik Youm ),( Hwal Woong Kim ),( Hwa Sook Moon ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-

Primary squamous cell carcinoma of the endometrium is extremely rare and its pathogenesis is unclear. Exclusion of cervical squamous cell carcinoma, extended to endometrium and squamous differentiation of endometrioid carcinoma is necessary to make the diagnosis of primary squamous cell carcinoma of the endometrium. Case: A 51-year-old postmenopausal woman presented with heavy vaginal bleeding. The patient had normal Pap smear. Transvaginal ultrasonography revealed a 3.8 × 3.1 cm mass mimicking submucosal myoma in the uterine endometrial cavity. The frozen section of the mass obtained by hysteroscopy was reported as sarcoma. Subsequently, the patient underwent laparoscopic hysterectomy with BSO and bilateral pelvic lymph node dissection. There was no tumor involvement in dissected pelvic lymph nodes. Postoperative histology confirmed the presence of a poorly differentiated squamous cell carcinoma in the uterine body while the cervix was normal. The results of immunohistochemical stainings were diffusely positive for cytokeratin, and negative for vimentin. Based on the histomorphologic findings, the diagnosis was primary squamous cell carcinoma of the endometrium. The patient was treated with chemotherapy and is alive without recurrence and metastais 8 months after the operation. Conclusion: To make the diagnosis of primary squamous cell carcinoma excluding cervical squamous cell carcinoma, extended to endometrium and squamous differentiation of endometrioid carcinoma, it is important to carry out multiple sections, immunostainings, and mucin stainings.

GG-11 : Suspension for uterine prolapse with cystocele and rectocele, via mesh anchored to both sides of inferior portion of pubic ramus, combined with levator ani and perineal myorrhaphy

( Gyeong Il Nam ),( Byeung Jum Kim ),( Sang Kook Kim ),( Hyun Jung Kim ),( Ja Seong Koo ),( Hyun Sik Youm ),( Hwa Sook Moon ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

목적: To evaluate the effectiveness of uterine suspension via mesh anchored to both sides of inferior portion of pubic ramus, combined with levator ani and perineal myorrhaphy as the surgical treatment of pelvic organ prolapse by assessing the surgical outcomes. 방법: This investigation was designed as retrospective analysis. From August 2006 to March 2014, 61 women who underwent uterine suspension via mesh anchored to both sides of inferior portion of pubic ramus, combined with levator ani and perineal myorrhaphy were included. 결과: In 61 women, age (mean ± SD) was 62.3 ± 8.3 years and 88.5 % were postmenopausal. BMI (mean ± SD) was 24.1 ± 2.9 kg/m2. Hypertension and diamellitus were presnt in 47.5% and 16.4%, respectively. The distribution of parity was 8.2 % (parity 1), 29.5 % (parity2), 36.1 % (parity 3), and 26.2 % (parity≥4). The operative data were as follow (median (25% - 75%)); operation time, 115 (105-135) minutes, estimated blood loss, 200 (100-250) mL, hospital stay, 7 (6-9) days, follow-up time, 4.0 (2.0-11.0) months, respectively. Comparison between preand postoperative data were as follow (mean ± SD ``preoperative``, mean ± SD ``postoperative``, p-value of paired T-test); C value, 4.2 ± 1.4cm, -6.7 ± 0.8cm, p<0.05, total vaginal length, 7.3 ± 1.2cm, 9.8 ± 1.3 cm, p<0.05, respectively. 결론: Uterine suspension via mesh anchored to both sides of inferior portion of pubic ramus, combined with levator ani and perineal myorrhaphy is a safe, effective, and minimally invasive method for pelvic organ prolapse.

Undifferentiated endometrial sarcoma mimicking submucosal myoma: A case report

( Gun Sik Park ),( Hyun Sik Youm ),( Soo Jin Song ),( Byeung Jum Kim ),( Mi Eun Jung ),( Sang Chill Kwon ),( Sang Kook Kim ),( Yu Kyung Cho ),( Ja Sung Koo ),( Hwal Woong Kim ),( Hwa Sook Moon ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

Endometrial stromal tumors are the second most common uterine sarcomas. They are divided into three types; endometrial stromal nodule, endometrial stromal sarcoma (ESS), and undifferentiated endometrial sarcoma (UES). UES is much less common than ESS. And it has a much more aggressive clinical course and poorer prognosis than ESS. Case: A 47-year-old woman presented to our hospital with a 4-month history of irregular vaginal bleeding. TVUS revealed a vascularized mass mimicking submucosal myoma in the uterine endometrial cavity. MRI was performed. A 5.9 × 5.1 × 4.8 cm submucosal mass filled up the endometrial cavity. Hysterocopy examination confirmed the protruding mass at the lower portion of the endometrial cavity. The frozen section of the hysteroscopy was reported as malignancy. Subsequently, the patient underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection. There was no cancerous involvement in 19 dissected lymph nodes. The results of immunohistochemical stainings were positive for vimentin and CD56, a few positive for CD68, and negative for smooth muscle actin, desmin, CD10, CD34, pan-cytokeratin, HMB-45, S-100 protein, chromogranins and synaptophysin. Based on these histomorphologic findings, the diagnosis of UES was made. The patient was referred to an oncological center for chemotherapy and radiation therapy. Conclusion: It is important to establish a proper classification of endometrial stromal tumors by cytologic and immunohistochemical findings becase of different clinical course and prognosis.

Factors to consider when performing high-intensity focused ultrasound (HIFU) treatment

( Gyeong Il Nam ),( Gun Sik Park ),( Sang Gap Kim ),( Mi Eun Jung ),( Byeung Jum Kim ),( Jee Yeon Lee ),( Tae Kyoung Kang ),( Ja Seong Koo ),( Hwa Sook Moon ) 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

목적: To introduce factors to consider when performing high-intensity focused ultrasound(HIFU) treatment in symptomatic uterine myomas and adenomyosis. 방법: A total of 26 women with symptomatic myomas and adenomyosis underwent HIFU between September 2015 and April 2016. The inclusion criteria were women with symptomatic myomas sized from 4-10 cm and adenomyosis. The exclusion criteria were pedunculated myomas with narrow stalk, calcified or degenerated myomas, the presence of more than 4 myomas, pregnant women, patients with active pelvic infection, standard contraindications for MRI, known intolerance to MRI contrast agents, and extensive abdominal scars directly anterior to the area of treatment. MRI was performed several days before treatment and 1month after treatment. Scaled signal intensity (SSI) was calculated by T2-weighted MRI before treatment. The non-perfused volume ratio was calculated by T1-weighted MRI after treatment. 결과: A total number of patients was 26, a total number of treated myomas was 42, a total number of treated adenomyosis was 7. Mean sonication time was 2h 46min ± 1h 7min. Pretreatment mean SSI was 18.4±7.2. After 1month of HIFU treatment, non perfused volume ratio of treated myoma and treated adenomyosis was 57.2 ± 18.2%, 25.3 ± 7.6% respectively. 결론: The NPV ratio was mainly influenced by SSI. HIFU can be offered as an alternative nonsurgical option for symptomatic myomas or adenomyosis in selected women.

Ultrasound-guided sclerotherapy of ovarian endometriomas : a safe and effective minimally invasive procedure

( Hwa Sook Moon ),( Ja Seong Koo ),( Tae Kyoung Kang ),( Mi Eun Jung ),( Byeung Jum Kim ),( Jee Yeon Lee ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-

Objective: To determine whether ultrasound-guided sclerotherapy with 95% ethanol is safe and effective treatment for ovarian endometriomas. Methods: We retrospectively reviewed the medical records of 115 women with 116 ovarian endometriomas(2.9-10.6 cm in diameter), who underwent ultrasound-guided sclerotherapy with 95% ethanol between February 2012 and July 2018. Results: The clinical characteristics are as follows: mean cyst volume aspirated (mL) 50.03 (SD 48.33; Range 2-352), mean volume of normal saline (ml) 46.92 (SD 31.37; Range 0-150) and alcohol irrigated 15.89 (mL) (SD 11.26; Range 0-55), mean volume of alcohol instilled 17.98 (mL) (SD 13.64; Range 0-125), Mean duration of procedure 34.60 (min) (SD 23.08; Range 10-135). Up to now, the conversion rate to laparoscopic cystectomy and recurrence rate after sclerotherapy were 8.70% (10 cases) and 1.74% (3 cases), respectively. Conclusion: The ultrasound-guided sclerotherapy with 95% ethanol is a safe and effective treatment for ovarian endometriomas. This conservative treatment could possibly achieve a symptomatic cure while preserving healthy ovarian tissue, thereby avoiding early menopause.