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Zavala-Romero L, Villanueva-Castro E, Datta-Banik R, Ortiz-Altamirano AG, Rodriguez-Esquivel MM, Cienfuegos-Meza J, Arriada-Mendicoa JN. Mature Teratoma at the Lumbar Spinal Cord: A Case Report and Literature Review. Cureus 2024; 16:e52307. [PMID: 38357074 PMCID: PMC10866183 DOI: 10.7759/cureus.52307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Mature spinal teratoma is a rare type of germ cell tumor that arises from any of the three germ cell layers (ectoderm, mesoderm, and endoderm) and consists of differentiated tissues and structures that reflect the cellular organization and morphology of normal adult tissues. It has the ability to grow independently and cause compressive symptoms when found in this rare location. In this article, we present the case of a 29-year-old male patient with the onset of neurological symptoms beginning with pelvic limb paresthesias and progressing to back pain. Magnetic resonance imaging (MRI) revealed a tumor at L1-L4, which was resected by laminotomy, and histopathology revealed a mature intradural teratoma. Fortunately, this histologic type had a good prognosis for our patient, who had a significant clinical improvement. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology with PubMed and Google Scholar to find similar case reports and to summarize the main features of this disease, which contributes to the understanding of its diagnostic presentation, treatment, and prognosis, improving clinical practice in the management of similar cases. The rarity of this condition, together with its wide clinical heterogeneity and prognosis, underscores the importance of a thorough evaluation of cases of intramedullary lesions, where the consideration of uncommon diseases in the differential diagnosis should be highlighted.
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Affiliation(s)
- Lilian Zavala-Romero
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Rudradeep Datta-Banik
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | | | - Jesús Cienfuegos-Meza
- Department of Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Monjarás-Romo G, Zavala-Romero L, Tejada-Pineda MF, Meraz-Soto JM, Ballesteros-Herrera D, Cienfuegos-Meza J, Alcaráz-Félix RJ, Moreno-Jiménez S. Lhermitte-Duclos Disease: A Case Series. Cureus 2023; 15:e44326. [PMID: 37779805 PMCID: PMC10536449 DOI: 10.7759/cureus.44326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Lhermitte-Duclos disease (LDD), or dysplastic cerebellar gangliocytoma, is a rare benign tumor characterized by unilateral hemispheric cerebellar expansion. It is linked to mutations in the phosphatase and tensin homolog (PTEN) gene, which inhibit the phosphatidylinositol-3'-kinase pathway, leading to increased cell division and defective neuronal migration. This study aims to compare the clinical, radiological, histopathological, surgical resolution, and follow-up characteristics of reported cases of this rare condition. An in-depth search of LDD patients' clinical records at our institute between 2003 and 2023 was conducted, in addition to a systematic literature review on PubMed. Three patients with a diagnosis of LDD were found. Cerebellar abnormalities, varying headaches, and visual impairment were all present clinically. On T2 in the posterior fossa, all three MRI scans displayed the typical hyperintense parallel streak appearance. The histopathological report showed that large ganglion cells had replaced the granular layer, Purkinje cells had degenerated, the molecular layer had become hyper-myelinated, and synaptophysin and chromogranin were positive. Partial tumor resection and avoiding intracranial hypertension were the main goals of treatment. Genetic follow-up was conducted for all three patients. Neurosurgeons must be aware of LDD to provide close genetic monitoring despite the benign nature of the tumor because of its link to Cowden syndrome and elevated risk of cancer in other organs.
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Affiliation(s)
- Gonzalo Monjarás-Romo
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Lilian Zavala-Romero
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | | | - Juan Marcos Meraz-Soto
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Daniel Ballesteros-Herrera
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Jesús Cienfuegos-Meza
- Pathology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | | | - Sergio Moreno-Jiménez
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
- Neurosurgery-Radiosurgery Department, American British Cowdray Medical Center, Mexico, MEX
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Torres-Ríos JA, Romero-Luna G, Meraz Soto JM, Zavala-Romero L, Aguirre Maqueda ML, Rodríguez Camacho A, Moreno Jiménez S. Nelson's Syndrome: A Narrative Review. Cureus 2023; 15:e39114. [PMID: 37332454 PMCID: PMC10272858 DOI: 10.7759/cureus.39114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Nelson's syndrome (NS) is an uncommon disease occurring as a complication of bilateral adrenalectomy (BLA) in patients with persistent Cushing's disease (CD) due to an adrenocorticotropin-producing pituitary tumor. The first reports of this syndrome were done in the 50s, although its pathophysiology is still not understood. Every year, between 1.8 and 2.6 cases are thought to occur per million people. It is characterized by hyperpigmentation, elevated adrenocorticotropic hormone (ACTH) plasma levels, and typical signs and symptoms related to pituitary adenomas, such as visual deficits due to optic pathway compression or decreased hormone production from the adenohypophysis. NS represents a challenge due to the lack of accepted diagnostic criteria and the complexity of its treatment. Moreover, the development of stereotactic radiosurgery (SRS) in the last few years has become an essential but controversial strategy for this syndrome. This review presents a comprehensive overview of NS.
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Affiliation(s)
| | - Gerardo Romero-Luna
- Neurosurgery and Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | - Juan Marcos Meraz Soto
- Neurosurgery and Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | - Lilian Zavala-Romero
- Neurosurgery and Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | - Monica L Aguirre Maqueda
- Neurosurgery and Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | - Alejandro Rodríguez Camacho
- Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
- Radioneurosurgery, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City, MEX
| | - Sergio Moreno Jiménez
- Neurology, ABC Medical Center, Mexico City, MEX
- Neurosurgery and Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
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Gurrola-Luna H, Rojas-Sernaque JK, Barajas Paulin AJ, Carvajal-Juarez I, Bermudez-Gonzalez JL, Rivera-Bravo B, Soto-Lopez ME, Garcia-Arroyo AJ, Cuellar-Vargas JK, Arce-Sandoval CR, Zavala-Romero L, Romero-Montiel RE, Gomez-Salgado M, Alexanderson Rosas E. Comorbidities associated with reduced myocardial flow reserve in non-obstructive disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Microvascular Dysfunction defined as a Myocardial Flow Reserve (MFR) <2 or <2.5 depending on the center, may present in the absence of significant obstruction (1,2); it is included as a diagnosis criteria of Microvascular Angina (MVA) (3,4) and is an independent risk factor associated with poor prognosis (5–7). Traditional Coronary Artery Disease (CAD)risk factors have also been associated with MVA (8–10), however, there is reduced data in latin populations with high prevalence of comorbidities. The aim of this study was to identify the comorbidities that alter MFR with 13N-ammonia Positron Emission Tomography/Cardiac Tomography (PET/CT) and Cardiac Computed Tomography Angiography (CCTA) in a cardiovascular imaging referral center.
Methods
Retrospective cross-sectional study of patients with suspected CAD in which both PET/CT and CCTA were performed. Inclusion:CCTA with obstruction <50%. Exclusion: incomplete study, previous infarction or intervention. Clinical data was assessed. Mean (±DE) or median (interquartile range) to present continuous variables according to their distribution; T student or U Man Whitney to compare them. For each variable two groups were conformed depending on its presence or absence in order to compare MFR between them. Statistical analysis was performed with Statistical Package for Social Science (SPSs Inc, Chicago, IL; version 23.0) and GraphPad Prism version 9.0. p<0.05 was considered as significant.
Results
335 patients included. MFR difference for each variable: female sex, hypertension (HT), Type 2 diabetes (T2D) and smoking – Appendix 1. Significant MFR difference for HT (p=0.024) and T2D (p=0.046). Severe ischemia had significant MFR reduction (p=0.006); patients with both HT and mild ischemia (p=0.018) – Appendix 2.
Discussion
Individuals with HT and T2D had a significantly lower MFR, consistent with previous studies (8,9). Absence of correlation with other risk factors, such as smoking (10) and female sex (11); latter may be caused by a significant lower number of women (108 vs 227). Further analysis in this subgroup ought to be done. When comparing MFR between level-of-ischemia groups, microvascular function was not reduced until severe ischemia. Remarkably, if we analyze the coexistence of HT with ischemia, MFR is reduced even in patients with mild ischemia. This finding highlights the importance of HT which alters function in early stages even in the absence of significant obstruction. This is one of the first studies correlating MFR with comorbidities in our population. Limitations the retrospective nature of the study.
Conclusions
MFR non-invasive assessment by PET/CT allows identifying very early stages of MVD, even in asymptomatic patients and when there's no evidence of ischemia or CAD. Therefore, timely recognition of this problem is mandatory to implement action strategies to stop the triggered events' cascade.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Gurrola-Luna
- National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | - I Carvajal-Juarez
- Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, Mexico
| | | | - B Rivera-Bravo
- National Autonomous University of Mexico, PET/CT Unit, Faculty of Medicine., Mexico City, Mexico
| | - M E Soto-Lopez
- Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, Mexico
| | | | | | | | - L Zavala-Romero
- National Autonomous University of Mexico, Mexico City, Mexico
| | | | - M Gomez-Salgado
- National Autonomous University of Mexico, Mexico City, Mexico
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5
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Márquez-Salinas A, Fermín-Martínez CA, Antonio-Villa NE, Vargas-Vázquez A, Guerra EC, Campos-Muñoz A, Zavala-Romero L, Mehta R, Bahena-López JP, Ortiz-Brizuela E, González-Lara MF, Roman-Montes CM, Martinez-Guerra BA, Ponce de Leon A, Sifuentes-Osornio J, Gutiérrez-Robledo LM, Aguilar-Salinas CA, Bello-Chavolla OY. Adaptive Metabolic and Inflammatory Responses Identified Using Accelerated Aging Metrics Are Linked to Adverse Outcomes in Severe SARS-CoV-2 Infection. J Gerontol A Biol Sci Med Sci 2021; 76:e117-e126. [PMID: 33721886 PMCID: PMC7989655 DOI: 10.1093/gerona/glab078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Chronological age (CA) is a predictor of adverse COVID-19 outcomes; however, CA alone does not capture individual responses to SARS-CoV-2 infection. Here, we evaluated the influence of aging metrics PhenoAge and PhenoAgeAccel to predict adverse COVID-19 outcomes. Furthermore, we sought to model adaptive metabolic and inflammatory responses to severe SARS-CoV-2 infection using individual PhenoAge components. Methods In this retrospective cohort study, we assessed cases admitted to a COVID-19 reference center in Mexico City. PhenoAge and PhenoAgeAccel were estimated using laboratory values at admission. Cox proportional hazards models were fitted to estimate risk for COVID-19 lethality and adverse outcomes (ICU admission, intubation, or death). To explore reproducible patterns which model adaptive responses to SARS-CoV-2 infection, we used k-means clustering using PhenoAge components. Results We included 1068 subjects of whom 222 presented critical illness and 218 died. PhenoAge was a better predictor of adverse outcomes and lethality compared to CA and SpO2 and its predictive capacity was sustained for all age groups. Patients with responses associated to PhenoAgeAccel>0 had higher risk of death and critical illness compared to those with lower values (log-rank p<0.001). Using unsupervised clustering we identified four adaptive responses to SARS-CoV-2 infection: 1) Inflammaging associated with CA, 2) metabolic dysfunction associated with cardio-metabolic comorbidities, 3) unfavorable hematological response, and 4) response associated with favorable outcomes. Conclusions Adaptive responses related to accelerated aging metrics are linked to adverse COVID-19 outcomes and have unique and distinguishable features. PhenoAge is a better predictor of adverse outcomes compared to CA.
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Affiliation(s)
- Alejandro Márquez-Salinas
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A Fermín-Martínez
- MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neftalí Eduardo Antonio-Villa
- MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Enrique C Guerra
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandro Campos-Muñoz
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lilian Zavala-Romero
- AFINES, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Edgar Ortiz-Brizuela
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Carla M Roman-Montes
- Direction of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bernardo A Martinez-Guerra
- Direction of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce de Leon
- Direction of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Direction of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Mexico
| | - Omar Yaxmehen Bello-Chavolla
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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