Cranial and intra-axial metastasis originating from a primary ovarian Dysgerminoma.

Dysgerminomas are aggressive germ cell tumors that typically have a favorable prognosis, especially in patients diagnosed with early stage disease. We recount the history of a 23-year-old woman who was treated for a stage IA ovarian dysgerminoma in November 2017. Postoperatively, the patient was noncompliant insofar as obtaining routine lab evaluations; ten months later, she was diagnosed with a cranial metastasis that extended into the meninges. The patient subsequently underwent a posterior fossa craniotomy and adjuvant etoposide, bleomycin and cisplatin chemotherapy to which she initially responded; however, during cycle 4, she developed pancytopenia whereupon the chemotherapy was summarily discontinued. Thereafter, the patient was surveilled and currently, she remains in clinical remission. Early stage ovarian dysgerminoma, albeit rarely, has the capacity to metastasize to the cranium or brain, further underscoring the significance of employing active follow-up with these patients

Complications of the spine in ankylosing spondylitis with a focus on deformity correction

NKYLOSING spondylitis is a systemic inflammatory disease of unknown origin. Affected patients are predominantly but not exclusively male. Chronic inflammatory back pain is the most common presenting symptom and typically develops between the ages of 20 and 40 years. 65 Patients with AS can also have extra-articular manifestations such as ocular, cardiac, pulmonary, gastrointestinal, and renal involvement. A patient's susceptibility to the disease is largely genetically determined. 60 Because there is no single suitable laboratory test, clinicians must know as many of the characteristic signs and symptoms as possible to make a diagnosis. Even though AS is a systemic disease, the presenting symptoms, treatment, and morbidity are largely dependent on how the disease affects the spine. Thus, we believe that a review on spinal disease in AS will be of great value. In this review, we first describe the latest published algorithm to diagnose early disease and the classic inflammatory lesions. We then explore the diseased spine's susceptibility to noninflammatory lesions such as microfractures and deformity. We also describe other sequelae of AS, such as early osteoporosis and CES. Both the medical and surgical approaches to treatment are summarized. There is a special focus on osteotomy techniques. By the conclusion of the article, the clinician should have a better understanding of the diagnostic and treatment possibilities in AS spinal disease. Diagnosis of Inflammatory Back Pain and AS Because AS can markedly respond to the newer biological agents (discussed later), effective treatment of the disease requires early diagnosis. However, the high prevalence of back pain in the general population and the lack of radiographically demonstrated characteristic lesions in early AS often delay recognition of the disease. To make an early diagnosis, it is important to distinguish inflammatory from mechanical back pain on presentation. Factors consistent with inflammatory back pain include morning stiffness lasting longer than 30 minutes, onset of chronic back pain at an early age (before 35 years of age), improvement in pain with physical activity rather than with rest, awakening with back pain during the 2nd half of the night, alternating buttock pain, and a prolonged period of back pain. 48 One factor by itself does not have sufficient sensitivity or specificity to determine if the back pain is inflammatory. Note, however, that in a study of European patients with AS in which only 4 factors were considered, if 2 symptoms Abbreviations used in this paper: AS = ankylosing spondylitis; CES = cauda equina syndrome; DEXA = dual energy x-ray absorptiometry; HLA = human leukocyte antigen; MR = magnetic resonance; NSAID = nonsteroidal antiinflammatory drug; PSO = pedicle subtraction osteotomy; SPO = Smith-Peterson osteotomy; TNF = tumor necrosis factor

Sertoli cells maintain leydig cell number and peritubular myoid cell activity in the adult mouse testis

The Sertoli cells are critical regulators of testis differentiation and development. In the adult, however, their known function is restricted largely to maintenance of spermatogenesis. To determine whether the Sertoli cells regulate other aspects of adult testis biology we have used a novel transgenic mouse model in which Amh-Cre induces expression of the receptor for Diphtheria toxin (iDTR) specifically within Sertoli cells. This causes controlled, cell-specific and acute ablation of the Sertoli cell population in the adult animal following Diphtheria toxin injection. Results show that Sertoli cell ablation leads to rapid loss of all germ cell populations. In addition, adult Leydig cell numbers decline by 75% with the remaining cells concentrated around the rete and in the sub-capsular region. In the absence of Sertoli cells, peritubular myoid cell activity is reduced but the cells retain an ability to exclude immune cells from the seminiferous tubules. These data demonstrate that, in addition to support of spermatogenesis, Sertoli cells are required in the adult testis both for retention of the normal adult Leydig cell population and for support of normal peritubular myoid cell function. This has implications for our understanding of male reproductive disorders and wider androgen-related conditions affecting male health