The levonorgestrel-releasing intrauterine system (LNG-IUS) is used for contraception and treatment of heavy menstrual bleeding as well as endometrial hyperplasia and early endometrial carcinoma. A 48-year-old woman visited an Internal Medicine outpatient clinic due to significantly elevated CA-125 and CA-19-9 levels in a routine health examination. She had been using LNG-IUS for 3 years. Before LNG-IUS insertion, she suffered from heavy menstrual bleeding and severe dysmenorrhea. Her endometrial sampling and ultrasonographic imaging showed no evidence of endometrial carcinoma at the time of LNS-IUS insertion. After insertion, she complained of neither abnormal uterine bleeding nor dysmenorrhea. She received a routine health check-up every year and showed results within normal range until last year. To rule out pancreatic cancer due to significantly elevated CA-19-9 levels, her physician performed positron emission tomography–computed tomography, which demonstrated increased FDG uptake in the endometrial cavity. We obtained endometrial biopsy and found endometrial carcinoma in her uterus and performed radical hysterectomy with bilteral pelvic lymphadectomy. Permanent pathology confirmed endometrial carcinoma with lymph node metastasis. She received concurrent chemoradiation therapy. We emphasize the necessity of regular follow-ups with ultrasonography and assessment of serum tumor markers for the early detection of endometrial carcinoma, although rare, in women using LNG-IUS, including those without abnormal uterine bleeding.

To investigate the association between maternal iron status at the third trimester and fetal birthweight, maternal serum iron, ferritin, total iron-binding capacity (TIBC), and complete blood count values were measured at 36-weeks gestation. Delivery database on mothers who delivered babies at Chungbuk National University Hospital between January 2008 and March 2013 was extracted. A total of 353 uncomplicated term babies were analyzed using hierarchical regression and ANCOVA. Maternal age (standardized regression coefficient β=0.115, P<0.05), height (β=0.108, P<0.05), BMI (β=0.210, P<0.001), and gestational age (β=0.298, P<0.001) were significantly associated with birthweight. However, birthweight was not associated with maternal iron parameters. After adjusting for maternal age, height, BMI, and gestational age, babies born to mothers with lower mean values of hemoglobin, hematocrit, and serum ferritin were heavier than those born to mothers with higher values. Babies born to lower hemoglobin (11 g/dL) mothers were heavier than those born to higher hemoglobin (12 g/dL) mothers. However, birthweight was not significantly different between mothers with 10 g/dL or 13 g/dL of hemoglobin. Comparing birthweight according to 30 ug/dL of serum iron, 360 ug/dL of TIBC, 15 ng/mL of serum ferritin, and 10% transferrin saturation, babies born to mothers of the lower group were heavier than those born to mothers of the higher group. Therefore, maternal serum iron status at the third trimester seems to not be associated with birthweight.

The previous studies of p16^INK4a, pRb, p53, and Ki-67 expression suggested that these markers may be preferentially expressed in cervical neoplasms. The purpose of this study was to assess the expression and the clinical significance of p16^INK4a, pRb, p53, and Ki-67 proteins in cervical lesions. We obtained 106 cases with various categories of cervical squamous mucosa, including squamous cell carcinoma (n=35), cervical intraepithelial neoplasia (CIN) II/III (n=26), CIN I (n=10), squamous metaplasia (n=15), and normal squamous mucosa (n=20). Immunohistochemical staining was performed for p16INK4a, pRb, p53, and Ki-67 proteins in formalin-fixed and paraffin-embedded tissue sections of the uterine cervix. Evaluation of immunohistochemical staining was based on the frequencies of expression and the mean immunoreactivity scores (IS) in each diagnostic category. p16INK4a positive sotaining was observed in 26 of 35 cases (74.3%) of squamous cell carcinoma, in 16 of 26 cases (61.5%) of CIN II/III, in six of 10 cases (60%) of CIN I, in nine of 15 cases (60%) of squamous metaplasia, and negative in normal squamous mucosa. pRb expression was detected in all diagnostic categories; however, the proportion of pRb positive cells was relatively decreased in CIN II/III (38.5%) and squamous cell carcinomas (51.4%), compared to normal squamous epithelium (90%) and squamous metaplasia (73.3%). No significant differences in expression of p53 were observed in any diagnostic categories. Ki-67 expression was increased in squamous cell carcinoma (37.1%), CIN II/ III (42.3%), and CIN I (40%), but negative in squamous metaplasia and normal mucosa. In 35 cases of squamous cell carcinomas, multivariate analysis revealed no differences in p^INK4a, pRb, p53, and Ki-67 expression according to the age of the patient, lymph node metastasis and clinical stage. In conclusion, the combined use of p16^INK4a and Ki-67 immunoreactivity could improve the diagnostic specificity of squamous cell carcinoma of the uterine cervix.

Malignant transformation of mature cystic teratoma (MCT) is rare. Sarcomatoid carcinoma is a neoplasm comprising malignant mesenchymal cells and a conventional carcinomatous area. Here, we report on a case of sarcomatoid carcinoma arising from an MCT in the left ovary of a 45-year-old female. A unilocular cyst consistent with MCT was observed; however, a nodule within the cyst was confirmed from the resected ovary. Microscopically, the nodule showed both squamous cell carcinoma and pleomorphic sarcomatous components admixing with each other. Lining epithelial cells at the periphery of the main tumor showed squamous metaplasia. When a sarcomatous component is observed in the ovary tumor, it is important to find a squamous cell component, either benign or malignant.