Abnormal fingernail beds following carbon monoxide poisoning: a case report and review of the literature.

INTRODUCTION: Carbon monoxide poisoning is a very common cause of death in accidental, suicidal, or homicidal cases throughout the world. Fingernail bed manifestation is reported in survivors of carbon monoxide poisoning. CASE PRESENTATION: A 40-year-old Caucasian woman was exposed to carbon monoxide when she was sleeping alone in her one-bedroom apartment; fortunately, the beeps from her First Alert combination smoke and carbon monoxide detector woke her and she was saved from any extensive health issues. The most indicative symptoms experienced were a severe headache, blurred vision, agitation, and confusion. Following contact with the Emergency Responses Services, she was promptly transferred to the hospital via ambulance and was treated with high-flow oxygen on the way. She was discharged from the emergency department on the same day, but carbon monoxide exposure had already had adverse effects on her fingernail beds. The fingernail tips were altered and appeared as if a bite had been taken out of their distal borders. The changes in the tips of her fingernails were significant, but they completely disappeared eight weeks later without any additional treatment. CONCLUSIONS: Worldwide, carbon monoxide poisoning is a potentially lethal condition that is preventable with educational programs and installation of carbon monoxide detectors in the home setting. Exposure to carbon monoxide frequently goes unrecognized until it is too late and causes silent death. To the best of the authors' knowledge, this is the first report in the literature of fingernail bed manifestations in a survivor of carbon monoxide poisoning.

Ezrin overexpression by transformed human ovarian surface epithelial cells, ovarian cleft cells, and serous ovarian adenocarcinoma cells.

OBJECTIVES: We have shown that ezrin expression correlates with ovarian epithelial cancer (OVCA) cell proliferation and metastatic behavior. In this study, we evaluated ezrin expression in transformed ovarian superficial epithelial cells (OSE) in ovarian clefts and in culture. STUDY DESIGN: Immunohistochemistry and Western blotting for immunoreactive ezrin (ir-ezrin) in normal ovarian tissue, cultured OSE, and ovarian epithelial cancer cells. RESULTS: While ir-ezrin was not demonstrable in normal cuboidal surface cells or interior ovarian organelles, cells lining the ovarian clefts strongly expressed ir-ezrin. Long-term culture of OSE increased ezrin expression and cytological abnormalities. Administration of estradiol and insulin at levels reported in inclusions dramatically induced OSE ir-ezrin expression to OVCA levels and membrane specializations; ruffling, pseudopodia and filopodia. Moreover epidermal growth factor (EGF) drastically increased ezrin translocation in OSE cells in a time-dependent manner. CONCLUSIONS: Ezrin expression by OSE increases during transformation. Ezrin expression is responsive to estradiol and growth factors previously shown to be present in ovarian inclusions. These findings suggest that the microenvironment in ovarian inclusions and clefts contributes to the development of OVCA. Our findings elaborate on the mechanism of the ovarian origin of OVCA.

Primary bilateral ovarian and uterine Burkitt's lymphoma following chemotherapy for breast cancer.

BACKGROUND: Burkitt's lymphoma is extremely rare in the United States, with reports of approximately 300 new cases each year. A case of Burkitt's lymphoma involving the uterus, cervix, ovaries and appendix 15 years after adjuvant chemotherapy for breast cancer is presented. CASE REPORT: A 58-year-old woman presented with an abdominal mass. MRI revealed a pelvic mass originating from the uterus. Her past medical history was significant for an infiltrating ductal carcinoma of the left breast with positive lymph nodes and extra nodal invasion diagnosed at age 43. She had a left modified radical mastectomy in 1990 with adjuvant chemotherapy. Histologic sections of the uterus, cervix, ovaries, appendix and external iliac lymph node obtained at laparotomy revealed diffuse neoplastic lymphoid infiltration with necrosis. Light microscopy revealed starry sky patterns and immunohistochemical staining demonstrated atypical lymphocytes which stained for CD20, CD10, bcl-6, and Ki-67. After complete staging, chemotherapy was started and the patient is presently tumor free 41 months after the diagnosis. CONCLUSION: Burkitt's lymphoma arising from the uterus/cervix is extremely rare and may present as a pelvic mass. Early diagnosis, aggressive chemotherapy, +/-surgical intervention, plays an important role in management and survival of patients with Burkitt's lymphoma.

Malignant struma ovarii--a case report and review of the literature.

BACKGROUND: Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue. Of these cases, 5-8% are clinically hyperthyroid and 5-10% of these tumors are malignant. CASE REPORT: A 53-year-old female presented with a 19 x 5 x 5 cm pelvic mass that was treated with bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node sampling, omentectomy and appendectomy and staging for an ovarian tumor. There was no evidence of distant metastases or lymph node invasion. Re-evaluation of the patient after surgery revealed that she was clinically euthyroid and there was no thyroid malignancy. Histopathology revealed papillary thyroid carcinoma arising in struma ovarii (malignant struma ovarii). CONCLUSION: Malignant struma ovarii is a very rare malignant ovarian teratoma. In young patients unilateral oophorectomy and complete surgical staging should be considered when the tumor is confined to the one ovary (stage Ia). Long-term follow-up for the detection of metastases or tumor recurrence by serial serum thyroglobulin and (131)I scan or positron emission tomography/computed tomography may be required in selected patients with this rare tumor.

Preserving fertility in invasive cervical adenocarcinoma by abdominal radical trachelectomy and pelvic lymphadenectomy.

A 32-year-old female was diagnosed by loop electrosurgical excision procedure with adenocarcinoma in situ and a focus suspicious for positive lympho-vascular invasion. An abdominal radical trachelectomy was performed to preserve her uterus and fertility. The patient recovered without complications. The patient has had one year of follow-up without any evidences of recurrence. At present, the patient is not actively trying to become pregnant. We concluded that abdominal radical trachelectomy may be a surgical option for early stage cervical cancer treatment in young women who wish to preserve fertility.

Hormone replacement therapy in breast cancer patients and survivors.

Menopause is arguably the most important phase of a woman's social, physiologic, and personal life. Approximately 1.3 million women reach this age in the United States annually. In the past decade, numerous studies have correlated breast cancer and the use of ERT (estrogen replacement therapy) or HRT (hormone replacement therapy) in menopausal women. Whether this is an actual increase in the creation of new cancers or a result of a diagnostic or other bias has yet to be determined. Even more uncertainty surrounds the use of hormones once breast cancer is diagnosed. Previously, once a woman was diagnosed with an estrogen-dependent tumor, ERT and HRT were simply forbidden. As discussed herein, that is no longer the case.