Paraneoplastic limbic encephalitis in a patient with extensive disease small-cell lung cancer.

Paraneoplastic limbic encephalitis (PLE) is a rare disorder infrequently accompanying malignancy, coexisting in ~50% of the cases with small-cell lung cancer (SCLC). The pathomechanism of PLE is considered to be immune-mediated, with production of specific anti-Hu antibodies and activation of T-cells directed against onconeural antigens present on both tumor cells and neurons. We herein report the case of a 50-year-old male patient who, prior to being diagnosed with SCLC, presented with typical symptoms of PLE (seizures, subacute cognitive dysfunction with severe memory impairment, anxiety and hallucinations). The initial brain magnetic resonance imaging examination revealed mild enlargement and hyperintensity of the hippocampal gyri bilaterally, with narrowed temporal horns of the lateral ventricles; the findings of the cerebrospinal fluid examination were compatible with the diagnosis of lymphocytic meningitis. Due to the suspected infectious origin of the disease, treatment with acyclovir and antibiotics was initially applied. However, following subsequent diagnosis of the underlying SCLC and the presence of antineuronal anti-Hu antibodies in the patient's serum, the diagnosis of PLE accompanying extensive-disease (ED) SCLC was confirmed. In addition to the standard cytotoxic therapy, throughout the course of his disease the patient also continued treatment with valproic acid (VPA) as prophylaxis for the initial seizures. VPA is known to be a potent histone deacetylase inhibitor that may reverse epigenetic changes in tumor cells and potentially improve the outcome of cancer patients. The patient succumbed to the disease 25 months after the diagnosis of malignancy; such a long course is observed in only ~5% of patients with ED SCLC. Therefore, it was hypothesized that the accompanying paraneoplasia and treatment with VPA may have improved the outcome in this patient.

[Value of spiral CT in diagnosing metastatic lymph node in lower lip cancer]. / Wartosc spiralnej tomografii komputerowej w rozpoznawaniu przerzutów do wezlow chlonnych w raku wargi dolnej.

The aim of the research was to es timate the efficiency of the computed tomography (CT) in diagnosing meta stasis of submandibular and submen tal lymph nodes (level 1) in patients with diagnosed lower lip cancer. CT of neck lymph nodes was con ducted in 31 patients with diagnosed lower lip cancer. The total of 136 lymph nodes were identified, of which 16 were diagnosed as metastatic in histopathological examination. T investigated parameters were: shape, size (longitudinal and axial diameter and the surface of the cross-sections), presence of the fatty hilus, and level of enhancement after introvascular contrast agent administration. Correlation between the level of enhancement in the primary tumor and the enhancement in the metastatic lymph nodes was observed; density values before and after the admini stration of the contrast agent were in both cases at a similar level. It was also found that the best criterion in the diagnosis of metastatic lymph nodes is the minimal axial diameter: for this parameter, the highest accuracy (74%) was observed for the value of 6 mm. As for the surface of the cross-sections of the lymph node, it was found that the best criterion is the axial cross-section surface: the accuracy of 74% was ob tained for the surface of 38mm2.

Magnetic resonance imaging in the evaluation of the fetal spinal canal contents.

Ultrasonography (US) remains the first method in the evaluation of fetal central nervous system (CNS) abnormalities but in case of the spinal canal and cord it is often insufficient since the bony structures may obscure these structures. Prenatal magnetic resonance imaging (MRI) is therefore the final noninvasive tool for the assessment of these malformations allowing for correction of sonographic findings, revealing the full extent of complex lesions and choosing the candidates for in utero treatment. The authors present the most frequent anomalies of spinal canal and spinal cord in the consecutive phases of pregnancy, illustrated with their own MR images, with reference to the literature and own experience. In 58 out of 252 fetuses examined due to suspicion of CNS anomalies (23.0%) the spinal canal and spinal cord abnormalities were found on MRI. The cases of diastematomyelia, myelomeningocele, tethered cord, caudal regression syndrome, anterior meningocele, cystic sacrococcygeal teratoma and syringohydromyelia are demonstrated.