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BACKGROUND AND PURPOSE: Patients presenting with a monosymptomatic episode of neurologic dysfunction (MEND) have a high probability of developing multiple sclerosis (MS). Our study was designed to determine whether magnetization transfer (MT) histogram analysis could predict the development of MS for a cohort of patients presenting with a MEND. METHODS: Eleven patients with a MEND and 21 age-matched control volunteers underwent MR imaging. Six patients underwent serial MR examinations. MT ratio histogram peak height (MTRHPH) and the location of the MT ratio histogram peak (LOC MTRHP) were determined for patients and control volunteers. T2 lesion volume was also calculated. Patients were clinically followed up for 587 +/- 308 days to determine or rule out the development of MS. RESULTS: Three patients went on to develop MS. There was no statistically significant difference in the MTRHPH (P = .65) and the LOC MTRHP (P = .71) between patients and control volunteers. For those patients who underwent multiple examinations, no statistically significant differences in the MTRHPH (P = .64), LOC MTRHP (P =.58), and T2 lesion volume (P = .47) were seen. There were no statistically significant correlations between any of the parameters studied. CONCLUSION: We found no difference in MT histogram parameters among control volunteers, patients with a MEND without MS, and patients with a MEND who went on to a diagnosis of MS. Our preliminary findings suggest that there may not be a substrate of disease in the normal-appearing white matter that is predictive of the development of MS.

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Two cases are presented of benign pneumatosis coli diagnosed on digital fluoroscopic barium enema examinations, in which the gas-filled cysts in the colonic wall were only recognized by postprocessing of the images (i.e. increasing the brightness and contrast settings) at the computer workstation. When digital barium enemas are performed, we therefore recommend image postprocessing to evaluate polypoid lesions in order to differentiate pneumatosis coli from true colonic neoplasms.

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BACKGROUND: To develop in vitro models of human ovarian carcinoma, fresh tumour cells derived from malignant effusions were cultured in vitro in the presence or absence of serum to establish cell lines. METHODS: Cell lines established were characterized by morphology in culture, surface marker expression, cytogenetic analysis, and growth in anchorage-dependent and anchorage-independent conditions. RESULTS: Four cell lines (MAC-2, RIC-2, SCHM-1, and SIB-1) were established from tumor cells isolated from the malignant effusions of four patients with epithelial ovarian carcinoma. These lines were able to grow in the presence of low concentrations of serum (3%), and two lines grew in the absence of serum (MAC-2 and SIB-1). All cell lines have been grown continuously for longer than 6 months. One cell line (SCHM-1) grew only in liquid medium whereas the other lines grew in both liquid and semi-solid media. Chromosome analysis revealed aneuploidy in three of the four lines. All of the lines stained positively for CA-125 and HMFG-2, consistent with an epithelial origin. CONCLUSION: The ability of these cells to grow in low concentrations of serum or in serum-free conditions should prove useful for the in vitro study of factors affecting the growth of human ovarian carcinoma. The serum-free medium developed will be of use in the isolation of factors from the conditioned medium of these cell lines and previously established cell lines.

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Two prostatic neoplasms that closely resemble adenoid cystic carcinoma of the salivary glands, but in the authors' opinion merit separate designation, are reported. Most of the well-documented examples of prostatic lesions interpreted as "adenoid cystic carcinoma" appear to have been similar to the cases reported herein. The lesions in this report, which the authors have designated as adenoid cystic-like tumors, occurred in men of 60 and 68 years of age who presented with urinary tract obstruction and had transurethral resection of the prostate. Both neoplasms were associated with a minor component of prostatic adenocarcinoma of the usual acinar type. Each adenoid cystic-like tumor had areas that closely resembled basal cell hyperplasia of the prostate, and one had conspicuous foci of squamous differentiation. One patient had a radical prostatectomy and is well six years after operation. The other patient was treated with transurethral resection and irradiation and is well eight months after operation. The prognosis associated with this neoplasm appears to be excellent on the basis of the limited experience to date.

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PIP: A case of primary ovarian pregnancy involving a Copper 7 (Cu 7) IUD is described, and the pertinent literature is reviewed. A 29-year old white woman, gravida 2, para 2, presented with nausea and fatigue of 1 months' duration and severe bilateral upper abdominal pain with radiation to both shoulders of 1 day's duration. Her menstrual cycles for the previous 4 months had been irregular and her last menstrual period started 35 days prior to admission. She was known to have had a Cu 7 IUD in situ for 26 months. On admission, the patient was in moderate abdominal distress. Direct and rebound tenderness with some voluntary guarding was found in the upper abdomen, with minimal lower abdominal tenderness. Pelvic examination was normal, except for slight tenderness. Pelvic examination was normal, except for slight tenderness in the right adnexal area. No vaginal bleeding was observed. Serum pregnancy test (RIA) was positive. Sonogram of the abdomen showed the IUD in situ, free fluid in the peritoneal cavity, and a mass in the right adnexal area containing fetal parts and a fetal heartbeat. Dilation and curettage after removal of the IUD obtained a minimal amount of tissue. Laparotomy revealed 500-600 ml of blood. The uterus, both fallopian tubes, and the left ovary were normal. A hemorrhagic cystic area at the distal pole of the right ovary was actively bleeding. Wedge resection of the right ovary was performed. The patient recovered well and was discharged from the hospital 4 days after the operation. The hemorrhagic ovarian mass measured 6.0x4.5x3.0 cm. Section demonstrated at 3.0 cm cavity filled with clear fluid. The cavity was lined with a smooth membrane and contained a 1.6 cm embryo. A corpus luteum, 1.5 cm in greatest dimension, was adjacent to the cavity. Microscopic sections showed an edematous stroma and an area of implantation with vascularized chorionic villi adjacent to a corpus luteum. Hemorrhage extended from the area of implantation to the ovarian surface. Sections of the fetus were histologically normal. The diagnosis was ovarian pregnancy. Available data allow an approximation of the proportion of woman years of IUD use that involve the Cu 7 IUD in the US since 1966, which is calculated to be 28%. This calculation agrees with the observed 27% of the cases of ovarian pregnancy with an IUD in situ that involved the Cu 7 IUD reported in the US literature. This comparison suggests that the Cu 7 does not increase or decrease the risk of ovarian pregnancy relative to inert plastic IUDs. Clinicians should be aware of the possibility of ovarian pregnancy in patients who use the IUD.^ieng

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The thirteenth case of erythromelanosis follicularis o the face and neck is reported and attention is called to this entity. Characteristically, it affects males in adolescence or young adulthood. It begins symmetrically on the preauricular cheeks and imperceptibly spreads onto the temples and lateral aspects of the neck. It presents an irregularly marginated, red-brown pigmentation with fine telangiectasia, small, pale, slightly scaly, follicular papules, and patchy alopecia of vellus hair. The histologic features, although nondiagnostic, correlate well with the clinical features. The possible relationship to keratosis pilaris rouge is discussed.

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The cytologic changes of rheumatoid pleural effusions have been reported infrequently. A case is presented illustrating that the recognition of these changes can have clinical significance. The diagnostic cytologic picture comprises multinucleated giant cells and histiocytes in a granular, necrotic background. The probable tissue origin of the cytologic findings is discussed.

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