RESUMO
Background: Adenomyosis is a common and benign uterine disease. Acute cerebral infarction (CI) associated with adenomyosis is rarely reported and difficult to treat. We experienced successful treatment for this disease. Case Description: A 50-year-old woman presented with a 2-day history of visual disturbance. Magnetic resonance imaging showed multiple tiny diffusion-weighted high-density spots on several lobes. No common risk factors for stroke were detected. Cancer antigen 125 level was 999 U/mL, along with massively expanded uterus and adnexa. Based on the diagnosis of benign adenomyosis, Xa inhibitor and GnRH agonists were administered for CI and adenomyosis, respectively. Acute CI recurred 7 days after admission. We suspected a relationship between infarction and adenomyosis and concluded hysterectomy as a proper treatment strategy based on the literature. Eighteen months after hysterectomy, no recurrence of CI without anti-thrombus medications has been detected. Conclusion: Hysterectomy is a radical therapy that is effective in preventing acute CI due to adenomyosis associated with ischemic symptoms.
RESUMO
The fluorescence of protoporphyrin IX (PpIX) induced endogenously by 5-aminolevulinic acid (5-ALA) administration has recently been used for the intraoperative visualization of glioma tissues. To increase the sensitivity of photodetection, the emission spectra of 5-ALA-induced PpIX fluorescence was quantitatively measured in tissues taken from six cases of en bloc resected diffusely infiltrating astrocytomas (2 diffuse astrocytomas, 2 anaplastic astrocytomas, and 2 glioblastomas), and the correlation assessed between the fluorescence intensity and histological features. A total of 65 slices were analyzed by ex vivo spectroscopy. The ratio of the peak emission intensity to reflected excitation intensity or fluorescence intensity ratio was less than 0.001 for all 36 non-tumor tissues. The tissues with glioblastoma morphology had a fluorescence intensity ratio in excess of 0.090. The spectroscopic fluorescence intensity was positively correlated with the MIB-1 labeling index as an indicator of proliferation activity, the CD31-microvessel density as a pan-endothelial marker, and the vascular endothelial growth factor expression as an angiogenetic factor. The MIB-1 proliferation index was the most powerful determinant, suggesting that higher cell proliferation may govern preferential PpIX accumulation in glioma cells. This preliminary study suggests that spectroscopic analysis may be useful for optimizing the removal of diffuse gliomas.
