Pregnancy complicated with struma ovarii is rare. We report a case of struma ovarii that enlarged during pregnancy. We also immunohistochemically investigated the expression of estrogen receptors (ER), progesterone receptors (PR), and thyroid stimulating hormone receptors (TSHR) in tumor cells to explore the mechanism of lesion enlargement. A 30-year-old woman was diagnosed with right ovarian mature teratoma 4 cm in diameter using MRI five months before pregnancy. After she became pregnant, transvaginal ultrasonography revealed that the mass size was gradually increased. MRI examination was again performed at 14 weeks of gestation, which showed enlargement of the tumor to 5.5 cm in diameter, however, there was no apparent malignant finding. The clinical diagnosis was mature teratoma or struma ovarii of the right ovary. Laparoscopy-assisted ovarian cystectomy was performed at 15 weeks of gestation, and the pathological diagnosis of the removed tumor was struma ovarii. Immunohistochemical examination of the tumor demonstrated the positive expression of PR, but the expression of ER and TSHR was negative. In the present case, the size of struma ovarii was increased during pregnancy, and this enlargement may be induced by pregnancy-related hormonal milieu via PR.
Meningioma, a benign tumor arising from the meninges, is reported to grow during pregnancy. Therefore, the first symptom may appear during pregnancy. We report a case of pregnancy complicated with spinal meningioma, who showed back pain as the first symptom followed by progressing neuropathy, which required surgical management. A 34-year-old woman experienced low back pain at 32 weeks of gestation. She then noticed numbness and muscle weakness in the lower limbs at 34 weeks of gestation. She visited our hospital at 37 weeks of gestation because of worsening motor disorder of the lower limbs and urinary and fecal incontinence. MRI revealed an intradural, extramedullary spinal tumor 20mm in diameter at the level of C7. Surgical decompression seemed necessary because the symptoms deteriorated even after hospitalization. Cesarean section under general anesthesia was performed at 37 weeks of gestation, and a 2478g male infant was delivered uneventfully. However, the symptoms worsened even after the Cesarean section ; therefore, the spinal tumor was removed in the prone position on the same day as the Cesarean section. After surgery, the neuropathy gradually improved. The pathological diagnosis of the removed tumor was meningioma and immunohistochemical staining showed the expression of progesterone receptor. Although lower back pain is a common symptom during pregnancy, meticulous examination including MRI should be considered when the pain is associated with neuropathy. Additionally, physicians should be aware of the possibility of rapid onset and progression of neuropathy during pregnancy in cases of spinal meningioma.
Neonatal transient myocardial ischemia (TMI) is a rare disease, and is known in term infants to show cyanosis, congestive heart failure, and acute left heart failure after birth, which needs differential diagnosis from severe congenital heart disease. We describe the case of a 2898g female term neonate with TMI. The course of pregnancy and delivery was normal. Because of a slow increase of saturation of percutaneous oxygen (SpO2) in the lower limbs, she required oxygen administration, and was admitted to the neonatal intensive care unit. Echocardiography revealed no cardiac malformations, but the left ventricular function was markedly reduced (left ventricular fractional shortening 14.5%). Moreover, right to left shunts in the ductus arteriosus and retrograde aortic arch blood flow were observed. Brain natriuretic peptide (BNP) was 888.5pg/ml. She was dependent on dopamine, dobutamine and phosphodiesterase-3 inhibitors to keep blood pressure in the normal range. At the age of 1 day, the left ventricular systolic function improved, and almost normalized at 3 days. After the drug infusions were discontinued, normal cardiac function was maintained, and she was discharged at the age of 14 days. As diseases exhibiting a difference in SpO2 in the upper and lower limbs after birth, congenital heart diseases such as aortic stenosis, and persistent pulmonary hypertension of newborns are well known. However, right-to-left shunting ductus arteriosus was considered to be one of the pathological conditions that could be observed in newborns with severe low cardiac output. SpO2 measurement in both the upper and lower limbs seems to be useful for early diagnosis of severe TMI.
An 82-year-old man had suffered from diplopia for 1.5 months, and he was referred to our department by an ophthalmologist due to bilateral abducens and oculomotor nerve palsy. Head CT and contrast brain MRI revealed a mass lesion with compression of the pituitary gland and bilateral cavernous sinus at the parasellar region. Bony erosion in the sella turcica and clivus was also confirmed. The serum β-D glucan and aspergillus antigen level were not elevated. The lesion was removed by the endoscopic endonasal approach. Creamy yellow pus and a black necrotic mass were removed. Histopathological examination demonstrated numerous aspergillus hyphae. Voriconazole and prednisolone were given postoperatively. The bilateral abducens and oculomotor nerve palsy gradually improved. Aspergillus sellar abscess is extremely rare and not recognized well among neurosurgeons. However, aspergillus sellar abscess is a life-threatening infection. Systemic antifungal therapy following endoscopic surgical resection in the acute phase is required for improvement of cranial nerve palsy and prevention of intracranial invasion. Preoperative diagnosis of aspergillus abscess in the sellar region is difficult in some cases. We report the clinical features, characteristics of radiological findings and optimal treatment for aspergillus sellar abscess.