Spontaneous rupture of benign cystic teratomas

Spontaneous preoperative rupture and/or perforation of an adjacent organ by a benign cystic teratoma is rare. Between 1952 and 1979 there were 4 documented cases at The Johns Hopkins Hospital. The incidence, etiology, and pathology of this complication are discussed.     

Laparoscopic resection of ovarian benign cystic teratomas: experience with 84 cases

Laparoscopic treatment of benign cystic teratoma of the ovary has been recommended following the study of relatively small numbers of patients. We reviewed our experience with a prospective ongoing protocol for the treatment of benign ovarian teratomas, between January 1990 and December 1996. Sonography established the diagnosis, and biochemical markers were used to screen for possible malignancy. Surgery consisted of resecting the cyst and conserving the ovary if appropriate. The resected cyst was aspirated of its contents following insertion into an EndoCatch bag. Removal was accomplished via the narrowest incision possible by pulling the bag's margins through the incision and grasping the solid parts with conventional surgical instruments. The diameter of the cysts ranged from 2 to 15 cm. Cystectomy was performed in 47, and oophorectomy in 37, patients. Spillage occurred in 11 cases, but none developed peritonitis or fever. The mean duration of post-operative stay was 0.9 days (range 0.5-2). We conclude that laparoscopic resection of benign teratomas of the ovary is safe, well tolerated, and shortens hospital stay.     

Trichomoniasis in a postmenopausal woman cured after discontinuation of estrogen replacement therapy

BACKGROUND: Epidemiologic and experimental data suggest that estrogen has a salutary effect on Trichomonas vaginalis. CASE: A metronidazole-allergic postmenopausal woman was cured of vaginal trichomoniasis in association with discontinuation of estrogen replacement therapy. CONCLUSION: Hormonal manipulation should be studied for the management of women with trichomoniasis who are allergic to metronidazole or who are infected with metronidazole-resistant strains of Trichomonas vaginalis.     

Origin of estrogen in a postmenopausal woman with a nonendocrine tumor of the ovary and endometrial hyperplasia

The origin and quantity of estrogen and androgen were measured in a postmenopausal woman with clinical signs of estrogen excess and a nonendocrine tumor of the ovary. The plasma androstenedione production rate was elevated 5-fold. The estrone production rate was also five times that normally expected for a postmenopausal women and could be accounted for totally by the extraglandular conversion of plasma and androstenedione. Following removal of the tumor, the concentration of plasma androstenedione and the estrone production rate fell dramatically to normal postmenopausal levels. It is concluded that this markedly increased androstenedione production was the result of excessive secretion of androstenedione by the hyperplastic stromal cells of the ovary containing the mucinous cystadenocarcinoma. The excessive prehormone production together with its normal extraglandular conversion to estrone resulted in the massive increase in endogenous estrogen formation.     

Conjoined gastric and mediastinal benign cystic teratomas. Case report of a rare occurrence and review of literature

In this study, we evaluated the permeation of piperacillin (PIPC), imipenem (IPM), amikacin (AKM), gentamicin (GM), ofloxacin (OFLX), levofloxacin (LVFX), ciprofloxacin (CPFX) and sparfloxacin (SPFX) through Pseudomonas aeruginosa biofilm with a simple new method. Bacteria used were a leucine-requiring mucoid mutant. Bacteria were grown on the membrane of a cell culture insert in chemically defined medium and incubated at 37 degrees C for 5 days. At days 0, 1, 3 and 5, the penetration rates through the biofilms were measured. PIPC and IPM demonstrated relatively high permeation both with penetration rates at day 5 of 50%, whereas AMK and GM, which are aminoglycosides, showed low permeation both with penetration rates after day 1 of less than 25%. Among the 4 fluoroquinolones, LVFX and SPFX demonstrated excellent permeation with penetration rates that reached 100% from day 0 to 5, while OFLX and CPFX showed almost the same permeation as IPM. This method of measuring penetration rates of antimicrobial agents through biofilm is very simple and useful for the evaluation of antibiotics against biofilm-forming bacteria.     

Ovarian stimulation and in vitro fertilization in women with mature cystic teratomas

OBJECTIVE: To report the results of ovulation induction and in vitro fertilization-embryo transfer (IVF-ET) in patients with ovarian cystic teratomas. METHODS: Six women with ultrasonographically diagnosed ovarian cystic teratomas (mean diameter 2.4 cm) who presented with infertility underwent IVF-ET (n = 4) or ovulation induction (n = 2). Serial ultrasound examinations were used to determine the size of the cystic teratomas during therapy and throughout pregnancy. RESULTS: Ovarian stimulation was successful, as evidenced by the serum estradiol concentration on the day of hCG administration (mean in IVF-ET patients, 3558+/-1319 pg/mL) and the number of oocytes retrieved (10+/-4.24). Three patients having IVF-ET and both patients having ovulation induction conceived, and six healthy infants were born. Cyst sizes remained unchanged throughout treatment and pregnancy. There were no cyst-related complications during ovulation induction or IVF-ET, or during the entire course of pregnancy, labor, and delivery. CONCLUSION: The presence of ovarian cystic teratoma should not be considered a contraindication for therapy in women undergoing ovulation induction and IVF-ET.     

Laparoscopic removal of gonads containing on occult seminoma in a woman with complete androgen resistance

Although nomograms to convert readings of resistance (R) and reactance (Xc) into estimates of body composition have begun to emerge for children as well as adults, there has been reluctance to use bioelectrical impedance analysis (BIA) in very young children due to the irritability of children, measurement instability, positioning of electrodes, and, of course, reproducibility of measurements. The precision of completely independent measurements of BIA indices was evaluated by two observers by comparing a series of 40 measurements of R and Xc and 36 measurements for weight in four malnourished children on 10 different days during the course of their nutritional recuperation. For weight, the CV (coefficient of variation) was 3.5% for observer A and 3.8% for observer B. There were no differences in the means across observers with respect to weight, R, and Xc. The results obtained in this study illustrate that properly trained observers following the same standards can produce equivalent data for BIA and weight measurements even in sick children.     

Toxic shock syndrome presenting as postoperative diarrhea in a postmenopausal woman

Three days after laminectomy, toxic shock syndrome (TSS) presented as acute diarrhea, rash, and fever in a 62-year-old postmenopausal woman. Forty-eight hours later, the full syndrome of TSS developed. Exploration of a benign-appearing wound revealed an occult Staphylococcus aureus infection. This report and literature review underscore the need to consider TSS in the differential diagnosis of acute diarrhea regardless of age, sex, race, and menstrual status, particularly when there has been recent soft tissue infection, injury, or surgery of any type.     

The effect of androgen deprivation on malignant and benign prostate tissue

The purpose of this research was to describe the changes in marker expression and histologic morphology following androgen deprivation in malignant and benign human prostates. Fourteen patients receiving pre-radical prostatectomy total androgen deprivation had pre- and post-androgen deprivation evaluation of marker expression and histologic morphology (both malignant and benign). Marker expression was significantly reduced for serum (p < 0.0001) and tissue (p < 0.004) PSA as well as bcl-2 expression (p < 0.008). There were significant histologic increases in vacuolization (p < 0.001), pyknosis (p < 0.04), fibrosis (p < 0.01) and lymphocytic infiltration (p < 0.008) in the malignant tissue. There were significant increases in squamous metaplasia (p < 0.0002), fibrosis (p < 0.0005), basal cell hypertrophy (p < 0.0005) and lymphocytic infiltration (p < 0.0002) in the benign tissue. Androgen deprivation therapy produces significant changes in marker expression and morphology in prostate specimens. At times these iatrogenic changes can be confusing. Clinicians and pathologists must be aware of these changes.     

Mature cystic teratomas of the ovary with intestinal wall structures harboring intestinal- type epithelial neoplasms

We report on a newborn infant with male pseudohermaphroditism and glomerular lesions (Denys-Drash syndrome) but without Wilms tumor. A constitutional heterozygous mutation in the WT1 gene (366Arg to His) was identified. In addition the child had a large diaphragmatic hernia, so far not described in Denys-Drash syndrome. The expression of the WT1 gene in pleural and abdominal mesothelium and the occurrence of diaphragmatic hernia in transgenic mice with a homozygous WT1 deletion strongly suggests that the diaphragmatic hernia in this patient is part of the malformation pattern caused by WT1 mutations.     

Precocious mating in male rats following treatment with androgen or estrogen.

Conducted 5 experiments with 179 male Royal Victoria Hospital hooded rats. Daily subcutaneous injections of 1,000 MUg/100gm testosterone propionate of 5 MUg/100gm estradiol benzoate (EB) after postnatal Day 10 accelerated initial intromission and ejaculation in intact Ss. Precocious Ss continued to copulate after treatments were stopped. Age at the 1st display of intromission was unrelated to age at the 1st injection of EB. However, initiation of EB treatments before Day 11 was associated with rapid loss of intromission following cessation of treatment in adulthood. EB activated the 1st mating of prepuberally castrated and sham-operated Ss with nearly equal facility. Also, prepuberal castrates primed with EB subsequently intromitted after receiving fewer androgen replacement injections than control Ss. (24 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A compound nevus in a benign cystic teratoma of the ovary

The occurrence of a compound nevus in an ovarian benign cystic teratoma is presented. This appears to be the first report of this lesion in the ovary without coincident melanoma. The case illustrates a probable origin for ovarian melanoma and raises a question concerning the origin of the melanocyte.     

The CAG repeat within the androgen receptor gene and benign prostatic hyperplasia

Thalidomide, a glutamic acid derivative, has recently been shown to inhibit in vitro angiogenesis, the process of formation of new blood vessels. This Phase II study examined the pharmacokinetics of thalidomide in patients with clinically progressive hormone-refractory prostate cancer. Patients (aged 55 to 80 years) were randomized to two different arms, low dose versus high dose. Patients in the low-dose group were given 200 mg of thalidomide and patients in the high-dose group received 200 mg of thalidomide, with subsequent dose escalations to 1200 mg. Serial serum or blood samples were obtained for pharmacokinetic assessment after administration of a single oral dose or multiple daily dosing of thalidomide and were assayed by reversed-phase HPLC. Pharmacokinetic parameters for both the single and multiple dosing were calculated with ADAPT II. A one-compartment model best fit the data. After single dosing, the oral clearance and apparent volume of distribution for the low-dose regimen (n = 13) were 7.41 +/- 2.05 L/h and 66.93 +/- 34.27 L, respectively, whereas for the high-dose regimen (n = 11), these values were 7.21 +/- 2.89 L/h and 165.81 +/- 84.18 L, respectively. The elimination half-lives for the low and high dose were 6.52 +/- 3.81 and 18.25 +/- 14.08 h, respectively. After the multiple dosing of thalidomide, the oral clearance and apparent volume of distribution for the low-dose group (n = 10) were 6.35 +/- 1.64 L/h and 64.63 +/- 23.20 L, respectively, whereas for the high-dose group (n = 11), these values were 7.73 +/- 2.27 L/h and 167.85 +/- 82.08 L, respectively. The elimination half-lives for the low and high dose were 7.08 +/- 1.87 and 16.19 +/- 9.57 h, respectively. For both the single and multiple dosing of thalidomide, the apparent volume of distribution and half-life were significantly higher for the high-dose group than those for the low-dose group. The higher apparent volume of distribution may be attributable to several factors, such as change in absorption, protein binding, etc. A dose-proportional increase in thalidomide steady-state concentrations was seen after multiple daily dosing of thalidomide.     

Video-assisted thoracoscopic excision of a benign cystic mesothelioma of pleura

We are reporting on the case of a 44-year-old woman upon which video-assisted thoracoscopic excision of a benign cystic mesothelioma of the pleura was performed. To our knowledge, this is the second report on a case of a benign cystic mesothelioma of the pleura. The cyst in our case was solitary and was easily excised. Microscopic examination revealed that the cyst was lined by a single layer of flattened and cuboidal cells. Immunohistochemical analysis revealed that the cells lining the cyst stained positively for keratin and negatively for factor VIII-related antigen. Benign cystic mesothelioma of the pleura was diagnosed based on histological findings. For seven months her condition has been monitored at our out-patient clinic with no signs of recurrence. However, continued careful observation is required because benign cystic mesothelioma often recurs locally. Local recurrence is thought to be related to incomplete resection of the tumor. Therefore, careful observations and techniques to ensure complete resection of the cyst, are important during video-assisted thoracoscopic surgery.     

Labial adhesion presenting as urinary incontinence and dysuria in a postmenopausal woman: a case report

A 68-year-old woman admitted to our hospital complaining of urinary incontinence and dysuria. On examination, the labia were found to be fused extensively, with a pinhole opening at the midline. Under spinal anesthesia, the adhesion was clearly separated with the Hegar's dilator. There remains no recurrence in this patient following therapy. The labial adhesion was considered to be an acquired disease caused by infection, trauma in the genitalia, or sexless life, according to hypoestrogenism.     

Acute hemodynamic effects of estrogen administration in postmenopausal women

The hemodynamic effects of estrogens in replacement doses have not been fully clarified; therefore, we studied the acute hemodynamic changes after 0.625 and 1.25 mg of conjugated estrogens, administered intravenously, using a thermodilution catheter, in postmenopausal women without structural heart disease. Pulmonary and systemic pressures and resistances and stroke volume did not change compared with baseline, but heart rate and cardiac output decreased significantly, which may be associated with estrogen's previously described calcium-blocking effect or with a more recently contemplated beta-blocking action.     

Kikuchi''s disease: a benign cause of pyrexia of unknown origin with lymphadenopathy

Varicose veins are a major and increasing burden on the health service with waiting lists growing in the majority of units. Most successive Governments have funded waiting list initiatives to deal with this problem. We report the results of a one year varicose vein waiting list initiative which dealt with a total of 1104 patients. A standard triage regime was established. Two hundred and eighty five patients were removed from the waiting list due to failure to attend, surgery performed elsewhere, medically unfit or no longer wishing to have surgery. There were 63 late cancellations and 23 operations were cancelled following admission due to unrelated medical complications. Planned operating lists worked well and complications were uncommon. Several important lessons were learnt during this initiative and recommendations are made with regard to the optimal method of dealing with the problem of varicose veins.     

Solid cystic tumor of the head of the pancreas in a young woman

This a case report of a solid papillary tumor of the pancreas in a young woman of 18 years, who was referred to after having suffered for a period of 8 months with a rather vague symptomatology, characterized by dyspepsia, fatigue and, towards the end of the 8 month period, weight loss (approximately 2 kg). In the last week, as a consequence of a modest abdominal trauma, the patient was submitted to abdominal CT that showed a burden at the head of the pancreas, demonstrating a round neoformation about 6 cm in diameter with solid echogenicity slightly hypodense. Subsequently, she underwent an operation with the diagnosis of pseudocystis of the pancreas. During surgery, a big cystic formation of the head of the pancreas, into which a drain was introduced, was revealed. The histological postoperative examination was compatible with pancreatic tumor with a low grade of malignancy, cystic papillary or solid papillary type. Therefore, the patient came under our observation and underwent an operation of pancreatoduodenectomy. Two years after the operation, the patient had completely recovered. In this case, we discussed the problem of performing certain preoperative diagnoses despite the aid of modern diagnostic imaging, this being a very rare illness that almost exclusively plagues young women (median age 19 years). This diagnosis has an uncertain histological origin and is generally accompanied by a modest and vague symptomatology. The surgical procedure, given the low grade of malignancy of the neoplasm and the excellent long-term prognosis, must be, with respect to the oncological radicality, as conservative as possible.