A 36-year-old woman presented with an intraperitoneally disseminated malignant struma ovarii, diagnosed by histopathology and 13'1 scintigraphy. The serum thyroglobulin level was elevated, and immu-noperoxidase staining for thyroglobulin was positive for disease both in the tumor cells lining the follicles and in the colloid. The patient was treated successfully by a bilateral ovariectomy followed by a total thyroidectomy and administration of radioactive iodine. The clinical behavior and the presence of thyroglobulin in both serum and tumor tissue demonstrate the similarity between neoplastic thyroid tissue in the ovary and in the thyroid gland. Cancer 60:178-182,1987. ERM CELL TUMORS represent 15% to 20% of all G ovarian tumors, ' 3 ' but in patients younger than 20 years of age, they account for approximately 60% of the tumors.* Only 5% of ovarian germ cell tumors are mdig-nant.3 Fortunately, 95% of all germ cell tumors are benign cystic teratomas, not leading to disagreements in diagnosis or treatment. In 5% to 15% of the teratomas, thyroid tissue may be present, but the term struma ovarii is reserved for tumors that mainly consist of thyroid tissue. Because this occurs only in less than 25% of those t u m ~ r s , ~. ~ struma ovarii represents about 2% of all teratomas. Five percent of all struma ovarii cases may be classified as malignant.6 Although most other malignant germ cell tumors respond well to combination chemo-therapy,' the treatment of a malignant struma ovarii remains controversial. According to some authors, the tumors respond well to treatment with radioactive iodine .*q9 This requires specific diagnostic and therapeutic measures, which will be discussed in the following case history. Leeuwarden, who made the initial diagnosis and did the immunoper-oxidase staining, and M. E. Pol, gynecologist, the Sionsberg Hospital, Dokkum, for refemng the patient. Mrs. W. J. A. Bruins-van der Weij has put everything into a readable form. Case Report In April 1984, a 36-year-old patient was admitted to another hospital with micturition complaints. Physical examination revealed an enlarged left ovary approximately 10 cm in diamter, which was confirmed during laparotomy. The left ovary was removed and a biopsy from the right ovary was taken. Gross examination showed a round to oval tumor measuring 10 X 10 X 6 cm with a smooth, slightly lobulated surface. On cross-section, the lesion was composed of multiple thin-walled cysts without significant solid areas. Eight blocks were taken for histologic examination. The biopsy from the right ovary measured 3 X 1.5 X 1 cm. On its surface were small, thin-walled multilocular cysts. Microscopic examination showed that the large cysts and follicles of varying size were lined by low cubic epithelium, and contained colloid. The follicles resembled those of normal thyroid tissue. No significant atypia, mitotic activity, nor vascular invasion were found (Fig. 1). The small cystic structures on the surface of the right ovary were histologically similar to the tumor tissue of t...
In Type 1 (insulin-dependent) diabetes mellitus, macrovascular complications and the increased risk for cardiovascular disease in patients with microvascular complications may be related to alterations in plasma cholesterylester transfer. The activity of cholesterylester transfer protein, which mediates cholesterylester transfer between lipoproteins and lipoprotein lipid levels, was assessed in 7 normolipidaemic control subjects, 7 Type 1 diabetic control subjects without complications, 11 Type 1 diabetic patients with microvascular complications (retinopathy, incipient nephropathy) and in 7 Type 1 diabetic patients with macrovascular atherosclerotic lesions. The cholesterylester transfer activity was 30% higher in the diabetic groups with macrovascular and microvascular lesions than in the 2 control groups. Very low + low density lipoprotein cholesterol was higher in the 3 diabetic groups than in the non-diabetic control group. High density lipoprotein cholesterol was not different. The cholesterylester transfer activity was correlated positively with HbA1, urinary albumin excretion rate, serum cholesterol, very low + low density lipoprotein cholesterol and apolipoprotein B. The high density lipoprotein over very low + low density lipoprotein cholesterylester molar ratio was lower in the diabetic groups with micro- and macrovascular complications. A role for cholesterylester transfer activity in the lipoprotein abnormalities found in complicated Type 1 diabetes is suggested. A high cholesterylester transfer activity might be indicative of mechanisms which promote atherogenesis.
From the dose-response relations between glucose and insulin after oral glucose loading, a reproducible parameter for beta-cell response was deduced. The main advantage of this parameter -corrected insulin response, defined as CIR = I- 100/G(G-70)- lies in it independence from the initial or reached glucose level.
The effect of continuous subcutaneous insulin infusion (CSII) on diabetic retinopathy was studied in 19 patients with insulin-dependent diabetes mellitus (IDDM). All had diabetes before age 30. Three patients had no retinal abnormalities at the start of the study, 12 had minimal or mild background retinopathy, and 4 had a preproliferative retinopathy. The follow-up period was 12-14 mo. Fundus photography and fluorescein angiography was performed every 2-6 mo. Despite marked improvement of metabolic control, none of the patients with retinopathy showed reversal of the fundal abnormalities. In seven patients with background retinopathy the abnormalities remained unchanged; in five patients a slight worsening was noted. Four patients with moderate-to-severe background retinopathy showed a rapid and severe progression of the fundal abnormalities into a florid proliferative diabetic retinopathy 3-6 mo after initiation of CSII. A higher incidence of hypoglycemic episodes could not be demonstrated in this group. Two of these patients showed a marked reduction in glomerular filtration rate (GFR), 34% and 38%, respectively, during the course of their follow-up. This is compared with a decrease in GFR by only 5.6% for the group as a whole. The four patients with rapidly progressive retinopathy all had long-standing poorly controlled diabetes with preproliferative retinal changes, diabetic neuropathy, and, with the exception of one patient, signs of nephropathy at the start of CSII. The incidence of these features was nil or very low in the remaining 15 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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