Prenatal diagnosis of fetal glioblastoma multiforme

Intracerebral tumours of the fetus are very rare conditions, most often presenting clinically as polyhydramnios and hydrocephalus. These conditions can be diagnosed with ultrasound and clearly differentiated from hydrocephalus and other intracranial lesions. The following report is of a case of an intracerebral tumour (glioblastoma multiforme) diagnosed at 33 weeks in utero using ultrasound. The prognosis for this condition is universally poor.     

Gastric cancer diagnosed by biopsy of the uterine cervix

Biopsy of the uterine cervix from a 46-year-old woman who suffered from epigastric pain and weight loss showed metastatic adenocarcinoma. The primary site of the tumor was the stomach. At laparotomy, disseminated adenocarcinoma on the peritoneum and Krukenberg's tumor in the right ovary were found. A palliative partial gastrectomy, resection of the right ovary, and postoperative chemotherapy were performed. The possible mechanism of metastasis of extragenital cancer to the uterus is discussed.     

Neurosarcoidosis diagnosed during pregnancy by thoracoscopic lymph node biopsy. A case report

BACKGROUND: Sarcoidosis is a multiorgan-system granulomatous disease causing respiratory complaints in most patients. Eye involvement, most commonly granulomatous uveitis, is seen in 5% of black patients with sarcoidosis. Neurosarcoidosis is also rare, affecting 5% of patients with sarcoidosis. Thoracoscopic lymph node biopsy in pregnancy has never before been reported. CASE: An otherwise-healthy, 25-year-old woman, gravida 2, para 1001, presented at 25 weeks' gestation with a painful facial palsy and visual defects. Ophthalmologic examination revealed uveitis, and a chest radiograph revealed asymmetric hilar adenopathy. At 28 weeks' gestation, the patient underwent thoracoscopic lymph node biopsy, which confirmed the diagnosis of sarcoidosis. The symptoms were stabilized with therapeutic corticosteroids, and the patient delivered a healthy neonate at term. CONCLUSION: The diagnosis of sarcoidosis remains one of exclusion and requires a high index of suspicion. Tissue confirmation is often necessary, especially when patients have extrathoracic complaints. For patients without other lesions amenable to biopsy, thoracoscopic lymph node biopsy can be considered despite pregnancy.     

阴道镜直视下宫颈活检诊断CINII中漏诊CINII以上病变的研究及意义

目的:评价阴道镜直视下活检诊断CINII的准确性,分析影响漏诊CINII以上病变(简称CINII~+)的相关因素,并探讨P16~(INK4a)蛋白表达在预测漏诊CINII~+中的价值。方法:回顾分析2013年12月至2015年7月在南京医科大学第一附属医院宫颈病中心阴道镜直视下宫颈活检诊断为CINII,且在短期内行LEEP的148例患者。研究患者手术前后病理诊断,同时对患者年龄、初次TCT结果、高危型HPV负荷量、阴道镜下病变累及宫颈象限数、转化区类型、阴道镜图像表现以及CINII组织中P16~(INK4a)蛋白表达等与漏诊CINII~+的关系进行单因素及多因素分析。结果:(1)阴道镜直视下活检诊断的148例CINII中,71例(49.97%)漏诊CINII~+,其中1例宫颈鳞癌IA1期,1例宫颈鳞癌IB1期。单因素分析显示,患者年龄、初次TCT结果、高危型HPV负荷量、阴道镜下病变累及象限数、转化区类型、阴道镜图像特征与CINII~+病变漏诊无明显相关性(P0.05),CINII组织中P16~(INK4a)蛋白表达与CINII~+病变漏诊明显相关(P0.05)。多因素分析显示,P16~(INK4a)蛋白阳性表达是影响阴道镜直视下活检诊断CINII漏诊CINII~+的危险因素(OR=9.846,95%CI为2.165~44.787;P=0.003)。(2)21例(14.19%)P16~(INK4a)蛋白呈阴性表达,127例(85.81%)呈阳性表达。P16~(INK4a)蛋白表达阴性组中漏诊CINII~+3例(14.29%),P16~(INK4a)蛋白表达阳性组中漏诊CINII~+68例(53.54%),两组比较差异有统计学意义(P0.05)。P16~(INK4a)阳性表达预测漏诊CINII~+的敏感性95.77%,特异性为23.38%,阴性预测值为85.71%,阳性预测值为53.54%。结论:阴道镜直视下活检诊断的CINII中存在CINII~+的漏诊,而CINII并P16~(INK4a)蛋白阳性表达是影响CINII~+漏诊的危险因素,对P16~(INK4a)蛋白表达阳性的CINII患者的临床干预存在其合理性。针对CINII的个体化管理,需综合考虑患者的年龄、P16~(INK4a)蛋白表达、对生育功能保护的需求及随访的依从性。     

The lesions of flat epithelial atypia diagnosed on breast biopsy

Among pre-invasive breast diseases, the lesion of flat epithelial atypia has a level of risk that remains unclear. The clinical significance of these lesions and how to behave during their diagnostic biopsy (monitoring vs. surgery) are still uncertain, because few studies (including monitoring) are available and because of the polymorphic spectrum of lesions and their many denominations across the studies in the literature. This article aims to update our knowledge and provide elements for the management of these lesions diagnosed on breast biopsy.     

Varicella arthritis diagnosed by polymerase chain reaction.

We report a 2-year-old girl who developed acute arthritis of the left knee 4 days after the onset of a typical varicella infection. She was first thought to have pyogenic arthritis caused by Staphylococcus aureus. Accordingly, oxacillin was administered upon hospitalization. On the third day after hospitalization, bacterial cultures of the synovial fluid and blood showed no growth and oxacillin was discontinued. Although a viral culture of the synovial fluid for varicella-zoster virus (VZV) was negative, varicella DNA was identified by means of polymerase chain reaction (PCR) with VZV-specific primers. The patient recovered spontaneously. To differentiate this condition from septic arthritis is important. PCR is a sensitive technique that can demonstrate the presence of VZV DNA in synovial fluid, even if viral cultures are negative.     

Pallister-Killian syndrome diagnosed by chorionic villus sampling.

The first prenatal diagnosis of Pallister-Killian syndrome by chorionic villus sampling is presented. Fetal hydrops was noted on ultrasound in early pregnancy, and the karyotype revealed isochromosome 12p mosaicism.     

Empty gestational sacs diagnosed by abdominal real-time ultrasonography.

310 patients with threatened abortion were examined by ultrasound. 86 cases showed empty gestational sacs of which 14 (16%) completed their pregnancy. All sacs were evaluated (and scored) with respect to size, shape, wall definition, trophoblastic reaction and position inside the uterus. Prediction of a non-viable pregnancy from a single ultrasound examination was achieved in some cases. However, this prediction could not be made in other cases before a follow-up ultrasound examination was performed. The proposed scoring system proved to be very helpful in identifying empty gestational sacs in which serial ultrasound examinations are highly required before termination of pregnancy.     

Fetal movements diagnosed by ultrasound in early pregnancy.

The purpose of this work was to ascertain whether ultrasonic techniques based on fetal movements were suitable for examinations in early pregnancy. The series consisted of 124 patients who came to be examined because of bleeding on the 6th-20th gestational week. The rapid B-scan method detected the fetal movements from the 8th week onwards, and the results were 100% reliable from the 10th week onwards. The combined A-B-scan method detected the fetal movements from the 12th week. Techniques based on the detection of fetal heart function were used as control methods. According to our results, the methods based on the indication of fetal movements constitute a practical alternative for elucidating the problems of early pregnancy.     

Flexible bronchoscopic diagnosis of airway injuries after intubation in children.

BACKGROUND: Airway intubation injuries occur frequently but are often neglected because of spontaneous regression. Although most airway injuries that result from intubation resolve without sequelae, severe complications can develop even when initial symptoms of upper airway obstruction are absent. This retrospective study assessed the clinical features, flexible bronchoscopic findings, and clinical outcomes in children with airway intubation injuries. METHODS: From February 1998 to February 1999, 90 children underwent flexible bronchoscopic examination in our hospital. Fifteen of these patients (6 girls, 9 boys; age range, 1 mo to 5 yr; mean, 21.1 +/- 24.4 mo) were noted to have intubation injuries. RESULTS: The average time for symptoms to emerge after extubation was 1.8 days (range, 0-14 days). The airway intubation injuries diagnosed by flexible bronchoscopy were subglottic stenosis in seven patients, vocal cord granulation in four, supraglottic granulation in two, subglottic web in two, bronchial granulation in two, glottic stenosis in one, and tracheal stenosis in one; two cases were discovered incidentally during postoperative follow-up. Four patients had undergone repeated intubation and eventually required tracheostomy. CONCLUSIONS: The results of this study indicate that flexible bronchoscopy is a simple, safe, and useful technique for the diagnosis and follow-up of airway intubation injury. It should be performed on all patients who have symptoms of upper airway obstruction after extubation as well as those who have undergone long-term or emergency intubation.     

Diagnosis of paraaortic and pelvic lymph node metastasis by ultrasound guided percutaneous fine needle aspiration biopsy (FNAB)

Ultrasonography (US) was performed in patients with gynecologic malignancies to detect paraaortic and pelvic lymphadenopathy. US of paraaortic lymph nodes was performed in 32 patients. Of the 32 patients 17 had lymphadenopathy, and ultrasound-guided percutaneous fine needle aspiration biopsies (FNAB) were therefore performed in 16 of these 17 cases. Of these 16 patients, 11 were positive and 5 were negative FNAB. US of pelvic lymph nodes was performed in 68 patients. Of the 68 patients 14 had lymphadenopathy, and FNAB were performed in 8 of these. All 14 of these FNABs were positive. There were no major complications from due to FNAB. It is therefore concluded that ultrasound-guided percutaneous FNAB is very useful in detecting metastatic lymph nodes of gynecologic malignancies.     

Fetal abdominal cavernous hemangioma diagnosed by duplex Doppler velocimetry.

A fetal abdominal wall mass was detected by ultrasound and analyzed by duplex Doppler showing a low resistance to blood flow through its vessels. The antenatal diagnosis of cavernous hemangioma was confirmed after birth.     

Nomogram with potential clinical use to predict lymph node metastasis in endometrial cancer patients diagnosed incidentally by postoperative pathological assessment

Purpose

To determine the clinical and pathological risk factors for lymph node metastasis (LNM) in patients with endometrial cancer and to create a nomogram to predict LNM in patients without surgical staging.

Methods

All patients with endometrial adenocarcinoma who were treated surgically at a university based gynecologic oncology clinic between January 2011 and December 2014 were recruited. Women with endometrial adenocarcinoma who were surgically staged including lymphadenectomy were included in the study. Data regarding clinical and pathological risk factors were recorded. The histopathologic slides from the staging surgeries were re-evaluated microscopically by a gynecologic pathologist for all parameters along with lymphovascular space invasion (LVSI).

Results

A total of 279 patients with endometrial cancer were analyzed. Among those, 31 (11.1%) had lymph node metastasis. According to the univariate analyses, elevated CA 125 (>35 U/mL), LVSI, myometrial invasion ≥50%, grade 3 disease, non-endometrioid type, and cervical stromal involvement were significantly associated with LNM. The multivariate logistic regression analysis showed that LVSI, non-endometrioid type, elevated CA 125, and cervical stromal involvement increased the risk of LNM. However, myometrial invasion and grade did not significantly affect the risk of LNM. A nomogram to predict LNM was constructed using these factors (concordance index 0.92).

Conclusions

LVSI is the most important predictor for LNM. The present nomogram can be useful to decide if adjuvant therapy is required for patients who undergo simple hysterectomy for a benign etiology and incidentally diagnosed with endometrial cancer by pathological evaluation.

     

Percutaneous biopsy of carcinoma of the pancreas guided by angiography.

Histologic verification of the angiographic diagnosis of carcinoma of the pancreas may be achieved by percutaneous, transperitoneal fine-needle aspiration biopsy. The method was used in conjunction with the angiographic procedure in 29 patients with tumors of varying size down to 3 centimeters in diameter. Positive diagnosis was obtained in 22. Complications were not encountered. Since the method is simple and harmless it is recommended whenever histologic verification is desired.     

Endometrial disease diagnosed by transvaginal ultrasound and dilatation and curettage.

BACKGROUND: This study is designed to compare endometrial thickness measured by transvaginal ultrasound with endometrial pathology by dilatation and curettage. METHODS: Fifty-four women with postmenopausal bleeding were evaluated. Endometrial thickness, including both layers of the endometrium, was measured by transvaginal ultrasound after which fractional curettage was performed and samples taken were then dispatched for histologic examination. RESULTS: Median endometrial thicknesses of 5 mm, 8.5 mm and 6 mm were found for benign, hyperplastic and carcinomatous endometrium, respectively. Of the eight hyperplastic samples, two cases had 4 mm, and one case had 3mm endometrial thickness. Similarly, of the nine malignant samples, three cases had an endometrial thickness of 3 mm. Three mm has been found to be the best cut off point for endometrial abnormalities in postmenopausal bleeding with 100% sensitivity but low specificity (13%). CONCLUSION: Fractional curettage seems to be the best method for detecting endometrial abnormalities in women with postmenopausal bleeding.