Treatment of Advanced-Stage Sertoli-Leydig Cell Tumor (SLCT): A Clinicopathologic Study of 1 Case / 대한산부인과학회잡지

Sertoli-Leydig cell tumors belong to the group of sex-cord stromal tumors of the ovary. They account for less than 0.5% of all ovarian tumor. They occur predominantly at premenopausal women and rarely at postmenopausal and prepubertal. Most common symptom is menstrual disorder including vaginal bleeding. This symptom is the results of excessive testosterone production of Leydig cell. Masculinization is occasionally accompanied by this symptom. but approximately 50% of patients with SLCT have no endocrine manifestations. Prognosis prove generally favorable with 5-year survival rate of 70-90%. Recurrence is rare.The majority of these tumors are benign and are unilaterally (97-98%) localized. Surgery varies with patient age, tumor stage, and differentiation from unilateral salpingo-oophorectomy to bilateral salpingo-oophorectomy and total hysterectomy concomitant with pelvic lymph node dissection. Herewith, we experienced a case of treatment advanced-stage Sertoli-Leydig cell tumor with poorly differentiation in that is ascitic and metastatic in a 53 years old menopause woman who has no virilizing symptom. After all the tumor has resulted in fatal outcome despite of surgery and aggressive chemotherapy. Therefore we present it with review of literature.

Treatment of Advanced-Stage Sertoli-Leydig Cell Tumor (SLCT): A Clinicopathologic Study of 1 Case / 대한산부인과학회잡지

Sertoli-Leydig cell tumors belong to the group of sex-cord stromal tumors of the ovary. They account for less than 0.5% of all ovarian tumor. They occur predominantly at premenopausal women and rarely at postmenopausal and prepubertal. Most common symptom is menstrual disorder including vaginal bleeding. This symptom is the results of excessive testosterone production of Leydig cell. Masculinization is occasionally accompanied by this symptom. but approximately 50% of patients with SLCT have no endocrine manifestations. Prognosis prove generally favorable with 5-year survival rate of 70-90%. Recurrence is rare.The majority of these tumors are benign and are unilaterally (97-98%) localized. Surgery varies with patient age, tumor stage, and differentiation from unilateral salpingo-oophorectomy to bilateral salpingo-oophorectomy and total hysterectomy concomitant with pelvic lymph node dissection. Herewith, we experienced a case of treatment advanced-stage Sertoli-Leydig cell tumor with poorly differentiation in that is ascitic and metastatic in a 53 years old menopause woman who has no virilizing symptom. After all the tumor has resulted in fatal outcome despite of surgery and aggressive chemotherapy. Therefore we present it with review of literature.

Spontaneous Ventriculostomy

Spontaneous ventriculostomy occurs with the spontaneous rupture of a ventricle resulting in a communication between ventricular system and subarachnoid space. It is usually the result of obstructive hydrocephalus but has been documented only rarely. Van Stackum verified the first case of spontaneous ventriculostomy at autopsy in 1910. Radiological demonstration of spontaneous ventriculostomy was reported by Leslie for the first time in 1964 and only 6 cases has been reported until now. We recently have experienced a case of spontaneous ventriculostomy beautifully demonstrated by conray ventriculography in a patient of posterior fossa tumor. We report our case with the brief review of the articles.

A Case of Myxopapillary Ependymoma

Myxopapillary Ependymoma was first designated by Kernohan(1932). It is characterized by its unique location at cauda equina and histologically well defined cuboidal or low columnar cells which appear to be planted firmly around a conspicuous central core of hyaline acellular connective tissue which contains small blood vessels. We recently experienced a typical case of myxopapillary ependymoma which was highly vascular and filled the entire dural sac.

Microsurgical Treatment of Hemifacial Spasm

Nine patients, 3 men and 6 women, ages 39 to 61, were operated on between May 1978 and August 1978 for classical hemifacial spasm. The operation consisted of a small retromastoid craniectomy performed through a short vertical incision with microsurgical exploration of the cerebello pontine angle and vascular decompression of the facial nerve root exit zone. Decompression was maintained by interposing a small piece of muscle between the artery and the brain stem. Five patient have had complete relief of the hemifacial spasm. Three patients have had partial relief of the hemifacial spasm. One patient have had no relief of the hemifacial spasm.

Two Cases of Mycotic Aneurysm with Intracerebral Hematoma

Mycotic aneurysms are produced by an infected embolus from vegetations on the heart valves in bacterial endocarditis, which breaks off and lodges in the cerebral blood vessels. The wall of the embolized vessel becomes infected, invasion by inflammatory cells and necrosis of the wall are often followed by rupture and formation of a aneurysmal sac. These aneurysms are very are in incidence and are usually located more peripherally in the vascular tree than berry aneurysms, are more irregular in shape and are not necessarily located at bifurcations. Recently we experienced a case of mycotic aneurysm with intracerebral hematoma which had developed in a subacute bacteria endocarditis patient. The patient was 44 years old male patient with dilated right pupil and left hemiplegia. He was treated surgically by evacuation of intracerebral hematoma and excision of mycotic aneurysm. We also experienced another case of mycotic aneurysm with intracerebral hematoma in 17 years old male patient who had been suffered from fever of unknown origin. He was also treated surgically. We now reports 2 cases of mycotic aneurysm with intracerebral hematoma with a brief review of the literatures.

A Case of Cryptococcal Meningitis

Cryptococcosis of the central nervous system if highly fatal, if unteated, but we experienced a case of cryptococcal meningitis that took a rather benign course with a marked hydrocephalus with deafness and visual disturbance simulating tuberculous meningitis clinically. A 31 year old Korean man was admitted to the department of Neurosurgery, Seoul National University Hospital, with the chief complaints of sudden visual disturbance and bilateral deafness of 4 years' duration. Simple skull films showed a sellar changes that was due to chronically increased intracranial pressure. Carotid angiogram revealed marked hydrocephalic changes and vertebral angiogram showed a 4th ventricle dilatation. On pneumoencephalogram, we could observe air trapping only below the tentorium. Conray ventriculogram showed marked dilatation of all ventricles. The 3rd ventricle was herniated into the sella and irregular filling defect at the posteroinferior portion of the 4th ventricle was observed. Lumbar CSF showed the finding compatible with tuberculous meningitis. India ink staining of CSF for fungus study gave a negative result. Posterior fossa exploration was performed to rule out possible mass lesion. Arachnoid membrance was thickened and adhered, so we couldn't separate tonsils and explore the 4th ventricle. And there was no CSF in the cisterna magna. We found a mass of yellowish and caseous material in the dorsal aspect of lower medulla. Ventriculo-operational shunt for hydrocephalus was done. Microscopic findings of the lesion revealed diffuse infiltration of many cryptococci with scattered neutrophils and monocytes. We report a case of cryptococcal meningitis that took and unusual benign course.

Two Cases of Posttraumatic Middle Cerebral Artery Occlusion

While posttraumatic occlusion of the extracranial carotid and vertebral arteries is well known, reports of occlusion of intracranial vessels following closed head injury are rare. Since Deveer and Browder reported the first case in 1942, only 22 cases of posttraumatic middle cerebral artery occlusion have been reported until now. We experienced 2 cases of posttraumatic middle cerebral artery occlusion recently. One patient was 27 years old male who developed right hemiplegia after relatively minor head injury. Reported angiograms taken on the 13th day after trauma revealed sparse middle cerebral artery branches with retrograde filling through left anterior cerebral artery in middle cerebral artery territory. He showed relatively satisfactory recovery by conservative treatment with steroid and cerebral vasodilator. The other patient became semicomatous with left hemiplegia after fall down accident from running train. Left carotid angiograms showed complete obstruction of left middle cerebral artery in its initial portion with corresponding avascular area. This patient died one week after the angiography in spite of all possible conservative care.

A Case of Leptomeningeal Cyst

Leptomeningeal cyst, so-called growing skull fracture, is one of the infrequent but important complications of skull fracture in childhood. The mechanism for production and the essential features of this condition appear to be a skull fracture with underlying dural tear, through which the arachnoid membrane projects out, resulting arachnoid herniation and cyst, aided by the normal pulsations of the growing brain to the fluid in the cyst, resulting in progressive enlargement of the dural defect and progressive erosion of adjacent bone edges. There may be underlying brain laceration as well, resulting in loss of brain substance and enlargement of ventricle, with communication of the cyst with the lateral ventricle. Commonly there are a palpable or visible scalp swelling which has gradually increased in size, or the signs of underlying brain damage which result in focal or hemiparesis. Roentgenographic findings are characteristic and usually permit an accurate diagnosis. There is an irregular defect in the bone, usually with a scalloped, saucerized margin and everted edges. Treatment consists of excision of the cyst and repair of the dural and bony defects. Recently we have treated a typical case of leptomeningeal cyst in a 6-year-old boy with intractable seizure of 3 years' duration.

A Study for the Determination of the Lumbar Intervertebral Discs

Although transitional vertebrae are relatively frequent in limbosacral area, it is generally accepted that one cannot state whether the transition is due to lumbarization of S1 or sacralization of L5 from simple lumbar X-ray film alone. However, for the practical purpose, the author attempted to obtain a possible method to determine the level of the lumbosacral spine in simple X-ray films through the analysis of the 100 operated patients and 25 lumbago and/or sciatica patients. Furthermore to determine the level of the intervertebral disc space in post-operative films, a silver clip was attached near the operated region and reviewed the post-operative findings in simple lumbar X-ray films. The results were as follows : 1) To determine the level of the interverbral disc space in simple lumber X-ray films, origin of the psoas muscle shadow can be utilized as a landmark with about 80% accuracy. But if one leave the silver clip at the operated region, he can state the level in 100% accuracy with the information of pre-operative symptoms. 2) Sacralization was 10% in operated cases, 6% in non-operated cases and lumbarization was 6% in operated cases, 3.2% in non-operated cases. Spina bifida was 12% in operated cases, 11.2% in non-operated cases. Lumbar rib was 2% in all of operated and non-operated cases.

Problems of Massive Transfusion in Neurosurgical Field

Massive transfusion may be defined as the acute administration of more than one and a half times of the patient's estimated circulating volume. Many of the problems associated with massive transfusion are due to the biologic changes of the stored blood with preservation which eventually replace the most of the recipient's circulating blood. In neurosurgical field, massive transfusion therapy is seldom necessary except in case of the operative intervention of meningioma, sinus rupture, aneurysm and large vessel injury from direct operative procedures. But the necessity of massive transfusion is getting increased recently with the improvement of neurosurgery and anestheology that permits the inoperable surgery in the past possible. On these basis. this article presents the case summary of the 3 patients who received massive transfusion during neurosurgical procedures and the brief review of the problems and their possible mechanisms associated with massive transfusion. The problems are acid-base disturbance, shift to the left of oxygen dissociation curve due to the decrease of 2,3-DPG, coagulopathy, shock lung and transmission of viral hepatitis through transfusion. To reduce these complication, the following managements will work well if properly handled. 1. Administer blood that is as fresh as possible. If available, prepare platelet concentrates. 2. Monitor platelet count, plasma fibrinogen level, partial thromboplastin time and clot for lysis after every 5 to 10 pints of blood administered. 3. Analyze arterial blood for PaCO2, PaO2 and pH after every 5 pints of blood transfusion to allow precise bicarbonate administration. 4. Monitor the EKG continuously to detect changes in potassium or calcium concentration and to correct immediately when indicated. 5. Warm all the blood before transfusion. 6. When the patient develops severe respiratory insufficiency with normocapneic hypoxemia and diffuse homogenous density due to parenchymatous infiltration, in the chest roentgenogram, consider the situation as the establishment of shock lung and treat with artificial respirator and oxygen.

Problems of Massive Transfusion in Neurosurgical Field

Massive transfusion may be defined as the acute administration of more than one and a half times of the patient's estimated circulating volume. Many of the problems associated with massive transfusion are due to the biologic changes of the stored blood with preservation which eventually replace the most of the recipient's circulating blood. In neurosurgical field, massive transfusion therapy is seldom necessary except in case of the operative intervention of meningioma, sinus rupture, aneurysm and large vessel injury from direct operative procedures. But the necessity of massive transfusion is getting increased recently with the improvement of neurosurgery and anestheology that permits the inoperable surgery in the past possible. On these basis. this article presents the case summary of the 3 patients who received massive transfusion during neurosurgical procedures and the brief review of the problems and their possible mechanisms associated with massive transfusion. The problems are acid-base disturbance, shift to the left of oxygen dissociation curve due to the decrease of 2,3-DPG, coagulopathy, shock lung and transmission of viral hepatitis through transfusion. To reduce these complication, the following managements will work well if properly handled. 1. Administer blood that is as fresh as possible. If available, prepare platelet concentrates. 2. Monitor platelet count, plasma fibrinogen level, partial thromboplastin time and clot for lysis after every 5 to 10 pints of blood administered. 3. Analyze arterial blood for PaCO2, PaO2 and pH after every 5 pints of blood transfusion to allow precise bicarbonate administration. 4. Monitor the EKG continuously to detect changes in potassium or calcium concentration and to correct immediately when indicated. 5. Warm all the blood before transfusion. 6. When the patient develops severe respiratory insufficiency with normocapneic hypoxemia and diffuse homogenous density due to parenchymatous infiltration, in the chest roentgenogram, consider the situation as the establishment of shock lung and treat with artificial respirator and oxygen.