Ovarian Tissue Cryopreservation versus Other Fertility Techniques for Chemoradiation-Induced Premature Ovarian Insufficiency in Women: A Systematic Review and Future Directions.

Current advances in cancer therapy have increased survival, emphasizing the need for life quality improvement. Fertility loss is common post-chemotherapy. Current guidelines establish embryo and oocyte cryopreservation to address premature ovarian insufficiency (POI). Ovarian tissue cryopreservation has also recently become an acceptable option for fertility preservation, particularly as it is the only option for pre-pubertal patients. Few definitions for optimum fertility outcomes, and few systematic reviews comparing embryo, oocyte, and ovarian tissue cryopreservation as a means of fertility preservation (FP) in pre- and post-pubertal female cancer patients exist. This systematic review aims to improve understanding of gonadotoxic effects of chemoradiation therapy in cancer patients, to analyze the different fertility preservation techniques and procedures available to women with chemoradiation induced ovarian insufficiency, and to compare and recognize the benefits of each technique in restoring fertility, sexual hormone function, and quality of life. Searches were conducted electronically on PubMed, Cochrane, and EBSCOHost, including clinical trials, prospective, and retrospective studies of female cancer patients undergoing anti-cancer therapy, with predefined MeSH terminology. Data were collected, analyzed, and compared. Non-randomized clinical studies were evaluated for risk bias through the Newcastle-Ottawa Scale. In total, 23 studies were included. From there, 647 patients opted for oocyte cryopreservation, 267 for embryo cryopreservation, and 1382 for ovarian tissue cryopreservation (OTC). A total of 175, 18, and 121 live births resulted respectively from oocyte, embryo, and OTC, respectively. Studies without live births discussed other fertility markers as indicators of improvement in sexual hormone function and fertility. The gonadotoxic effects of chemotherapy call for FP intervention. Oocyte and embryo cryopreservation/implantation are well-established procedures. With changing trends and life quality consideration, OTC is a promising interventional method for pre-pubertal patients facing the prospect of fertility loss.

A challenging diagnosis of spinal epidural lipomatosis: A case report and review of the literature.

INTRODUCTION: Spinal Epidural Lipomatosis (SEL) is a rare disorder of pathological overgrowth of the spinal epidural fat in the extradural space. The pathogenesis of SEL usually involves exogenous steroid use or endogenous steroids overproduction. However, idiopathic cases have been reported. Magnetic resonance imaging (MRI) is the gold standard for diagnosis. Both conservative and surgical approaches are employed in management of these patients. CASE PRESENTATION: A 17-year-old male presented to our hospital complaining of progressive lower limb weakness, loss of sensation with urinary incontinence which ended up with paraplegia. He underwent extensive investigations and received multiple inaccurate diagnoses. MRI of the thoracic spine showed spinal epidural lipomatosis with dorsal kyphosis. Hemi-laminectomy for spinal cord decompression and trans-pedicular fixation for correction of kyphosis were performed showing excellent outcomes. CLINICAL DISCUSSION: Diagnosing SEL can be challenging due to its symptom overlap with other neurological conditions. Thus, higher levels of clinical suspicions and utilization of numerous diagnostic modalities including MRI are required. Treatment is largely determined by the clinical presentation and the severity of symptoms. Given the severity of neurological symptoms in our case, surgical intervention was performed resulting in fully regained functionality of previously paralyzed muscles. CONCLUSION: This case highlights the rare presentation and the diagnostic challenges of spinal epidural lipomatosis SEL in a young patient who was misdiagnosed for 9 consecutive months before receiving the correct diagnosis, emphasizing the importance of considering SEL in the differential diagnosis for progressive neurological deficits and the importance of MRI, especially in atypical cases.

Synovial sarcoma of the ethmoid sinus with extension to the cavernous sinus: a case report and literature review.

Synovial sarcomas are rare soft tissue tumors primarily affecting the extremities but can occasionally manifest in unusual locations such as the ethmoid sinus, posing diagnostic challenges. We present a case of a 38-year-old male with a 7-month history of recurrent throbbing headaches, left eye pain, and facial nerve palsy, evolving into multiple stroke episodes. Radiological studies showed extension to the cavernous sinus, raising an initial suspicion of vasculitis. Histological findings of an endoscopic biopsy, however, confirmed a monophasic synovial sarcoma. The patient was referred to a specialized center for further management. Unfortunately, he developed another stroke before receiving treatment. Management included chemotherapy and definitive radiation therapy targeting the ethmoid sinus. The patient is currently receiving ongoing palliative care for symptom management. This case underscores the importance of early diagnosis and a multidisciplinary approach in managing rare and aggressive tumors such as synovial sarcoma of the ethmoid sinus.

Medulloblastoma at the cerebello-pontine angle resembling vestibular schwannoma: A case report and review of the literature.

Cerebello-pontine angle (CPA) tumors account for only less than 10 % of intracranial tumors, it usually affects children at a young age with the midline being the most favorable location. Our adult patient demonstrated a very unusual site for medulloblastoma at the CPA. Less than 50 cases all around the world have been reported in the English literature for Medulloblastoma to be located at the CPA, and most of them in pediatric age group. We report a 43 year old female patient who presented to our neurosurgical ward in Jerusalem with a 4 months history of progressive decreased hearing at the left side, accompanied with tinnitus, dizziness, and imbalance on walking. Medulloblastoma at the CPA was one of the differential diagnosis and was confirmed at our histopathology unit after gross total resection of the tumor, the surgery followed by radiotherapy and the patient was well after 9 months after procedure. MB-CPA is a relatively rare tumor, and the early diagnosis make a difference in the management, prognosis, and outcomes, so it should be considered as a differential diagnosis of a lesion of the CPA.

Clear cell sarcoma at D12-L1 paraspinal region: A reported case and review of the literature.

BACKGROUND: Clear cell sarcoma is a very rare malignant tumor originating from neural crest cells, the tumor most commonly affects the lower limbs but there have been few cases reported to affect the trunk and para spinal area. Patients with Para spinal sarcoma have a variety of clinical presentations and a variable prognosis depending on several prognostic factors including tumor size. CASE PRESENTATION: A 14-year-old male patient presented with paraplegia for one month duration and he was diagnosed later on to have a paraspinal clear cell sarcoma at D12-L1 level. A wide local excision was made and patient was referred for oncology treatment. However, the patient came back to the same hospital after two months due to the recurrence of the tumor at the same site. CONCLUSION: Clear cell sarcoma, although rare, can affect the spine and present with weakness, paraplegia and backache. It also affects people from all age groups and can have a high metastatic rate and a high recurrence rate.

Association Between Joint Hypermobility and Gastroesophageal Reflux Disease: An Observational Analytical Cross Sectional Study.

OBJECTIVES: This study aims to assess the association between joint hypermobility (JHM) and gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: This cross sectional study included 100 consecutive Iraqi patients (43 males, 57 females; mean age 30±6.6 years; range 18 to 40 years) with GERD diagnosed by a gastroenterologist according to the guidelines for diagnosis and management of GERD and age and sex matched 100 healthy controls (36 males, 64 females; mean age 30±5.2 years; range 20 to 40 years). JHM was measured using Beighton score method by a blinded observer. A score of 4 or more was considered hypermobile. RESULTS: Joint hypermobility values were significantly higher in GERD patients than in controls [46 (71.9%) vs 18 (28.1%), p<0.001, odds ratio=3.88; 95% confidence interval=2.04-7.39]. Multiple logistic regression analysis to detect predictors of GERD in JHM patients revealed that patients with high total mobility score (7- 9) had the highest risk for developing GERD [about 41 fold compared to those with normal mobility score (<4), P model <0.001, and overall prediction accuracy of 68%]. CONCLUSION: There is a significant association between JHM and GERD. The high total mobility score (7-9) was associated with a significantly high risk for developing GERD, indicating that early recognition of JHM may assist in early diagnosis and treatment of GERD.