GO-58 : Metastatic choriocarcinoma as initial presentation of small bowel perforation in absence of primary uterine lesion: A case report

( En Bee Cho ),( Daehoon Jeong ),( Young Nam Kim ),( Mi Jung Kim ),( Da Hyun Kim ),( Moon Su Sung ),( Kyung Bok Lee ),( Ki Tae,Kim ),( Jung Mi Byun ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

Choriocarcinoma is a highly malignant tumor of gestational trophoblastic neoplasm that characteristically outgrows its blood supply. Metastases occur most commonly in lung, vagina, central nervous system, liver and gastrointestinal tract. Five percent of patients presenting with choriocarcinoma develop small bowel metastasis. We report a rare case of metastatic choriocarcinoma, which is initial presentation of jejunal perforation in absence of primary uterine lesion. A 40-year-old woman was admitted to the emergency department with abdominal pain, vaginal bleeding. She gave a past history of dilatation and curettage (D&C) at local clinic center under the impression of H-mole, 2 years ago. She had been treated with single dose methotrexate, too. The radiological studies revealed distal jejunal mass,such like lymphoma, with perforation and liver and lung metatstasis. But there was no intrauterine lesion. The initial serum beta-human chorioanic gonadotropin (β-hCG) level was 8,837mIU/mL. She underwent end-to-end anastomosis for panperitonitis, which was suspected to rupture due to lymphoma. And diagnostic curettage was done for vaginal bleeding and elevated hCG level. The biopsy of small bowel was revealed a metastatic choriocarcinoma but curettage finding was not specific. Seven days after the operation, she had the rupture of aggravated metastatic liver mass, and was performed the embolization. Chemotherapy was started with EMA/CO regimen.

GO-60 : Carcinoid tumor arising in ovarian mature cystic teratoma and coexisting mature cystic teratoma of omentum, peritoneum and ovary : A Case Report

( Ju Eun Cha ),( En Bee Cho ),( Jeong Eun Jeong ),( Mi Sun Kang ),( Jung Mi Byun ),( Young Nam Kim ),( Dae Hoon Jeong ),( Moon Su Sung ),( Ki Tae Kim ),( Kyung Bok Lee ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

Mature cystic teratoma is the most common tumor of the ovary. However, Carcinoid tumor arising from mature cystic teratoma is very rare andmultiple parasitic teratomas are extremely rare. There is nopublished report on carcinoid tumor arising in ovarian mature cystic teratoma and coexisting mature cystic teratoma of omentum, peritoneum, and ovary in the world until now. A 50-year old woman stumbled upon pelvic mass in health screening and she was referred to our clinic. The pelvic ultrasonography and abdomen-pelvisMRI showed the presence of about 20 cm sized left ovarian mass, about 7 cm sized right ovarian mass, and omental masses(the largest one: about 8 cm). So, we considered the malignancy possibility and performed a total abdominal hysterectomy with bilateral salpino-oophorectomy, excision of omental and peritoneal mass. The histology confirmed carcinoid tumor in left mature cystic teratoma and mature cystic teratoma in bilateral ovary, omental and peritoneal mass. After the operation, she had discharged without complication and has been outpatient follow-up. We report a case of carcinoid tumor arising in ovarian mature cystic teratoma and coexisting mature cystic teratoma of omentum, peritoneum and ovary for the first time in the world.

The prevalence of Group B Streptococcus (GBS) colonization in pregnant women using selective culture media

( Da Hyun Kim ),( Hye Ree Jang ),( En Bee Cho ),( Jeong Eun Jeong ),( Jung Mi Byun ),( Dae Hoon Jeong ),( Kyung Bok Lee ),( Moon Su Sung ),( Ki Tae Kim ),( Young Nam Kim ) 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

목적: The colonization rate for GBS infection in pregnant women have been reported to vary from 4.8% up to 11.5% in Korea. These discrepancies might result from different sampling procedure and media among studied centers. Recently, the Centers for Disease Control and Prevention (2010) recommended a universal prenatal screening strategy to identify GBS carrier and intrapartum antimicrobial prophylaxis (IAP) with positive cultures. We aimed to analyze the prevalence of maternal GBS colonization and vertical transmission under a universal prenatal screening using selective culture media. 방법:We included 830 pregnant women who visited and delivered at Busan Paik Hospital between January 2015 and June 2016. The specimens for GBS culture were obtained from both the lower vagina and perianal area in women who were admitted for threatened preterm delivery or who visited at our clinic for antenatal care at 35-37 weeks of gestation. These swabs were then inoculated into Todd-Hewitt broth and CHROMagar StrepB agar. IAP were given to women with rectovaginal GBS-positive cultures under CDC guideline. 결과: Among the 830 cultured pregnant women, 94 (11.3%) were positive for GBS colonization. 22 (23.4%) were positive culture from lower vagina, 33 (35.1%) from perianal area and 39 (41.5%) from both. Maternal characteristics including age, delivery mode and time were not different between positive and negative GBS groups. GBS positive rate was also not differ between preterm and full-term delivery groups. Among 115 neonates who were born from GBS colonized women, 37 (32.2%) neonates had neonatal sepsis, however, GBS was not causative organism and there was no early onset GBS sepsis. 결론: With the universal prenatal screening using selective culture media, the GBS colonization rate of 11.3% was higher than that performed by previous studies in Korea. Therefore, it is necessary to screen for GBS colonization using selective culture media, and IAP for positive culture women or high risk women is obligatory.

Does massive proteinuria have the effects on maternal and fetal morbidites in preeclampsia?

( Mi Jung Kim ),( Cha Ju Eun ),( En Bee Cho ),( Jung Mi Byun ),( Dae Hoon Jeong ),( Kyung Bok Lee ),( Moon Su Sung ),( Ki Tae Kim ),( Young Nam Kim ) 대한산부인과학회 2015 대한산부인과학회 학술대회 Vol.101 No.-

Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge

( Jung Mi Byun ),( Dae Hoon Jeong ),( Young Nam Kim ),( En Bee Cho ),( Ju Eun Cha ),( Moon Su Sung ),( Kyung Bok Lee ),( Ki Tae Kim ) 대한산부인과학회 2015 Obstetrics & Gynecology Science Vol.58 No.6

Objective We investigated the features of endometrial hyperplasia with concurrent endometrial cancer that had been diagnosed by endometrial sampling. Further, we attempted to identify an accurate differential diagnostic method. Methods We retrospectively studied 125 patients who underwent a diagnostic endometrial biopsy or were diagnosed after the surgical treatment of other gynecological lesions, such as leiomyoma or polyps. Patients were diagnosed between January 2005 and December 2013 at Busan Paik Hospital. Clinical and histopathological characteristics were compared in patients who had atypical endometrial hyperplasia with and without concurrent endometrial cancer. Results The patients were grouped based on the final pathology reports. One hundred seventeen patients were diagnosed with endometrial hyperplasia and eight patients were diagnosed with endometrioid adenocarcinoma arising from atypical hyperplasia. Of the 26 patients who had been diagnosed with atypical endometrial hyperplasia by officebased endometrial biopsy, eight (30.8%) were subsequently diagnosed with endometrial cancer after they had undergone hysterectomy. The patients with endometrial cancer arising from endometrial hyperplasia were younger (39.1 vs. 47.2 years, P=0.0104) and more obese (body mass index 26.1±9.6 vs. 23.8 ± 2.8 kg/m2, P=0.3560) than the patients with endometrial hyperplasia. The correlation rate between the pathology of the endometrial samples and the final diagnosis of endometrial hyperplasia was 67.3%. Conclusion In patients with atypical endometrial hyperplasia, the detection of endometrial cancer before hysterectomy can decrease the risk of suboptimal treatment. The accuracy of endometrial sampling for the diagnosis of concurrent endometrial carcinoma was much lower than that for atypical endometrial hyperplasia. Therefore, concurrent endometrial carcinoma should be suspected and surgical intervention should be considered in young or obese patients who present with atypical endometrial hyperplasia.

Association between the increasing incidence of placenta previa and IVF treatment in nulliparous women222

( Do Hwa Im ),( Jung Mi Byun ),( Young Nam Kim ),( Eun Jeong Jeong ),( Hye Mi Eom ),( Mi Jeong Kim ),( En Bee Cho ),( Dae Hoon Jeong ),( Byung Jin Min ),( Kyung Bok Lee ),( Moon Su Sung ),( Ki Tae Kim 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

목적: To describe the incidence of placenta previa in nulliparous women and to assess risk factors between nulliparous and multiparous women with placenta previa after adjustment for pervious dilatation and curettage, in vitro fertilization (IVF), smoking, previous cesarean section and maternal age. 방법: A retrospective study was conducted based on the descriptive and statistical analysis risk factors of placenta previa and maternal and fetal prognosis of 221 patients who underwent cesarean section for placenta previa between January 2010 and December 2015 in Busan Paik hospital. We divided the patients into two groups, nulliparous women and multiparous women, and compared with cause of previa and prognosis. 결과: 106 patients (48.0%) was nulliparous women and 115 patients(52.0%) was mutiparous women. Placenta previa totalis was the most common type of previa but there was no significant difference between nulliparous women and multiparous women(43.9% vs 56.1%). Nulliparous women were younger than multiparous women(32.6±3.4 years old vs 34.5±4.5 years old, p=0.0005). Placental previa with risk factors was occurred in 141 patients( 63.8%) and the others, 80 patients(36.2%) showed placenta previa without risk factors. It was presented that no risk factor in nulliparous women was significantly many compared with multiparous women(61.2% vs 38.8%, p=0.0045). In the multiple logistic regression analysis the strongest independent risk factor of placenta previa was IVF between nulliparous and multiparous women(78.1% vs 21.9%, p=0.0003). There was no significant difference in the incidence of postpartum hemorrhage(PPH) but was significantly different in management. Cesarean hysterectomy for PPH was significantly increased in multiparous women(80.0% vs 20.0%, p=0.0352). 결론: Increasing maternal age and in vitro fertilization(IVF) treatment are all risk factors for placenta previa in nulliparous women in this study. Therefore the strategies to prevent placental previa in nulliparous women undergoing IVF are needed.