Predictive value of ultrasound-related scoring system on embryo development in early pregnancy after IVF/ICSI: An observation of embryonic quality

ObjectiveThis study aims to evaluate the value of the ultrasound-related scoring system on pregnant patients receiving assisted reproductive technology (IVF/ICSI) and early pregnancy outcome.Materials and methodsThis prospective study included 208 pregnant women receiving assisted reproductive technology (IVF/ICSI). The following ultrasound parameters were measured: gestational sac size, the proportion of the embryo and gestational sac (embryo/gestational sac), yolk sac size, and fetal cardiac activity. The above data were assigned according to the ongoing pregnancy rate (up to 14 weeks), and the score increased parallel to the pregnancy rate. All patients were grouped according to their scores.ResultsPatients with a score of 4–5 had a low ongoing pregnancy rate of 14.29%, while patients with a score of 6–7 had an ongoing pregnancy rate of 55.56%. Surprisingly, patients with a score of 8–9 had an ongoing pregnancy rate of 97.22%. In addition, it was found that the ongoing pregnancy rate was 100% (36/36) in patients with a score of 9. Conversely, there was no ongoing pregnancy in patients with a score of 4.ConclusionFirst, this scoring system is strongly associated with an ongoing pregnancy of over 14 weeks. Second, some reassurance can be given to patients with favorable ultrasound parameters, regardless of maternal age or previous pregnancy loss. Third, it would be meaningless to continue the pregnancy in patients with a score of 4, according to the scoring system. Fourth, patients without cardiac activity and embryos at days 33–35 after embryo transfer should discontinue the pregnancy, while patients with embryos should proceed with the pregnancy.     

Yolk sac tumor of endometrium: A case report and literature review

ObjectiveTo report a rare case of endometrial yolk sac tumor (YST) and review published cases of YST of the endometrium.Case reportA 68-year-old female presented with intermittent vaginal spotting for nine months. An endometrial biopsy showed adenocarcinoma. Complete surgical staging operation was performed and the final pathology revealed stage II endometrial yolk sac tumor. The post-operative α-fetoprotein (AFP) level was 133.4 ng/mL. Post-operative adjuvant chemotherapy with bleomycin, etoposide, and cisplatin (BEP) regimen was prescribed for 6 cycles. AFP levels were normal before the fourth cycle of chemotherapy. She is disease free 6 months after completion of therapy.ConclusionPrimary YSTs arising in the endometrium is an extremely rare disease especially in postmenopausal women. Complete surgical staging operation with adjuvant chemotherapy will lead to good outcome in this disease.     

Virilization in a Girl Caused by an Ovarian Yolk Sac Tumor: A Case Report

BackgroundYolk sac tumors (YSTs) are rare malignancies that originate from germ cells and rarely present with endocrine symptoms. We report a case of a 13-year-old girl with a YST manifesting as virilization.CaseA 13-year-old girl was diagnosed with a YST with endocrine symptoms because of Leydig cells in the stroma, which were identified using hematoxylin and eosin staining and immunohistochemistry.Summary and ConclusionThis case suggests that clinicians should consider the possibility of YST when encountering patients with symptoms of virilization. When a YST is found to have endocrine function, a functioning stroma could present. Immunohistochemistry is useful for identifying stromal cells and performing a differential diagnosis.     

Gonadoblastoma-Associated Mixed Gonadal Germ Cell Tumor with Dysgerminoma and Hepatoid Yolk Sac Tumor Components in 46XY Gonadal Dysgenesis

BackgroundDisorders of sex development are congenital conditions with atypical chromosomal, gonadal, or anatomical sex development. Gonadal dysgenesis in patients containing a Y chromosome have a high risk of developing germ cell tumors with potential for malignant transformation.CaseWe present the case of a 17-year-old phenotypic female with primary amenorrhea and 46,XY complete gonadal dysgenesis. Pelvic ultrasound showed a solid cystic lesion in the right gonad. Pathology showed a gonadoblastoma-associated mixed gonadal germ cell tumor with dysgerminoma and hepatoid yolk sac tumor.Summary and ConclusionTo our knowledge, this mixed neoplasm association has not been previously reported and this case illustrates the challenges for the diagnosis of gonadal dysgenesis-associated tumors, emphasizing its recognition and prognostic implications.     

超声在早孕卵黄囊预测妊娠结局的临床价值

目的探讨超声在早孕卵黄囊预测妊娠结局的意义。方法对100例早孕妇女卵黄囊的声像图特点进行分析及对孕妇进行随访。结果正常卵黄囊超声显像呈球形的囊性结构,卵黄囊大小从孕5周至孕10周随孕周增加而增长。最小直径3mm,最大直径不超过6mm,随后缩小,孕12周后不再超声显示。卵黄囊大小正常与卵黄囊异常（包括未见卵黄囊显示及大小异常）在妊娠结局中存在明显差异（P〈0.01）。结论超声监测孕早期卵黄囊直径可预测妊娠结局,可指导临床采取有效的治疗措施。     

Pathogenic implications of remnant vitelline structures in gastroschisis

Purpose

The pathogenesis of gastroschisis is unknown. It may be helpful in understanding its pathogenesis to know the structural relationships among umbilical components including umbilical vessels, urachus, and vitelline structures, and thus, the authors investigated the remnants of vitelline structures in a series of cases of gastroschisis.

Methods

Medical records of 41 cases with gastroschisis treated in our institute from 1979 to 2009 were retrospectively reviewed.

Results

Paraumbilical bands, possible remnants of vitelline structures, were observed in 4 cases (9.8%). All 4 bands were attached to the skin edge of the abdominal defect without incorporation into the umbilical cord. The band ended at the mesentery in 3 cases and at the antimesenteric site of the ileum in the remaining case. Histologic findings showed fibrous tissues in all cases. One was possibly associated with the development of colonic atresia. Another was noticed after silo reduction when herniated bowels became strangulated by the band. The other 2 cases were uncomplicated.

Conclusions

Our findings may support the recently proposed hypothesis that the developmental failure of the yolk sac and related vitelline structures to merge with or to be incorporated into the umbilical stalk might be associated with the pathogenesis of the abdominal wall defect in gastroschisis. Paraumbilical bands derived from vitelline structures may possibly cause intestinal ischemia prenatally or postnatally.     

孕早期出血者卵黄囊超声特征与妊娠结局的相关性研究

目的研究孕早期出血者卵黄囊的超声表现与妊娠结局的相关性。方法回顾性分析160例孕早期出血妇女卵黄囊的阴道超声表现,分为正常组和异常组,随访其妊娠结局并进行对比分析。结果正常组与异常组的妊娠结局比较差异有统计学意义（P〈0.01）。结论孕早期出血者卵黄囊的超声特征可以评估妊娠结局。     

Brief Report: A Second Primary Endodermal Sinus Tumor 9 Years after Initial Diagnosis

Background

Ovarian yolk sac tumors (YSTs) are rare malignant germ cell tumors known to present unilaterally, allowing for fertility-sparing surgical treatment with adjuvant chemotherapy. The few published cases of bilateral ovarian involvement were at the time of original diagnosis in patients with widely metastatic disease. We present, to our knowledge, the first case of bilateral ovarian YSTs, diagnosed several years apart, and discuss the implications on recurrence and tumor marker surveillance for these tumors.