OBJECTIVESpontaneous paralysis from hourglass-like fascicular constriction of peripheral nerves is rare, its clinical manifestations are not well documented, and its pathogenesis remains unknown. The unclear origin of this disorder and difficulty in diagnosis result in its uncertain management. The authors sought to gain a more thorough understanding of this condition through describing the anatomy, clinical features, etiology, and treatment of hourglass-like constriction.METHODSThe authors retrospectively reviewed 20 patients (22 nerves) with hourglass-like constriction. The patients’ clinical information was reviewed. Preoperative sonographic assessment and electrophysiological examination of involved nerves were performed. Surgical treatments included interfascicular neurolysis and neurorrhaphy. Samples of tissue subjected to resected constriction were sent for pathological analysis. The patients had regular face-to-face follow-up visits.RESULTSAcute pain was always the first symptom and was followed by paralysis. Paralysis progression was rapid and serious. Surgical exploration indicated an hourglass-like constricted segment completely unrelated to the compressive structures. Electrophysiological analysis showed severe denervation, and histopathological examination showed inflammatory cell infiltration, demyelination, and reduction of nerve fibers.CONCLUSIONSHourglass-like fascicular constrictive neuropathy has an integrative effect from multiple different mechanisms. Surgical intervention is beneficial for selected patients who do not recover in a timely fashion and have hourglass-like lesions confirmed by preoperative ultrasound imaging. The authors recommend that early surgical intervention of the nerve be offered to patients who do not show any signs of recovery 3 months after onset. Both interfascicular neurolysis and neurorrhaphy are effective treatment methods. Mild to moderate constriction can usually be treated successfully by interfascicular neurolysis alone, whereas more advanced lesions with loss of fascicle continuity (severe constriction) may be best treated with resection and direct neurorrhaphy.

Aldosterone reductase family 1 member B10 (AKR1B10) is a nicotinamide adenine dinucleotide phosphate (NADPH) (reduced coenzyme II)-dependent oxidoreductase, and its biological functions include carbonyl detoxification, hormone metabolism, osmotic adjustment, and lipid synthesis. Studies suggested that AKR1B10 is a new biomarker for cancer based on its overexpression in epithelial tumors, such as breast cancer, cervical cancer, and lung cancer. At present, studies on the expression of AKR1B10 in laryngeal cancer have not been reported. However, we found that AKR1B10 is upregulated in laryngeal carcinoma, and its expression was negatively correlated with the degree of differentiation. In addition, AKR1B10 expression was positively correlated with tumor size; lymph node metastasis; long-term drinking; and Ki-67, mutant p53, and matrix metalloproteinase 2 expression. AKR1B10 was overexpressed in Hep-2 laryngeal carcinoma cells. Oleanolic acid inhibited AKR1B10 activity and expression in Hep-2 cells and suppressed Hep-2 cell proliferation, migration, and invasion. Therefore, AKR1B10 may be related to the development of laryngeal carcinoma, suggesting its use as a prognostic indicator for laryngeal cancer.

Background: Malignant transformation of ovarian mature cystic teratoma rarely develops, especially when multiple malignant components simultaneously occur. Case presentation:A 47-year-old woman presented with a 12-month history of intermittent abdominal distension and pain along with bloody stool for 3 weeks. Abdominal computed tomography revealed a cystic mass in the right ovary adjacent to the colon. Additionally, fluids were observed in the colon cavity . Colonoscopy showed a protuberant mass on the surface of the sigmoid colon covered with blood . Considering the large size of the colonic mass and the undetermined diagnosis of the mass, the patient underwent laparoscopic partial colectomy, hysterectomy, and bilateral appendage resection.Grossly, the ovarian cyst was connected to the colon wall, and the cut surface of the colon tumor was cystic and contained mucus. Histopathological examination revealed that the surface of colonic lesions was the granulation tissue, and the lower part was composed of fibrous stroma and mucinous cyst. The cyst wall was covered with columnar cells and contained abundant intracellular mucin. No nuclear atypia was observed. The lesions penetrated the entire intestinal wall and connected with ovarian cysts. Mucus, lipids, and hair could be observed in the ovarian cyst cavity. Histopathological examination showed that the cyst wall was lined with stratified squamous epithelium, and the sebaceous glands could be observed in the fibrous stroma of the cyst wall. Thyroid follicular components could be found in the surrounding area, and some cells were arranged in a chrysanthemum-like cluster . Under high magnification, the nuclei of these cells were characterized as pepper-salt-like . In another area, the typical papillary structure of papillary thyroid carcinoma and the formation of multiple cysts containing mucus were observed; some of which were lined with columnar epithelium containing goblet cells . Under high magnification, the nuclei of these papillae were crowded, ground glass-like, with nuclear grooves. Notably, no malignant tumor components were observed in the colon wall and colon polyps, which are only composed of benign mucinous epithelium. Based on these findings, the patient was suspected of ovarian mature cystic teratoma, which contained mucinous cysts, carcinoids, goiters, and papillary thyroid carcinoma. Moreover, mucinous cysts involved the colon wall and formed a polypoid appearance. At the time of this writing, 6 months had passed since treatment completion, without clinical or histological evidence of recurrence. Conclusion: Herein, we present a rare case of malignant ovarian mature cystic teratoma, including mucinous cysts, goiters, papillary thyroid carcinoma, and carcinoids. The tumor remarkably invaded the intestinal wall and formed a benign polypoid appearance, suggesting the occurrence of this rare tumor type should be considered when intestinal polyps are found during gastrointestinal endoscopy.