We report 3 cases of extrapulmonary lymphangioleiomyomatosis incidentally found in pelvic and paraaortic lymph nodes in association with uterine cancers. Three women, 47-year-old, 59-year-old, and 71-year-old, respectively, had uterine cancers and underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node excision. None of the 3 patients had tuberous sclerosis complex or lymphangioleiomyomatosis in other organs. None had any history of extrinsic hormonal administration. The postoperative pathologic diagnoses were uterine cervical squamous cell carcinoma for the first patient and endometrioid adenocarcinomas for the second and the third patients. Besides these malignant lesions, all 3 patients showed spindle cell proliferation, 2 to 5 mm in size, in 1 to 8 foci of the pelvic and paraaortic lymph nodes. The spindle cells having small polygonal nuclei and inconspicuous nucleoli with palely eosinophilic cytoplasm, reminiscent of immature smooth muscle cells, proliferated in nested and whorling patterns. Neither cellular atypia nor mitotic figures were observed. Immunohistochemically, these spindle cells were positive for α-Smooth Muscle Actin, Desmin, HMB45, Microphthalmia Transcription Factor, Estrogen receptor, and Progesterone receptor. And the network of the vascular-like channels surrounded by these spindle cells was positive for D2-40. From the pathologic and immunohistochemical findings, the spindle cell proliferation in the lymph nodes is best interpreted as lymphangioleiomyomatosis.
Aim
Most Japanese institutions screen for post‐partum depression (PPD) using the Edinburgh Postnatal Depression Scale (EPDS) at outpatient visits conducted at 2‐ and 4‐week post‐partum, but there are no published data on the usefulness of EPDS scores 2‐week post‐partum. In the present study, relationships between 2‐week post‐partum EPDS scores and 4‐week post‐partum EPDS scores were investigated to determine whether 2‐week scores may facilitate early intervention in high‐risk mothers.
Methods
A retrospective analysis of 451 deliveries from 2017 to 2019 was conducted at a single institution. EPDS scores were obtained using the Japanese EPDS 2‐ and 4‐week post‐partum, in conjunction with other perinatal data from medical records.
Results
In total, 334 of 451 mothers (74.1%) completed the EPDS at both 2‐ and 4‐week post‐partum and were included in the analysis. Of 48 who had higher scores 2‐week post‐partum, 21 (43.8%) continued to be at high risk of PPD. Of 284 who had lower scores 2‐week post‐partum, 9 (3.2%) transitioned to scores indicating high risk. Women considered high‐risk 4‐week post‐partum tended to have exhibited higher scores 2‐week post‐partum. Women who had experienced more deliveries tended to exhibit lower scores, and psychiatric illness was strongly associated with higher EPDS scores (odds ratio 11.2, 95% confidence interval 3.7–33.8, P < 0.01).
Conclusion
Two‐week EPDS scores closely reflected 4‐week scores, and may facilitate early intervention to prevent PPD. Primiparous mothers and those with a history of psychiatric illness should be followed‐up closely.
A pregnant patient with systemic lupus erythematosus experienced hypertension and underwent cesarean delivery. They experienced uterine atony and a very thin myometrium with uterine fibrosis.
Granulosa cell tumors (GCTs) can have a wide variety of appearances on magnetic resonance imaging (MRI), ranging from entirely solid to multilocular cystic, suggesting that GCTs undergo remarkable morphological changes during growth. These temporal changes in MRI appearance of individual GCTs have not been documented. A 54-year-old asymptomatic postmenopausal woman was referred to our department for a small ovarian mass. This 3-cm solid mass showed high intensity on diffusion-weighted MRI and low intensity on apparent diffusion coefficient mapping. Close clinical follow-up was recommended, but she did not return to our hospital until the age of 63, when she was referred for a large ovarian tumor. MRI showed a 15-cm multilocular cyst containing a solid component with hemorrhaging. Postoperative diagnosis was adult GCT (AGCT). These temporal changes demonstrate a possible reason why GCTs can have such a wide range of MRI appearance. This knowledge might promote accurate preoperative diagnosis of AGCTs.
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