Early diagnosis of Balo's concentric sclerosis by diffusion tensor tractography: a case report and literature review.

Balo concentric sclerosis is an infrequent variant of a demyelinating disease related to multiple sclerosis, initially thought to have an acute presentation and a fatal outcome. Recent studies have reported non-fatal forms of Balo concentric sclerosis, focusing on the importance of early diagnosis using magnetic resonance imaging (MRI), along with spectroscopy and diffusion/perfusion sequences. Recently, we have been able to draw a three-dimensional image of a specific bundle of fibers by means of a diffusion tensor technique of the magnetic resonance imaging tractography (t-MRI). We report the case of a young woman presenting with acute and progressive focal neurological symptoms, including right body paresis, whose diagnosis was suggested by MRI and confirmed by pathology to be Balo concentric sclerosis. She was treated with boluses of methylprednisolone, achieving full neurological remission one year after admission. This is, to our knowledge, the first report describing the use of t-MRI for diagnosing BCS. We consider that t-MRI will allow, in a near future, early diagnosis of the disease, its prompt treatment, and establishing new classification criteria. This case confirms the existence of benign forms of Balo concentric sclerosis with a good response to steroid therapy, where functional recovery is possible.

La esclerosis concéntrica de Baló es una variante infrecuente de enfermedad desmielinizante relacionada con la esclerosis múltiple, inicialmente considerada de progresión fatal. En estudios recientes se reportan variantes no fatales de esclerosis concéntrica de Baló en los que se enfatiza la importancia del diagnóstico por medio de la imagen por resonancia magnética, utilizando además la espectroscopia y las secuencias de difusión y perfusión. En los últimos años se ha logrado reproducir la imagen tridimensional de un fascículo en particular y observar la presencia de lesiones por medio de la tractografía por imagen por resonancia magnética mediante la técnica de tensor de difusión. Presentamos el caso de una mujer joven con síntomas neurológicos focales agudos, incluyendo paresia de extremidades derechas, cuyo diagnóstico por biopsia fue de esclerosis concéntrica de Baló, confirmando el resultado de los estudios de imagen. La paciente recibió tratamiento con bolos de metilprednisolona, obteniendo remisión clínica completa a largo plazo. A nuestro entender, este es el primer reporte que describe los hallazgos de la esclerosis concéntrica de Baló utilizando la técnica de tensor de difusión. Consideramos que dicha técnica permitirá en el futuro la detección temprana de la enfermedad, su tratamiento oportuno y permitirá establecer nuevos criterios de clasificación y estratificación. Este caso demuestra la existencia de variantes benignas de esclerosis concéntrica de Baló, que tienen buena respuesta a la terapia con glucocorticoides y donde se logra la recuperación funcional.

Hepatolithiasis with secondary cholangitis and supernumerary left hepatic lobe.

We report the case of a 31-year old woman with recurrent cholangitis secondary to hepatolithiasis. The stones were composed of calcium bilirubinate. The patient also had a supernumerary hepatic lobe connected to the inferior aspect of the segment III of the liver. The role of the supernumerary hepatic lobe in the development of hepatolithiasis is unclear and may be coincidental.

Mucinous cystadenoma of the pyelocaliceal system: a report of 3 examples and an analysis of 17 previously published cases.

We report 3 patients all men between 45 and 64 years of age with unilocular or multilocular mucinous cystadenomas of the kidney. One tumor arose from the renal pelvis, and 2 involved the entire pyelocaliceal system. The tumors measured between 2.4 and 37 cm in greatest dimension. Two patients were asymptomatic, and 1 had recurrent attack of acute pyelonephritis. Microscopically, the morphology and immunophenotype (CK20, MUC2, and CDX2 positive) of the tumors were similar to the colonic adenomas. Two patients were asymptomatic 24 and 64 months after surgery, including the patient with mucinous cystadenoma and intramucosal carcinoma. One patient died of acute myocardial infarction, and his tumor was an autopsy finding. Only 17 cases of mucinous cystadenomas and 5 cases of mucinous cystadenocarcinomas have been reported. Of the 17 mucinous cystadenomas, 2 arose in horseshoe kidneys. The mean size of these neoplasms was 15 cm (2.4-37 cm). Despite their large size, some patients with mucinous cystadenomas were asymptomatic. Sixty percent were associated with renal lithiasis. Thirty percent progressed to mucinous adenocarcinomas, and only 2 cases showed areas of intramucosal carcinomas. Two cases were associated with carcinoid tumors, similar to those reported in the appendix. Most patients were asymptomatic after surgery, and only 1 patient died by abdominal sepsis related to adenomucinosis. The 3 examples of mucinous cystadenomas of the pyelocaliceal system reported here, and those previously published indicate that they are very uncommon neoplasms with morphology and intestinal immunophenotype similar to the colonic adenomas.