Superficial Echogenic Lesions Detected on Neonatal Cranial Sonography: Possible Indicators of Severe Birth Injury.

OBJECTIVES: The purpose of this study was to evaluate the characteristics and importance of superficial echogenic lesions around cranial sutures on neonatal cranial sonography. METHODS: We retrospectively reviewed the clinical records and neuroimaging studies of 40 neonates who had superficial echogenic lesions around sutures on neonatal cranial sonography. Magnetic resonance imaging (n = 18) and computed tomography (n = 2) were performed within 2 weeks after sonography. We correlated sonographic findings with computed tomographic and magnetic resonance imaging findings and analyzed them. We also evaluated the associated lesions, neurologic signs, and follow-up changes. RESULTS: Sonographically, the superficial echogenic lesions involved both sulci and perisulcal parenchyma in 39 neonates and were located in the frontal and parietal areas around the sagittal suture in 38 neonates. Magnetic resonance imaging revealed a pattern of hypoxic ischemic encephalopathy in 9 neonates, birth trauma in 3 neonates, a mixed pattern of hypoxic ischemic encephalopathy and trauma in 3 neonates, nonspecific single infarctions in 2 neonates, and lack of a defined lesion in 1 neonate. The associated lesions were subdural hemorrhage (n = 12), epidural hematoma (n = 4), germinal matrix hemorrhage (n = 3), intraventricular hemorrhage (n = 2), and periventricular leukomalacia (n = 1). All epidural hematomas were associated with scalp hematoma, and 2 patients had skull fractures. One neonate with epidural hematoma associated with a hypoxic ischemic encephalopathy pattern showed mild spasticity in both ankles until 16 months. CONCLUSIONS: Superficial echogenic lesions detected around cranial sutures on neonatal sonography may be an indicator of more serious intracranial lesions such as more extensive hypoxic ischemic encephalopathy and intracranial hematomas, including epidural hematoma.

Costunolide inhibits osteoclast differentiation by suppressing c-Fos transcriptional activity.

Costunolide, a sesquiterpene lactone, exhibits anti-inflammatory and anti-oxidant properties and mediates apoptosis. However, its effects and mechanism of action in osteoclasts remain unknown. Herein, we found that costunolide significantly inhibited RANKL-induced BMM differentiation into osteoclasts in a dose-dependent manner without affecting cytotoxicity. Costunolide did not regulate the early signaling pathways of RANKL, including the mitogen-activated protein kinase and NF-κB pathways. However, costunolide suppressed nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1) expression via inhibition of c-Fos transcriptional activity without affecting RANKL-induced c-Fos expression. The inhibitory effects of costunolide were rescued by overexpression of constitutively active (CA)-NFATc1. Taken together, our results suggest that costunolide inhibited RANKL-induced osteoclast differentiation by suppressing RANKL-mediated c-Fos transcriptional activity.

Adenoma malignum of the uterine cervix: imaging features with clinicopathologic correlation.

BACKGROUND: Adenoma malignum, also known as minimal deviation adenocarcinoma, is a subtype of mucinous adenocarcinoma of the cervix. PURPOSE: To evaluate the clinical, pathologic, and imaging features of the adenoma malignum of the uterine cervix. MATERIAL AND METHODS: We retrospectively analyzed the CT and MRI findings in 13 patients: size, endoluminal fluid, appearance of the solid and cystic component, margin, enhancement, characteristics of locules of the cystic lesion, tumor spread, and associated ovarian lesion. Clinical and pathologic features were determined in 24 patients. RESULTS: The mean of the major tumor diameter was 4.1 cm (range, 2.2-6.5 cm). In the imaging features, 77% of 13 tumors demonstrated endoluminal fluid. All tumors showed enhancing solid components; 62% were multicystic and 38% had solid lesions. Most solid lesions exhibited an irregular margin (80%). The locules of the multicystic lesions tended to have smooth margins (75%), to have an average major diameter of ≤1 cm (88%), and to be 11-20 in number (75%). The solid lesions were associated with invasion and metastases (60%). Clinically, 38% of 24 patients had watery discharge and 13% had Peutz-Jeghers syndrome, while pathologically, most patients were low stage (I or II) (83%). Over the 2-year follow-up of 17 patients, 82% was free from disease. The patients with more aggressive tumors or an unfavorable prognosis that manifested as tumor recurrence or metastasis tended to have invasion, watery discharges, high stages (III or IV) (100%) and solid lesions, metastases, and associated ovarian lesions (67%). CONCLUSION: Awareness of imaging features as well as clinicopathologic manifestations of adenoma malignum can aid in accurate diagnosis, treatment, and prediction of prognosis.

Congenital portosystemic shunts: prenatal manifestations with postnatal confirmation and follow-up.

OBJECTIVES: The purpose of this study was to evaluate prenatal sonographic findings that could be helpful for diagnosis of congenital intrahepatic portosystemic venous shunts and the follow-up results. METHODS: Six neonates with congenital shunts between the portal vein and hepatic vein were enrolled in this study. Prenatal sonography was performed in 5 cases. We categorized the cases according to a previously published classification of intrahepatic portosystemic venous shunts and retrospectively reviewed the prenatal and postnatal sonographic examinations to identify findings that might be helpful for diagnosing shunts prenatally. Follow-up sonographic examinations were done until closure of the shunts. Clinical features were also determined. RESULTS: According to the original reports, intrahepatic portosystemic venous shunts were diagnosed by prenatal sonography in 2 of 5 cases. In the remaining 3 cases, there were suggestive abnormal findings on retrospective review, including an abnormal intrahepatic tubular structure, a prominent hepatic vein, and congestive heart failure. Postnatal sonography showed type 2 shunts in all 6 cases. In 1 case, there were 2 type 2 lesions between two branches of the left portal vein and the middle and left hepatic veins. On follow-up sonography, 5 of the 6 congenital shunts had spontaneously closed by 11 months of age. One case was treated with coil embolization during the neonatal period. Intrauterine growth restriction was the most commonly clinical feature prenatally. CONCLUSIONS: Findings such as an abnormal tubular structure, a prominent hepatic vein, and congestive heart failure can be important clues for identifying congenital intrahepatic portosystemic venous shunts on prenatal sonography. The use of prenatal and postnatal sonography is feasible for detection and evaluation of these shunts.

Paleoparasitological surveys for detection of helminth eggs in archaeological sites of Jeolla-do and Jeju-do.

A paleoparasitological survey to detect helminth eggs was performed in archaeological sites of Jeolla-do and Jeju-do, the Republic of Korea. Total 593 soil samples were collected in 12 sites of Jeolla-do and 5 sites of Jeju-do from April to November 2011, and examined by the methods of Pike and coworkers. A total of 4 helminth eggs, 2 eggs each for Trichuris trichiura and Ascaris sp., were found in soil samples from 1 site, in Hyangyang-ri, Jangheung-eup, Jangheung-gun, Jeollanam-do. The egg-recovery layer was presumed to represent a 19th century farm, which fact suggested the use of human manures. This is the third archaeological discovery of parasite eggs in Jeolla-do. Additionally, no helminth eggs in archaeological sites of Jeju-do is an interesting problem to be solved in the further investigations.

Clear Cell Borderline Tumor of the Ovary: A Case Report.

Clear cell borderline ovarian tumor (CCBOT) is quite rare, and only a few cases of CCBOT have been reported. Unlike most borderline ovarian tumors, CCBOTs appear solid because they are almost always pathologically adenofibromatous. Herein, we report the MRI findings of a CCBOT discovered in a 22-year-old female.

Ectopic lesions in the abdomen and pelvis: a multimodality pictorial review.

Various ectopic lesions occur in the abdomen and pelvis and affect multiple organs including liver, gallbladder, pancreas, spleen, and organs of the genitourinary system. Ectopic organs may be present outside their normal positions, or ectopic tissues may develop while the original organ exists in its normal position. Both benign and malignant lesions can occur in ectopic organs and tissues. Owing to their unusual location, they can often be misdiagnosed as other lesions or even malignant lesions, such as metastasis or seeding. This multimodality pictorial review provides various cases of ectopic lesions in the abdomen and pelvis, which will help narrow the differential diagnosis and guide clinical decision-making.

Multilocular cystic lesions in the uterine cervix: broad spectrum of imaging features and pathologic correlation.

OBJECTIVE: The objective of this article is to describe the broad spectrum and imaging features of multilocular cystic lesions in the uterine cervix from benign lesions, such as uterine cervicitis, endocervical hyperplasia, nabothian cyst, and tunnel cluster, to malignant lesions including adenocarcinoma and adenoma malignum. CONCLUSION: Familiarity with the clinical setting and imaging features of multilocular cystic lesions in the uterine cervix can help prevent unnecessary radical surgery before histopathologic proof of malignancy and can facilitate prompt and accurate diagnosis and treatment.

High-resolution sonographic findings of ovarian granulosa cell tumors: correlation with pathologic findings.

OBJECTIVE: This study was performed to determine the high-resolution sonographic findings of ovarian granulosa cell tumors (GCTs) and to correlate the sonographic findings with the pathologic findings. METHODS: A retrospective review of sonographic findings was conducted on 16 patients with surgically proven ovarian GCTs. Patients' ages ranged from 10 to 64 years (mean, 37.7 years). We evaluated the sizes and morphologic appearances of the ovarian tumors. The blood flow patterns of the tumors were assessed with Doppler sonography (n = 6). Sonographic findings were compared with pathologic findings. RESULTS: The maximal diameters of the masses were 2.0 to 15.4 cm (mean, 8.2 cm). The morphologic appearances of the masses were classified into 3 patterns; solid and cystic (n = 10), solid with a sponge form appearance (n = 4), and entirely solid (n = 2). The measured resistive index and pulsatility index of the solid portions were 0.23 to 0.5 and 0.26 to 0.62, respectively. Pathologic diagnoses of 13 adult ovarian GCTs and 3 juvenile GCTs were obtained. The solid and cystic masses had GCTs with macrofollicular and microfollicular patterns pathologically. The solid masses with a sponge form appearance had prominent hemorrhagic necrosis and diffuse proliferation of granulosa cells with trabecular and microfollicular patterns. The entirely solid masses had diffuse cellular proliferation with a trabecular pattern without cystic changes or hemorrhagic foci. CONCLUSIONS: Sonographic findings of ovarian GCTs included solid and cystic masses, solid masses with a sponge form appearance, and entirely solid masses, and the sonographic findings correlated well with the histopathologic findings.

Multiparametric magnetic resonance imaging of endometrial polypoid lesions.

Endometrial polypoid lesions encompass various conditions from physiologic changes to benign or malignant disease. Differentiating between the various causes of endometrial polypoid lesions remains difficult by transvaginal sonography. Magnetic resonance imaging (MRI) can provide valuable information regarding endometrial polypoid lesions in situations where it is difficult to obtain histologic samples. Multiparametric MRI including T2-weighted images, T1-weighted fat-saturation contrast-enhanced images, and diffusion-weighted images may be helpful for differentiating the various endometrial polypoid lesions and establishing specific diagnoses and appropriate treatment.

Serial transvaginal sonographic findings of cervical ectopic pregnancy treated with high-dose methotrexate.

OBJECTIVE: We analyzed transvaginal sonographic findings from patients with cervical ectopic pregnancies treated with high-dose methotrexate (MTX). METHODS: This was a retrospective analysis of cervical pregnancies diagnosed in our institution from 1996 through 2006. We divided the cases into an MTX treatment group and a surgical treatment group. We included cases treated with high-dose MTX alone. We analyzed 9 cervical ectopic pregnancies treated with MTX, which was injected intravascularly at 100 mg/m(2) plus 200 mg/m(2) in 500 mL of a normal saline solution with folinic acid rescue. The gestational sac sizes and serum human chorionic gonadotropin (hCG) levels were periodically monitored to determine the resolution status. RESULTS: Fifty cervical pregnancies were diagnosed during the study period. Thirty cases were treated with MTX, and 20 were treated with surgical procedures. Among the 30 cases in the MTX treatment group, 9 had high-dose MTX injection without surgical procedures. Cervical mass regression appeared at a median of 40 (range, 10-88) days after treatment, whereas the serum hCG level decreased at a median of 14 (range, 9-17) days after treatment. The median time to complete regression of the cervical mass was 86 (range, 48-141) days, and the median time to complete regression of the serum hCG level was 68 (range, 19-143) days. Cervical pregnancy was noted as a gestational sac at first but coexisted with a mixed echoic lesion 19 days after treatment. At 33 days after treatment, the cervical pregnancy was completely replaced by the mixed echoic lesion. CONCLUSIONS: Resolution of the cervical mass on sonography lagged far behind resolution of the serum hCG level. The cervical mass evolved from a gestational sac into a mixed echoic lesion on serial transvaginal sonography.

Characteristic sonographic vesicular pattern of a complete hydatidiform mole in the early first trimester.

OBJECTIVE: To evaluate the sonographic vesicular pattern of a complete hydatidiform mole (CHM) in the early first trimester. STUDY DESIGN: A retrospective study was performed on 30 cases of histologically proven CHMs in the early first trimester. Two radiologists reviewed the sonograms of all cases before evacuation and determined the extent of vesicular pattern for each case independently. The extent of vesicular area was divided into 4 categories: absent, mild (less than one third), moderate (one third to two thirds) or severe (more than two thirds). Interobserver agreement between the reviewers was calculated by weighted kappa. RESULTS: The mean gestational age of all cases at ultrasound was 7.6 +/- 2.0 weeks (mean +/- SD) with a range of 5.0-12.5 weeks. Reviewer 1 classified the extent of sonographic vesicular pattern as absent (10%), mild (63.3%), moderate (20%) and severe (6.7%). Reviewer 2 classified the cases as absent (10%), mild (53.3%), moderate (33.3%) and severe (3.3%). There was almost perfect agreement in categorizing the vesicular pattern between the reviewers (kappa = 0.866). CONCLUSION: A mild sonographic vesicular pattern of CHM was common in the early first trimester.

Vertebral abnormality without spine-curvature deformity on prenatal ultrasonography: sonographic findings and postnatal radiographic correlations.

PURPOSE: To evaluate prenatal US features and postnatal radiographic findings of fetuses with a sonographically detected vertebral abnormality (VA) without spine-curvature deformity (SCD). METHODS: Twenty-six fetuses showing a VA without SCD on prenatal US at our ultrasound center for a 5-year period were retrospectively identified and evaluated for sonographic data and coexisting anomalies. Medical records and postnatal radiographs of all 16 live births were reviewed. RESULTS: Coexisting major anomalies were suspected prenatally in 8/26 fetuses (30.8%). Sonographic abnormalities were noted in the vertebral body in 27/31 (87.1%) and in the posterior element in 4/31 (12.9%). US features were absent (n = 2) or small vertebral body echo (n = 21), two separate vertebral body echoes (n = 4), or smaller or lobulated posterior arch echoes (n = 4). Among 16 live-born neonates, postnatal radiographs revealed a vertebral abnormality in 20 (95.2%) of 21 prenatally detected VA without SCD. The abnormalities were vertebral body hypoplasia (18/19) with an incomplete sagittal cleft, asymmetric/unilateral hypoplasia, or hypoplasia with a complete sagittal cleft; or abnormalities in the spinous process (2/2). CONCLUSIONS: Most fetuses with prenatally detected VA without SCD had hypoplastic vertebrae on postnatal radiographs. Prenatal recognition of VA without SCD can lead to an early postnatal diagnosis of a vertebral abnormality and guidance for follow-up.

Prenatal diagnosis of aberrant right subclavian artery in an unselected population.

PURPOSE: The purpose of this study was to determine the frequency of aberrant right subclavian artery (ARSA) among unselected fetuses and to evaluate its association with chromosomal abnormalities and other congenital anomalies. METHODS: In all, 7,547 fetuses (gestational age, 20 to 34 weeks) were examined using routine antenatal sonography at our institution between April 2014 and September 2015. The right subclavian artery was assessed using grayscale and color Doppler ultrasonography in the transverse 3-vessel and tracheal view, and confirmed in the coronal plane. RESULTS: ARSA was found in 28 fetuses (0.4%). Further, 27 of these 28 fetuses were euploid (96.4%). Trisomy 18 was the only chromosomal anomaly (3.6%) found in the study sample. ARSA was an isolated finding in 23 of the 28 cases (82.1%). In the remaining three cases (10.7%), ARSA was accompanied with extracardiac anomalies. Other cardiac defects were present in three cases (10.7%). CONCLUSION: Isolated ARSA does not seem to be associated with a significantly increased risk of aneuploidy. However, the possibility of fetal karyotyping, which is a more invasive procedure, should be discussed in the light of the overall risk of the fetus.

Oral misoprostol and uterine rupture in the first trimester of pregnancy: a case report.

We are reporting the case of a woman with 8 weeks of amenorrhea who orally received a single dose of misoprostol 400 microg at midnight for ripening of cervix before uterine evacuation of an intrauterine gestational sac containing a single fetus (6.3 weeks of gestation) without cardiac activity. The patient had severe abdominal pain an hour later. Her blood pressure was 70/40 mmHg and her abdomen was slightly distended with direct and rebound tenderness. A transvaginal ultrasonography showed a 3-cm depth of a free fluid collection in the rectouterine pouch. Her hemoglobin and hematocrit levels were of 6.5 g/dL and 18.4%, respectively. A rupture of 1.5 cm at the left uterine horn with a protruding gestational sac was identified by laparoscopy. The gestational sac was removed and hemoperitoneal collection were successfully drained. The site of uterine rupture was primarily sutured and postoperative course was satisfactory. In summary, misoprostol administered in the first trimester of pregnancy may produce uterine rupture.

Dacryocystocele on prenatal ultrasonography: diagnosis and postnatal outcomes.

PURPOSE: To report the incidence of dacryocystoceles detected by prenatal ultrasonography (US) and their postnatal outcomes and to determine the factors associated with the postnatal persistence of dacryocystoceles at birth. METHODS: We retrospectively reviewed the prenatal US database at our institution for the period between January 2012 and December 2013. The medical records of women who had fetuses diagnosed with dacryocystocel larger than 5 mm were reviewed for maternal age, gestational age (GA) at detection, size and side of the dacryocystoceles, delivery, and postnatal information, such as GA at delivery, delivery mode, and gender of the neonate. RESULTS: A total of 49 singletons were diagnosed with a dacryocystocele on prenatal US, yielding an overall incidence of 0.43%. The incidence of dacryocystoceles was the highest at the GA of 27 weeks and decreased toward term. Of the 49 fetuses including three of undeter mined gender, 25 (54%) were female. The mean GA at first detection was 31.2 weeks. The dacryocystocele was unilateral in 29 cases, with a mean maximum diameter of 7 mm. Spontaneous resolution at birth was documented in 35 out of 46 neonates (76%), including six with prenatal resolution. Multivariate analysis demonstrated that GA at delivery was a significant predictor of the postnatal persistence of dacryocystoceles (P=0.045). CONCLUSION: The overall incidence of prenatal dacryocystoceles was 0.43%; the incidence was higher in the early third trimester and decreased thereafter. Prenatal dacryocystoceles resolved in 76% of the patients at birth, and the GA at delivery was a significant predictor of postnatal persistence.

Fetal musculoskeletal malformations with a poor outcome: ultrasonographic, pathologic, and radiographic findings.

The early and accurate antenatal diagnosis of fetal musculoskeletal malfomations with a poor outcome has important implications for the management of a pregnancy. Careful ultrasonographic examination of a fetus helps detect such anomalies, and a number of characteristic features may suggest possible differential diagnoses. During the last five years, we have encountered 39 cases of such anomalies, and the typical prenatal ultrasonographic and pathologic findings of a number of those are described in this article.

Prenatal ultrasound findings of fetal neoplasms.

A variety of neoplasms can develop in each fetal organ. Most fetal neoplasms can be detected by careful prenatal ultrasonographic examination. Some neoplasms show specific ultrasonographic findings suggesting the differential diagnosis, but others do not. Knowledge of the presence of a neoplasm in the fetus may alter the prenatal management of a pregnancy and the mode of delivery, and facilitates immediate postnatal treatment. During the last five years, we experienced 32 cases of fetal neoplasms in a variety of organs. We describe their typical ultrasonographic findings with correlating postnatal CT, MRI, and pathologic findings.

Complications arising in twin pregnancy: findings of prenatal ultrasonography.

Multifetal gestations are high-risk pregnancies involving higher perinatal morbidity and mortality, and are subject to unique complications including twin oligohydramnios-polyhydramnios sequence, twin-to-twin transfusion syndrome, acardiac twins, conjoined twins, co-twin demise, and heterotopic pregnancies. The purpose of this study is to describe the prenatal ultrasonographic and pathologic findings of these complications.