Ovarian papillary serous cancer recurrence with ipsilateral isolated axillary lymph node metastasis as an unusual presentation: A case report

Introduction: From among gynecologic cancers, epithelial ovarian cancer (EOC) is the leading cause of mortalities due to gynecologic cancers in the United States, constituting 3.6 of all types of gynecologic cancers. A major reason for this poor treatment outcome is that most EOC patients are frequently diagnosed in advanced stages of the disease. A standard management for EOC patients involves a primary cytoreductive surgery followed by adjuvant chemotherapy if needed. However, primary breast cancer is one of the most common malignancies in women, and metastasis of other cancers to the breast is relatively rare. Case Presentation: Here, we report the case of a 70-year-old patient who five years ago had undergone laparotomy due to post-menopausal bleeding, adnexal mass, and elevated CA125. With the diagnosis of metastatic papillary serous, she underwent primary cytoreductive surgery and adjuvant chemotherapy. Regarding the history of ovarian cancer diagnosed five years ago, and further examination of this suspicious lymph node, and rejection of the risk of breast cancer, the patient was examined for the risk of metastasis. In biopsy and immunohistochemistry study, metastatic lymph node was diagnosed with the origin of epithelial ovarian cancer, and the patient was treated with beta-taxol + carboplatin, and the size of the axillary lymph node shrank. Conclusion: Regarding the unusual nature of recurrence of ovarian cancer as isolated axillary lymph node involvement, this report emphasizes the importance of considering metastasis in the axilla and its differential diagnosis from breast cancer in patients with a history of ovarian cancer, since prognoses and treatments are different for each diagnosis. © 2018, Mashhad University of Medical Sciences. All Rights Reserved

Craniometrical imaging and clinical findings of adult Chiari malformation type 1 before and after posterior fossa decompression surgery with duraplasty

Background: Posterior fossa decompression both with and without duraplasty are accepted treatments for symptomatic adult patients with Chiari Malformations Type 1 (CM-1). There is still debate of the superiority of one technique over the other. The purpose of this study was to determine the clinical and craniometrical imaging outcomes of a series of patients who underwent posterior fossa decompression with duraplasty. Materials and methods: All adult patients with symptomatic CM-1 operated at a single institution with a minimum of 6 months follow-up were enrolled prospectively. Clinical outcomes and craniometrical parameters based upon MR imaging pre- and post-surgery were analyzed. Results: A series of 33 consecutive patients who met the inclusion criteria were enrolled; mean age of 33.93 ± 10 years (range 14�56 years). The most common preoperative complaint was headache. The most common clinical sign was sensory dysfunction which was relieved or improved in 63 of patients. The mean syringomyelia size had a significant reduction after the surgery (p =.01). The mean tonsillar descent also had significant reduction (p =.00). The mean McRae line length before the surgery and after that were 33.4 and 53.1 mm respectively that this change was not statistically significant (p =.42). The odontoid process parameters had no significant changes after surgery. Conclusions: Posterior fossa decompression surgery with duraplasty can improve both clinical and imaging outcomes such as syringomyelia size and tonsillar descent for patients with symptomatic CM-1. However, no significant difference was found in craniometrical parameters before and after the surgery. © 2019, © 2019 The Neurosurgical Foundation

Factors predicting the outcome of intravenous thrombolysis in stroke patients before rt-PA administration

Background: To determine whether it is possible to predict intravenous thrombolytic therapy (IVT) outcome after 3 months in acute ischemic stroke patients who are candidate to receive recombinant tissue plasminogen activator (rt-PA), before rt-PA administration based on their risk factors and some available laboratory results. Methods: We enrolled 118 ischemic stroke patients who were treated with standard dose of Alteplase in our hospital. Baseline characteristics, door-to-needle time (DTN), onset-to-treatment time (OTT), the National Institute Health Stroke Scale (NIHSS), systolic and diastolic blood pressure on admission, history of diabetes, hypertension, dyslipidemia, coronary artery disease (CAD), previous ischemic stroke, atrial fibrillation (AF), laboratory results were retrospectively collected. The modified Rankin Scale (MRS) was recorded after 3 months of admission and patients were divided into good (MRS 2) and poor (MRS>2) outcome groups. Chi-square test and t-test were used for categorical and continuous variables, respectively. Predictors for outcome after 3 months were studied by multivariable logistic regression. Results: Good outcome was seen in 60 (51) patients and poor outcome was seen in 58 (49) patients. Significant predictors for outcome at 3 months according to multivariable regression analysis were NIHSS score (odds ratio OR, 0.61; 95% confidence interval CI, 0.498-0.750; p<0.001), SBP (OR, 0.95; 95% CI, 0.925-0.991; P=0.01), AF (OR, 0.09; 95% CI, 0.013- 0.708; P=0.02), CAD (OR, 17.08; 95% CI, 0.013-0.708; p=0.003). Conclusion: Higher NIHSS score, higher SBP on admission, AF and history of CAD could be the independent predictors of outcome after IVT in acute ischemic stroke patients. © 2019 Babol University of Medical Sciences. All rights reserved