Fibrothecomas are mesenchymal tumors deriving from the ovarian stromal and consisting of theca-like elements and fi brous tissue. They are common, but their malignant counterpart is extraordinarily rare. Classical malignant fi brothecomas are said to show four or more mitotic fi gures per 10 high power fi elds. We have experienced a rare case of malignant ovarian fi brothecoma in a 72-year-old postmenopausal woman. We report a case with brief review of literature.Keywords: Thecoma; Fibroma; Malignant neoplasms; Ovary; Mitotic Index Received: 2011.10.8. Revised: 2011.12.20. Accepted: 2012 Th is is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2012. Korean Society of Obstetrics and GynecologyFibrothecomas are benign neoplasms which belong to the estrogenic group of sex cord tumors with differentiation in fi broblastic or theca cells. Fibroma is purely composed of mature fi broblastic cells producing abundant collagen and thecoma contains many cells resembling theca cells and/or lutein cells as well as a number of fibroblastic cells. However, in some instances, differentiation between fi broma and thecoma is often diffi cult, justifying use of the term 'fi brothecoma'. Malignant ovarian fi brothecoma is a rare entity. Classical malignant fi brothecomas are said to show four or more mitotic fi gures per 10 high power fi elds (HPF). These tumors occur generally in older menopausal patient. Histologically, these tumors have a stromal origin and are composed of variable proportion of spindle cells forming collagen and theca cells containing lipids. They may be hormonally active and thus responsible for estrogenic manifestations. We report a rare case of malignant ovarian fibrothecoma in a 72-year-old postmenopausal woman. Case ReportA 72-year-old gravida 3 para 2 postmenopausal woman with no signifi cant medical history presented to our gynecology outpatient clinic with constipation and abdominal distention. No associated fever, vomiting, or localized abdominal pain occurred. The pelvic examination revealed a palpable non-tender pelvic mass. Transvaginal ultrasonogram shows a 11.3 ×11.7 ×10.2 cm sized well defi ned heterogenous echoic solid mass with some tiny cystic changes abutting on atrophic uterus in right adnexa (Fig. 1). The result of laboratory studies, including analysis of tumor markers, such as CA-125, CA19-9, squamous cell carcinoma related antigen were all within normal limits. At laparotomy, there was no ascites and a lobulated bulging mass measuring 15 cm was observed on the right ovary. The left ovary, uterus, omentum, and pelvic lymph node were unremarkable. A frozen section of the ovarian mass revealed a sex-cord stromal tumor with nuclear atypia and mitosis. The patient underwent abdominal total hystrectomy, bilateral salpingo-oophorectomy,...

Mucinous ovarian tumors account for 15% all ovarian neoplasms, of which giant variants rarely occur. Recently huge ovarian cysts (more than 12 kg) are now rarely seen because of the development in health care systems and education. The patient is 26-yearold nulligravida female who presented with abdominal distension. A laparoscopic left salpingo-oophorectomy was performed. Laparoscopic approach to giant ovarian cyst may be difficult regarding the risk of cyst rupture and limited working space. To reduce the limitations of the laparoscopy, we performed laparoscopy after aspirating the cystic contents. During laparoscopy, abdominal cavity was explored by the scope. Cyst contained about 53 L of fluid. The histopathologic examination revealed a borderline mucinous tumor of the left ovary. Laparoscopic excision of giant ovarian cyst seems to be safe and applicable treatment modality. Copyright © 2012. Korean Society of Obstetrics and GynecologyLaparoscopic approach is more advantageous over laparotomy, considering better cosmetic results, lesser blood loss, lesser pain and analgesic requirement, faster recovery, and shorter hospitalization time [1]. Laparoscopic approach to giant ovarian cyst, in cases when the cysts' sizes exceed to the umbilicus, may be difficult regarding the risk of cyst rupture and limited working space [2]. However, if the laparotomy is chosen as the operative treatment, a larger incision is required to excise the cyst. We present a case of laparoscopic extirpation of a giant ovarian cyst. Case ReportA 26-year-old woman was referred to our department for a giant abdominal mass in July 2011. She was single and nulliparous female who presented with a gradually increasing abdominal swelling first noticed 4 years ago. Due to the huge mass she was unable to walk and had anorexia and weight gain. At admission, the emaciated patient weighted 120 kg, had a body height of 177 cm and abdominal girth at the level of the umbilicus was 190 cm (Fig. 1). There was no history of colicky pain fainting attacks, vomiting or other gastrointestinal attacks. She had no previous history of any illnesses, allergies or operations. On abdominal examination, abdomen was grossly distended engorged veins present, fluid thrill was present. There were no abnormalities in hematologic and biochemical data including cancer biomarkers CA-125, CA 19-9, and carcinoembryonic antigen. On ultrasonography, a huge, multilocular cystic tumor with low echogenic content was found (Fig. 2). There were no papillary or solid parts of associated with the wall or septa, and no ascites. She could not fit into the computed tomography machine due to the giant abdominal mass. After consultation with the anesthesiology and cardiology teams, the patient was placed in a semiFowler's position in the operating room due to dyspnea, general anesthesia and endotracheal tube intubation was performed. After CASE REPORT Korean J Obstet Gynecol 2012;55(7):534-537 http://dx

A 59-year-old woman was hospitalized with weight loss, anorexia, and low grade fever for 2 weeks. She had undergone a total gastrectomy followed by adjuvant chemotherapy 10 years prior due to advanced gastric cancer. To evaluate recurrence, fluorine-18 fluorodeoxyglucose (FDG) dual time point positron emission tomography/computed tomography (DTPP) was conducted with a Gemini GXL 6 PET/CT system (Philips, Hamburg, Germany). FDG DTPP was performed twice, with an early scan 60 min after FDG injection and a delayed scan 150 min after FDG injection (Fig. 1a). The early scan showed that multiple hypermetabolic lesions were located along left supraclavicular, mediastinal (1R, 2R, 3, 4R and 7) and left paraaortic (retroperitoneal) nodal stations (Fig. 1b). The delayed scan showed that all the above mentioned lesions revealed a more increased maximal standard uptake value (SUVmax) than was detected in the early scan. Both scans did not show intrapulmonary lesion. For example, the left supraclavicular lymph node, 2R and retroperitoneal lymph node were observed with early and delayed SUV maxes of 4.5/7.7/3.6 and 6.7/10.7/4.4, respectively. To confirm diagnosis and establish a treatment plan, a mediastinoscopic biopsy of one of the mediastinal lymph nodes (4R) was subsequently performed and tuberculosis was ultimately diagnosed. Then, the patient started an antituberculosis treatment instead of antichemotherapy (Fig. 1c). A follow-up FDG PET/CT performed 12 months later showed disappeared FDG uptake and significant decreased change of multiple peripheral tuberculous lymphadenitis.Whole-body FDG PET/CT has widespread use in diagnosing and staging variable malignancies, and plays an important role in detection of gastric cancer recurrence [1]. However, FDG is not cancer-specific and some inflammatory diseases have shown higher FDG uptake on PET imaging [2]. Infection, inflammation, and granulomatosis are also known to cause false positive FDG PET scans because activated inflammatory cells show avidity for FDG [3,4]. So, for alternative measure differentiating malignancy from benign disease [5], early standard FDG PET/CT and delayed scan after early scan, namely FDG DTPP, has been introduced and often performed worldwide. FDG DTPP used the phenomenon that with time, FDG uptake in tumor tissues increases, while FDG uptake in normal or benign tissues decreases [5,6]. Although FDG DTPP has been not accepted routinely, the retention index inferred from FDG DTPP predicted patient prognosis in lung cancer [7]. We had considered multiple hypermetabolic lymph nodes as metastasis rather than benign lymphadenopathies because of increased FDG uptake on the delayed scan versus the early scan, before pathologic results were confirmed. It is presumed that FDG DTPP could not help differentiate malignancy from benign diseases in cases of active infectious disease such as ongoing tuberculosis. Peripheral tuberculous lymphadenitis (PTL) is a common manifestation of extrapulmonary tuberculosis and remains an important cause of adenopathy globall...

Pemphigus vulgaris is an uncommon, autoimmune disease characterized by acantholysis and blister formation in the skin and mucosa. Pemphigus vulgaris during pregnancy is exceedingly rare. The disease may be associated with adverse neonatal outcome, including prematurity and fetal death. The clinical features of this patient were similar to those of pemphigoid gestationis. Circulating antibodies directed at desmosomal proteins may cross the placenta and place children at risk for neonatal pemphigus. Transient skin lesions may occasionally appear in the neonate. We report a case of pemphigus vulgaris in a 32-yearold pregnant woman who showed erythematous bullae, erosions and crusts on the whole body. She was diagnosed by clinical and histopathological fi ndings, direct immunofl uorescent test. This patient was treated with high dose of corticosteroids to control the disease.