A Case of Endometrioid Stromal Sarcoma of ovary / 대한산부인과학회잡지

Endometrioid stromal sarcoma of ovary is so rare that it has been reported 45 cases in the world. Endometrioid stromal sarcoma of ovary is concomitant with endometriosis at 40%, with same tumor in uterus at 30%. The age of pateint is between 11 and 76, half of them are fifties and sixties. Most frequent presenting symptom is abdominal distension and abdominal pain. Surgery, chemotherapy, radiotherapy, progesterone was helpful, but any management do not result in conclusion because of rarity of cases. Clinical course is indolent because lesion is well-differentiated and grows slowly, so only cytoreductive surgery will be effective. Progesterone may be effective in residual or recurrent low-grade endometrioid stromal sarcoma of ovary. If endometriotic tissue is origin of tumor, estrogen play a role in malignant transformation. We had experienced a case of endometrioid stromal sarcoma of ovary of 42 years old woman. We managed by TAH and BSO, radiotherapy, progesterone therapy. Until now no recurrence was found for 15 months. So, we report this case with review of the literature.

A case of simultaneous bilateral tubal pregnancies following the ovulation induction and intrauterine insemination / 대한산부인과학회잡지

Bilateral tubal pregnancy is the least common type of all extrauterine pregnancies, 1:725-1:1580 of pregnancies are bilateral. Simultaneous tubal pregnancies have been reported in natural cycles, recently, after ovulation induction, assisted reproductive techniques. The high incidence of ectopic pregnancy assisted with ovulation induction continues to be a problem. Bilateral tubal pregnancy associated with the ovulation induction has been reported few cases of 3.0% to 6.0% in frequency. This paper describes a case of simultaneous bilateral tubal pregnancy after ovulation induction and intrauterine insemination in a 27 year old patient. The diagnosis was confirmed by laparoscopy performed 30 days after intrauterine insemination, which revealed bilateral tubal pregnancy and mild hyperstimulated ovaries. Bilateral salpingectomy was performed. With a review of the literature on this topic, diagnostic aspect and incidence and treatment options are discussed.

A Case of Complete Remission by Combination Chemotherapy with BEP Regimen after Operation in Endodermal Sinus Tumor of Ovary / 대한산부인과학회잡지

Endodermal sinus tumor (EST) has also been referred to as yolk sac carcinoma because they are derived from the primitive yolk sac. These lesions are the third most frequent malignant germ cell tumor of the ovary. Patient with EST have a median age of 18 years, but approximately one third of the patients are premenarchal at the time of initial presentation. Abdominal and/or pelvic pain is the most frequent presenting symptom, most EST secrete AFP. Radical surgery has not been helpful, but recent advances in treating the EST of the ovary with the combination chemotherapy after unilateral salpingo-oophorectomy result in improvement of the prognosis. We had experienced a case of endodermal sinus tumor of 36 years old woman. So, we report this case with brief review of the literature.

A Case of Cerebral Venous Thrombosis Associated with Minimal Change Nephrotic Syndrome

Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. Thromboembolic events occur frequently in patients with nephrotic syndrome. However, central venous thrombosis occurs less frequently as a complication of minimal change nephrotic syndrome. The pathogenic mechanisms are not yet unclear, but various alterations in coagulant and anti-coagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with minimal change nephrotic syndrome. A 27-year-old man was admitted due to sudden, severe headache with nausea and vomiting. He complained of a continuous throbbing-type headache in bifrontal area. One month prior to the symptoms, he was diagnosed as having nephrotic syndrome based on clinical manifestations and biopsy findings. The routine laboratory findings showed that he had hyperlipidemia, hypoalbuminemia and proteinuria. In clotting factor analysis, fibrinogen, factor VII, VIII and von Willebrand factor were increased and factor XII, antithrombin III and protein S were decreased. The unenhanced brain CT scan showed a triangle-shape high density in a superior sagittal sinus and gadolinium enhanced brain MRI showed unenhanced blood clot in a superior sagittal sinus. Initial brain MR venography showed a lack of filling of a superior sagittal sinus and poor visualization of cortical veins.

Findings of Perfusion MR Imaging in Acute Middle Cerebral Artery Territory Ischemic Stroke

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.

A Case of Ophthalmoplegic Migraine with Gadolinium Enhancement of the Oculomotor Nerve on MR Imaging

The typical manifestation of repeated migraine headache followed by ophthalmoplegia can be diagnosed as a ophthalmoplegic migraine. The diagnosis requires exclusion of other causes. MRI was useful in excluding other causes of ophthalmoplegia with headache and there is few abnormal findings on MRI in ophthalmoplegic migraine patients. A 55-year-old man with a familial and personal history of migraine was admitted due to left ptosis and diplopia followed by insidiously developed headache. The migraine headache and ophthalmoplegia were improved spontaneously within 3 days and within 4 weeks, respectively. MRI demonstrated gadolinium enhancement on the cisternal portion of left oculomotor nerve.

Clinical and Neuroimaging Features of Moyamoya Disease

BACKGROUND: Moyamoya disease is a chronic cerebrovascular disorders in which stenosis of the major arteries of the circle of Willis at the base of the skull progresses to occlusion. We observed two kinds of collateral pathways from the extracranial to the intracranial arteries. Also we evaluated clinlcal and neuroimaging features of moyamoya disease to give on aid in diagnosis. METHODS: We analysed 17 patients with moyamoya disease through the medical record and neuroimaging (conventional angiography and/or MR angiography) review. Six out of 17 patients were children(< OR =15 years) and the other 11 patients were adults(15 years). There were 8 males and 9 females. RESULTS: In our result, moyamoya disease was more common in the adult. There was bimodal age distribution, so average age of onset in children was 8-year-old and in adult 37-year-old. Common clinical features are seizure (66%), TIA (17%), and psychotic behavior (17%) in childrens and hemorrhages (73%), infarction (18%), seizures (9%) in adults. According to angiographic staging classification of Suzuki et al. (1967), our cases showed distribution of stage I (13%), stage II (8.8%), stage III (65.3%), stage IV (4.3%), stage V (4.3%), stage VI (4.3%). In collateral vessels of moyamoya disease, there were 7 cases of ethmoidal moyamoya, 3 of vault moyamoya and 1 of mixed form. It is interesting that there were five cases of unilateral moyamoya disease and one case had pseudoaneurysm. CONCLUSION: According to our results, we may say that seizures are common in the children and hemorrhages are in the adult. Unilateral moyamoya were mainly occurred in the adult. Ethmoidal collaterals were common among collaterals and stage III had a more cases than others in our neuroimaging data. These clinical and neuroimaging data may help interpretation and diagnosis of moyamoya disease.

A case of spinal epidural lipomatosis associated with phenytoin induced hypothyroidism and obesity

Spinal epidural lipomatosis(SEL) is characteristic by abnormal accumulation of unencapsulated fat in the epidural space, which usually occurred as a complication of longterm steroid therapy or Cushing's syndrome and occasionally in obese patients with no other known etiology. This condition, which may result in devastating neurologic complications has also been reported without exogenous steroid intake. Magnetic resonance imaging is the meet helpful diagnostic means and should be used initially. We describe a case of nonsteroid induced symptomatic SEL associated with phenytoin-induced hypothyroidism and obesity. A 27-year-old woman was hospitalized with inability to walk for 2 months ago. She has back pain in her legs associated with radiating pain. She had a history of myoclonic seizure and treated with phenytoin 300 mg for 8 years. On admission, she shows mild hypothyroidism on thyroid function test. Serum phenytoin level was elevated as to 22.1 ug/ml. On cross sectional MRI, the thecal sac has a striking stellate appearance with three rays emanating from a central core. It produces a trifid shape resembling the letter "Y". Correction of underlying endocrine abnormality with weight reduction instead of decompressive laminectomy can reverse the process. In a obese patient with radicular pain or progressive paralysis, SEL may be the etiologic factor involved.