Introduction: It has been suggested the relationship between infertility treatment and ovarian cancer. Furthermore, endometriosis that is one of the causes of the infertility tends to develop into endometrioid adenoca...Introduction: It has been suggested the relationship between infertility treatment and ovarian cancer. Furthermore, endometriosis that is one of the causes of the infertility tends to develop into endometrioid adenocarcinoma and clear cell carcinoma in many studies. Case: A 38-year-old woman underwent laparoscopic enucleation of bilateral ovarian endometrial cysts at 29 and 33 years old. She then received 11 sessions of artificial insemination and 7 cycles of ovarian stimulation, egg collection,?in vitro?fertilization, and embryo transfer at multiple medical institutions before conceiving and giving birth to her first child. After naturally conceiving her second child, she presented at our hospital for pregnancy/delivery management with a right ovarian tumor. She underwent abdominal right adnexectomy for a mucinous cystic tumor of borderline malignancy at 36 years old (17 weeks of pregnancy with the second child). After vaginal delivery at 38 weeks, a 1-month postpartum checkup revealed a left adnexal mass and ascites. Further workup led to a diagnosis of left ovarian cancer. The cancer was diagnosed by ovarian biopsy as unresectable stage-IIIc endometrioid carcinoma. Despite chemotherapy, the patient developed liver metastasis during treatment and died due to worsened general condition 9 months after childbirth. In addition to ovarian endometrial cyst, repeated cycles of injury and repair of the ovarian surface epithelium are also suggested to mediate the development of epithelial ovarian cancer. Conclusion: Evaluation of long-term outcome and follow-up of patients who have undergone fertility treatment should be addressed.展开更多
A 39-year-old female with a history of partial salpingectomy for tubal pregnancy was diagnosed as having recurrent ectopic pregnancy in the distal portion of the fallopian tube remnant, which was successfully treated ...A 39-year-old female with a history of partial salpingectomy for tubal pregnancy was diagnosed as having recurrent ectopic pregnancy in the distal portion of the fallopian tube remnant, which was successfully treated by laparoscopic surgery. The patient was multigravida (9 pregnancies) and uniparous. She had undergone right partial salpingectomy by laparotpmy for right isthmic ectopic pregnancy at the age of 31 years. At 6 weeks of the current pregnancy, she was referred to our hospital for suspected ectopic pregnancy. The gestational sac was not observed in the uterus, and a mass was observed in the right adnexal region by transvaginal ultrasonography. Emergency laparoscopic surgery revealed the pregnancy site in the ampulla of the remnant portion of the right fallopian tube;therefore, this portion was resected. Because the proximal portion of the fallopian tube remnant was completely occluded, we concluded that this was a case of ectopic pregnancy resulting from the intraperitoneal migration of a fertilized ovum. With current developments in assisted reproductive technologies, reanastomosis of the fallopian tube is rarely performed. While partial salpingectomy is less likely to contribute to the preservation of fertility, it increases the risk of recurrent ectopic pregnancy. A single-stage total salpingectomy on the affected side should be the first choice of treatment when fallopian tube preservation surgery is not selected.展开更多
文摘Introduction: It has been suggested the relationship between infertility treatment and ovarian cancer. Furthermore, endometriosis that is one of the causes of the infertility tends to develop into endometrioid adenocarcinoma and clear cell carcinoma in many studies. Case: A 38-year-old woman underwent laparoscopic enucleation of bilateral ovarian endometrial cysts at 29 and 33 years old. She then received 11 sessions of artificial insemination and 7 cycles of ovarian stimulation, egg collection,?in vitro?fertilization, and embryo transfer at multiple medical institutions before conceiving and giving birth to her first child. After naturally conceiving her second child, she presented at our hospital for pregnancy/delivery management with a right ovarian tumor. She underwent abdominal right adnexectomy for a mucinous cystic tumor of borderline malignancy at 36 years old (17 weeks of pregnancy with the second child). After vaginal delivery at 38 weeks, a 1-month postpartum checkup revealed a left adnexal mass and ascites. Further workup led to a diagnosis of left ovarian cancer. The cancer was diagnosed by ovarian biopsy as unresectable stage-IIIc endometrioid carcinoma. Despite chemotherapy, the patient developed liver metastasis during treatment and died due to worsened general condition 9 months after childbirth. In addition to ovarian endometrial cyst, repeated cycles of injury and repair of the ovarian surface epithelium are also suggested to mediate the development of epithelial ovarian cancer. Conclusion: Evaluation of long-term outcome and follow-up of patients who have undergone fertility treatment should be addressed.
文摘A 39-year-old female with a history of partial salpingectomy for tubal pregnancy was diagnosed as having recurrent ectopic pregnancy in the distal portion of the fallopian tube remnant, which was successfully treated by laparoscopic surgery. The patient was multigravida (9 pregnancies) and uniparous. She had undergone right partial salpingectomy by laparotpmy for right isthmic ectopic pregnancy at the age of 31 years. At 6 weeks of the current pregnancy, she was referred to our hospital for suspected ectopic pregnancy. The gestational sac was not observed in the uterus, and a mass was observed in the right adnexal region by transvaginal ultrasonography. Emergency laparoscopic surgery revealed the pregnancy site in the ampulla of the remnant portion of the right fallopian tube;therefore, this portion was resected. Because the proximal portion of the fallopian tube remnant was completely occluded, we concluded that this was a case of ectopic pregnancy resulting from the intraperitoneal migration of a fertilized ovum. With current developments in assisted reproductive technologies, reanastomosis of the fallopian tube is rarely performed. While partial salpingectomy is less likely to contribute to the preservation of fertility, it increases the risk of recurrent ectopic pregnancy. A single-stage total salpingectomy on the affected side should be the first choice of treatment when fallopian tube preservation surgery is not selected.
