Faculty Bibliography

BACKGROUND: Hyperreactio luteinalis in pregnancy is associated with theca lutein cysts (TLCs) and androgenization. CASE: A 24-year-old, primigravid woman was referred at 35 weeks' gestation for bilateral enlarged cystic ovaries. She showed signs of androgenization. On ultrasonogram the ovaries bore a spoke-wheel appearance. A nonvirilized female infant was subsequently delivered by cesarean section because of obstruction of the birth canal by a large impacted ovarian cyst. There was an initial delay in lactogenesis; however, it was well-established after regression of the TLC, by postpartum week 6. Signs ofandrogenization resolved and testosterone levels returned to normal by 3 months postpartum. CONCLUSION: Hyperreactio luteinalis is associated with TLC and maternal androgenization in the antepartum period and persists into the postpartum period with subsequent resolution. Aromatization of testosterone in hyperreactio luteinalis prevents fetal virilization, unlike that seen with masculinizing ovarian tumors. There is some evidence of genetic predisposition and a possibility for recurrence in future pregnancies.

INTRODUCTION: Cerebral metastasis are seen in 3-28% of patients with choriocarcinoma, constitute about 10% of all metastasis of choriocarcinoma, with high morbidity and mortality and even rarer, successful future pregnancies. Low serum CSF HCG ratio is diagnostic of cerebral metastasis even in absence of histo-pathological proven disease. METHODS: We did literature review of choriocarcinoma, trophoblastic tumors, brain/cerebral metastasis/complications, for original publications in English language and translations; and present a patient with two subsequent pregnancies, about 6/7 years after treatment for choriocarcinoma with cerebral metastasis. RESULTS: On reviewing the literature, excluding duplications and those who did not strictly fit in this search criteria, we came across relevant 24 series (6 or more cases in each) and a total no. of 941 patients; and 77 case reports (1-5 cases). Largest series had 146 patients and the smallest 6 patients. There were reports of cerebral hematoma, which were result of rupture of metastasis related cerebral aneurysm. Case: A 27 yr old gr 3, para 3 presented with continued vaginal bleeding and L weakness and ataxia, about 10 weeks postpartum. She had metastatic choriocarcinoma on head MR and pulmonary mets. Subsequently she developed intracranial bleed when on heparin for basilar artery thrombus. She received 7 courses of chemo but no irradiation. Contraception was advised for the next 5 years. Six years after onset, she had a midtrimester loss of a spontaneous pregnancy. A year later, she had an uneventful pregnancy with vaginal delivery of a healthy newborn, weighing 3100 gm. Her postpartum period was uneventful and the newborn did well. Her BHCG levels were followed up for a year- normal. We came across pregnancy following successful treatment of term chorioca with cerebral mets in 5 additional patients, details of which are reported in English literature, although a reference but no details of future pregnancies in these patients have been reported. A!

We present here a case of vasa previa in a multipara, diagnosed at the time of her late second trimester ultrasonogram. The patient subsequently underwent an elective cesarean section after 37 weeks gestation, giving birth to a healthy child with an uneventful post-partum, neonatal and infant course. At the time of cesarean section, the incision was gradually deepened in layers through the myometrium by utmost care allowing the amniotic sac to protrude through the uterine incision hereby avoiding laceration of the vasa previa and its branches. Fetal exsanguination and a need for blood transfusion as well as a possible adverse neonatal course were therefore avoided.

BACKGROUND AIMS: Interleukin (IL)-15 and fms-like tyrosine kinase-3 (FLT-3) are crucial factors for the development of human and murine natural killer (NK) cells. Previously, we have demonstrated significant ex vivo expansion and activation of unrelated cord blood (UCB) NK cells with an antibody/cytokine cocktail consisting of anti-CD3 + IL-2 + IL-12 + IL-7 and anti-CD3 + IL-2 + IL-12 + IL-18. METHODS: In the current experiments, we investigated the effects of short-term culture with anti-CD3 + IL-2 + FLT-3 + IL-15 on cord blood (CB) NK cell and NK-cell subset expansion and function. CB mononuclear cells were cultured for 48 h in AIM-V media or AIM-V + IL-2 (5 ng/mL) + anti-CD3 (50 ng/mL) + FLT-3 (50 ng/mL) +/- escalating doses of IL-15 (1, 10 or 100 ng/mL). Flow cytometric analysis was performed using various fluorescent-conjugated monoclonal antibodies. In vitro cytotoxicity was determined with a standard europium assay against K562 and Daudi cells. RESULTS: There was a 4.8-fold significant increase in NK-cell population (CD3(-)/16(+)/56(+); P < 0.03), 21-fold significant increase in CD3(-)/56(+)/158a(+) (KIR2DL1/S1; P < 0.002), 46-fold significant increase in CD3(-)/56(+)/158b(+) (KIR2DL1/S2; P < 0.002) and 11.5-fold significant increase in CD3(-)/56(+)/NKB1(+) (KIR3DL1; P < 0.01). We also noted a significant increase in both NK and lymphokine-activated killer (LAK) cytotoxicity with IL-2 + anti-CD3 + FLT-3 + IL-15 (100 ng/mL) compared with IL-2 + anti-CD3 + FLT-3 and media alone against K562 (P < 0.01) and Daudi (P < 0.001), respectively. CONCLUSIONS: We have demonstrated a significant increase in UCB NK cells and NK cells expressing a variety of killer immunoglobulin-like receptor (KIR) receptors after short-term culture with anti-CD3, IL-2, FLT-3 and IL-15. Furthermore, there was a significant increase in in vitro NK/LAK cell cytotoxicity.