A primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is an extremely rare lesion. To date, only 49 cases have been reported. The presence of mural nodules in a PRMC may indicate a worse prognosis. We report the case of a 40-year-old Japanese woman with a PRMC with mural nodules. Microscopic examination revealed that the stromal cells of the nodules were spindle-shaped and varied in size. The nodules were immunoreactive for vimentin but negative for cytokeratin and EMA, and the nuclei of the stromal cells were pleomorphic and strongly Ki-67 immunoreactive. The nodules were diagnosed as true sarcoma. To the best of our knowledge, this is 11th published case report of a PRMC with mural nodules.
To investigate the relationship between maternal hyperventilation and fetal blood gas values and to estimate its possible association with fetal oxygenation, maternal transcutaneous partial pressure of carbon dioxide (tcP(CO2)) values were analyzed in association with umbilical venous P(CO2) (UVP(CO2)), umbilical venous partial pressure of oxygen (UVP(O2)), and umbilical venous oxyhemoglobin saturation (UVHbo (2)) values. Pregnant women without labor (30.7 ± 3.7 mm Hg, n = 20) showed significantly lower tcP(CO2) values compared with nonpregnant women (37.4 ± 4.0 mm Hg, n = 10). Pregnant women in the second stage of labor showed even lower tcP(CO2) values compared with pregnant women during the first stage of labor (20.8 ± 5.9 mm Hg vs 28.4 ± 5.0 mm Hg, n = 26). Maternal tcP(CO2) values had significant positive correlations with UVP(CO2) (r = .78, P < .001), UVP(O2) (r = .62, P < .001), and UVHb(O2) values (r = .59, P < .001). Maternal hyperventilation had a close relationship with lower UVP(CO2), UVP(O2), and UVHbo(2) values, which might interfere with optimal fetal cerebral oxygenation.
The current study tested the hypothesis that abnormal pressure-wave reflection may have an important role in identifying pregnant women with chronic hypertension who might develop pre-eclampsia (PE) and/or fetal growth restriction. Pulse-wave analyses were performed to assess maternal arterial stiffness during 26-32 weeks of gestation in 41 women with chronic hypertension. We measured the central systolic pressure (CSP) and augmentation index (AIx) noninvasively using pulse waveforms of the radial artery with an automated applanation tonometric system. In a multiple regression analysis that included AIx-75 (AIx at a heart rate of 75 beats per minute), brachial systolic pressure, maternal height, smoking status, gestational age at testing and the presence of antihypertensive treatment at testing as independent determinants, AIx-75 was the only significant determinant of birth weight, whereas the brachial systolic pressure was not. In pregnant women with chronic hypertension who subsequently developed both superimposed PE and fetal growth restriction, CSP, AIx, AIx-75, and the brachial systolic and pulse pressures were all significantly higher than those who did not develop superimposed PE nor small for gestational age. In contrast, AIx-75 was the only significantly elevated hemodynamic parameter in patients who developed fetal growth restriction but not superimposed PE. In addition, CSP was the only significantly elevated hemodynamic parameter in patients who developed superimposed PE but not fetal growth restriction. Abnormal pressure-wave reflection during 26-32 weeks of gestation showed a stronger correlation with birth weight than conventional brachial blood pressure. Our findings might provide new insight into the pathophysiology of fetal growth restriction as well as superimposed PE in pregnancies complicated with chronic hypertension.
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