We report a 32-year-old woman (1-gravid, 1-para) with a vesicular lesion in her uterus that was pointed out on ultrasound at 8 weeks' gestation. Amniocentesis at 15 weeks' gestation showed a normal female karyotype, 46XX. As the pregnancy advanced, the mole-like lesion became relatively reduced. Throughout gestation, the maternal human chorionic gonadotropin level was normal, but the serum alpha fetoprotein level rose as her pregnancy progressed. Her fetus did not exhibit any remarkable anomalies. The patient visited our hospital complaining of a diminished feeling of fetal movements at 36 weeks 5 days' gestation, and intrauterine fetal death (IUFD) was confirmed. She delivered a 2336-g female without any definite anomalies. A pathological examination led to a diagnosis of placental mesenchymal dysplasia, and androgenetic/biparental mosaicism in the placenta was identified using p57kip2 immunohistochemical staining. And it also revealed that the rupture of the cirsoid chorionic vessels had led to IUFD.
We investigated the relationships between tumor necrosis factor (TNF) gene polymorphism, circulating TNF-alpha (TNF-alpha) concentrations, and bone mineral density (BMD) in the lumbar spine. TNF gene polymorphisms studied were the Nco I polymorphism within the first intron of TNF-beta (TNF-beta) and three single nucleotide polymorphisms in the promoter region of the TNF-alpha gene, at positions -857, -863, and -1031. Allelic variants of the TNF gene were identified using restriction fragment length polymorphism (RFLP) analysis in 177 postmenopausal Japanese women within 10 years after menopause, aged 56.4 +/- 4.5 years (mean +/- SD). A significantly higher prevalence of the alleles TNF-alpha-863A (20.3% versus 9.9%) and TNF-alpha-1031C (21.3% versus 12.4%) was seen in the low BMD group (Z-score < 0, n = 91) than in the high BMD group (0 < Z-score, n = 86). In genotype analysis, although difference did not reach a significant level, women with the rarest allelic variants, i.e., homozygous TNFbl, TNF-alpha-863A, and TNF-alpha-1031C, showed the lowest BMD Z-scores. Women with another rarest allelic variant, TNF-alpha-857T/T had significantly lower BMD Z-scores than did women with TNF-alpha-857C/T or -857C/C. The BMD Z-score decreased significantly with an increase in the total number of such rare alleles. Serum concentrations of TNF-alpha did not differ significantly among groups divided by genotypes. Multiple linear regression analysis revealed that the total number of rare alleles, in addition to the body mass index and the number of years since menopause, was an independent predictor of the BMD. These presumptive functional polymorphisms of the TNF gene may be associated with the lumbar spine BMD in early postmenopausal Japanese women.
We encountered two cases of parasitic peritoneal leiomyomatosis occurring after laparoscopic myomectomy using a morcellation device. Case one is a 42-year-old, gravida 2, para 1 woman who underwent laparoscopic myomectomy (LM).
Cases of an acute abdomen caused by a rupture of an ovarian endometrioma commonly occur. We report a case of an acute abdomen that was not caused by a rupture of ovarian endometrioma' rather, it was due to an intracystic hemorrhage with a large hematoma within an ovarian endometrioma. The patient was a 29-year-old, gravida 1, para 0 single woman. MRI revealed a left ovarian intracystic hemorrhage with a hematoma (7.0 × 7.0 cm) within the cyst (12.2 × 9.0 cm). On admission, she was in relatively good condition, with normal laboratory findings. Moreover, she preferred to avoid surgery. Thus, conservative therapy was administered. Eight days after admission, CA125 (217.0 IU/ml), CA19-9 (75.8 IU/ml) and D-dimer (1.1 μg/ml) were elevated; in addition, slight leakage of liquid contents from the ovarian cyst into the vesicouterine excavation was noted. Rupture of an ovarian endometrioma was suspected; however, her condition and other laboratory data were within normal limits. Since she declined surgery, she was discharged the next day and followed as an outpatient. During outpatient care, CA125 and CA19-9 gradually normalized and the ovarian cyst shrunk (9.0 × 6.0 cm) as the hematoma dissolved. She underwent a laparoscopic cystectomy of the left ovarian cyst six months after the initial consultation. The histopathologic diagnosis was a benign endometrioma. This case showed that a large endometrioma can cause an acute abdomen due to intracystic hemorrhage forming a large hematoma. As this is not an intraperitoneal hemorrhage, the symptoms are mild; however, rupture is possible. Therefore, such a case requires meticulous follow-up and appropriate treatment.
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