Struma ovarii with massive ascites mimicking ovarian carcinoma treated with conservative laparoscopic surgery: a case report

Struma ovarii is a rare taratoma that accounts for 0.5-1% of all ovarian tumors. It is sometimes difficult to differentiate struma ovarii from ovarian carcinoma. We encountered a case of struma ovarii that was suspected to be malignant due to the accumulation of massive ascites and an elevated CA125 level. It was successfully treated with laparoscopic surgery.A 37-year-old nulliparous woman consulted a local physician with a chief complaint of abdominal distention. Computed tomography (CT) of the abdomen revealed a pelvic tumor with a large amount of ascites. She was referred to our department. Contrast-enhanced magnetic resonance imaging (MRI) and CT showed bilateral ovarian tumors with multicystic and solid components. CA125 level was markedly elevated. Two cytological examinations of ascites showed no malignant cells. Preoperatively, malignancy was strongly suspected, but considering the possibility of a benign ovarian tumor, laparoscopic surgery was scheduled. During laparoscopic surgery, 4,850 mL of ascites were aspirated, and the left adnexa was removed. Intraoperative rapid pathology suggested struma ovarii with no evidence of malignancy. Postoperative pathology showed mature teratoma and struma ovarii.Although struma ovarii is benign in 90-95% of cases, there have been scattered case reports in which suspected malignancy led to unnecessary or excessive surgery. We propose that appropriate preoperative imaging and accurate intraoperative rapid pathology can prevent excessive surgery, conservative or laparoscopic excisions should be considered

A case of polypoid endometriosis mimicking advanced ovarian carcinoma with rapid growth, invasion, and dissemination

Polypoid endometriosis is a rare form of endometriosis characterized by polypoid masses that histologically often resemble endometrial polyps. We report a case of rapidly progressing polypoid endometriosis that was preoperatively assumed to be advanced ovarian cancer. A 46-year-old woman, para 0, underwent laparoscopic myomectomy and left adnexectomy for uterine fibroids and a left ovarian endometrial cyst after administration of gonadotropin releasing hormone (GnRH) agonist for 4 months. Eleven months postoperatively, rapid right ovarian enlargement occurred. CT and MRI (both contrast-enhanced) showed masses in the right adnexa, cecum, sigmoid colon, and omentum, and PET-CT demonstrated increased uptake, suggesting ovarian cancer and peritoneal dissemination. The patient later developed intestinal obstruction, and colonoscopy revealed multiple polypoid lesions in the sigmoid colon. The omental tumor and right adnexa were biopsied during exploratory laparotomy, and diagnosed as polypoid endometriosis with no malignancy by permanent pathology. The right adnexal tumor shrunk markedly after 4 months of GnRH antagonist treatment. Second laparotomy was then performed for right adnexal tumor resection and ileocecectomy. Pathological examination revealed polypoid endometriosis extending from the ovary to the cecal mucosa. The patient has been asymptomatic for over 1 year postoperatively. The sigmoid colon tumor shrunk but is still present.Polypoid endometriosis predominantly affects the ovaries, colon, peritoneum, and omentum of patients in their 40s and 50s. It is a benign disease but is often difficult to distinguish from malignancy preoperatively because it rapidly forms numerous solid lesions. Although polypoid endometriosis is rare, with no specific imaging findings, including it in a differential diagnosis may facilitate preoperative identification

Four cases of pseudomyxoma peritonei with ovarian tumors at our hospital

We describe four cases of pseudomyxoma peritonei (PMP) that were diagnosed and treated at our hospital.Case 1: A 26-year-old woman with a large multicystic ovarian tumor and massive ascites was diagnosed with PMP originating from a borderline mucinous ovarian tumor. She underwent fertility-preserving staging laparotomy and was treated with three courses of intraperitoneal chemotherapy. There has been no recurrence in the 15 years since her first operation. Case 2: A 72-year-old woman with a giant ovarian tumor and massive ascites was diagnosed with PMP originating from low-grade appendiceal mucinous neoplasm (LAMN). After laparotomy, the patient was managed conservatively because she did not want aggressive treatment. She has remained asymptomatic with a small amount of ascites for 3 years. Case 3: A 82-year-old woman with ovarian tumors, massive ascites, and suspected PMP underwent emergency laparotomy due to appendiceal perforation and pan-peritonitis. She was diagnosed with PMP originating from LAMN. She has remained asymptomatic with a small amount of ascites for 2 years. Case 4: A 42-year-old woman with multicystic ovarian tumors and massive ascites underwent laparotomy. She was diagnosed with PMP originating from LAMN. Since multidisciplinary treatment was indicated and desired, the patient was referred to a specialized facility where cytoreductive surgery and hyperthermic intraperitoneal chemotherapy was performed. The patient has done well since the treatment.Although most cases of PMP originate from mucinous tumors of the appendix, female patients with PMP often present with ovarian tumors and are commonly referred to gynecology clinics. It is therefore important for gynecologists to be familiar with PMP and to be able to diagnose it accurately and select the most suitable management including multidisciplinary treatments

The genotype-dependent phenotypic landscape of quinoa in salt tolerance and key growth traits

スーパー作物キヌアの多様性を解明 --高い環境適応性と優れた栄養特性をもつキヌアの品種改良に期待--. 京都大学プレスリリース. 2020-10-15.Cultivation of quinoa (Chenopodium quinoa), an annual pseudocereal crop that originated in the Andes, is spreading globally. Because quinoa is highly nutritious and resistant to multiple abiotic stresses, it is emerging as a valuable crop to provide food and nutrition security worldwide. However, molecular analyses have been hindered by the genetic heterogeneity resulting from partial outcrossing. In this study, we generated 136 inbred quinoa lines as a basis for the molecular identification and characterization of gene functions in quinoa through genotyping and phenotyping. Following genotyping-by-sequencing analysis of the inbred lines, we selected 5, 753 single-nucleotide polymorphisms (SNPs) in the quinoa genome. Based on these SNPs, we show that our quinoa inbred lines fall into three genetic sub-populations. Moreover, we measured phenotypes, such as salt tolerance and key growth traits in the inbred quinoa lines and generated a heatmap that provides a succinct overview of the genotype–phenotype relationship between inbred quinoa lines. We also demonstrate that, in contrast to northern highland lines, most lowland and southern highland lines can germinate even under high salinity conditions. These findings provide a basis for the molecular elucidation and genetic improvement of quinoa and improve our understanding of the evolutionary process underlying quinoa domestication

Comparative study of dimer vacancies and dimer-vacancy lines on Si(001) and Ge(001)

Although the clean Si(001) and Ge(001) surfaces are very similar, experiments to date have shown that dimer-vacancy (DV) defects self-organize into vacancy lines (VLs) on Si(001), but not on Ge(001). In this paper, we perform empirical-potential calculations aimed at understanding the differences between the vacancies on Si(001) and Ge(001). We identify three energetic parameters that characterize the DVs on the two surfaces: the formation energy of a single DV, the attraction between two DVs in adjacent dimer rows, and the strain sensitivity of the formation energy of DVs and VLs. At the empirical level of treatment of the atomic interactions (Tersoff potentials), all three parameters are favorable for the self-assembly of DVs on the Si(001) surface rather than on Ge(001). The most significant difference between the defects on Si(001) and on Ge(001) concerns the formation energy of single DVs, which is three times larger in the latter case. By calculating the strain-dependent formation energies of DVs and VLs, we propose that the experimental observation of self-assembly of vacancies on clean Ge(001) could be achieved by applying compressive strains of the order of 2%.Comment: 3 tables, 4 figures, to appear in Surface Scienc

Crosscap states in N=2 Liouville theory

We construct crosscap states in the N = 2 Liouville theory from the modular bootstrap method. We verify our results by comparing it with the calculation from the minisuperspace approximation and by checking the consistency with the conformal bootstrap equation. Various overlaps with other known branes are studied. We further discuss the topological nature of the discrete terms in the crosscap wavefunction and their connection with the Landau-Ginzburg approach in a nontrivial dilaton background. We find that it can be mapped to the Landau-Ginzburg theory with a negative power superpotential by a simple change of variables, extending the known duality to the open string sector. Possible applications to the two-dimensional noncritical string theories and supersymmetric orientifolds in the higher dimension are also discussed.Comment: 35pages, v2:references added, typos corrected, v3:consistency check with the conformal bootstrap is added, v4:typos corrected published version in NP

Gastric cancer screening by combined assay for serum anti-Helicobacter pylori IgG antibody and serum pepsinogen levels — “ABC method”

The current status of screening for gastric cancer-risk (gastritis A, B, C, D) method using combined assay for serum anti-Helicobacter pylori (Hp) IgG antibody and serum pepsinogen (PG) levels, “ABC method”, was reviewed and the latest results of our ongoing trial are reported. It was performed using the following strategy: Subjects were classified into 1 of 4 risk groups based on the results of the two serologic tests, anti-Hp IgG antibody titers and the PG I and II levels: Group A [Hp(−)PG(−)], infection-free subjects; Group B [Hp(+)PG(−)], chronic atrophic gastritis (CAG) free or mild; Group C [Hp(+)PG(+)], CAG; Group D [Hp(−)PG(+)]), severe CAG with extensive intestinal metaplasia. Continuous endoscopic follow-up examinations are required to detect early stages of gastric cancer. Asymptomatic Group A, which accounts for 50–80% of all the subjects may be excluded from the secondary endoscopic examination, from the viewpoint of efficiency. Hp-infected subjects should be administered eradication treatment aimed at the prevention of gastric cancer