A description is presented of the first documented case of placental aromatase deficiency. The deficiency caused maternal virilization during pregnancy and pseudohermaphroditism of the female fetus. A 24-yr-old primigravida showed progressive virilization during the third trimester. Urinary excretion of estrogen was less than 14 mumol/day between 35-38 weeks of pregnancy, although nonstress tests showed reactive patterns and serum levels of human placental lactogen were above 460 nmol/L. Maternal serum levels of estrogens were low, and those of androgens were high in the third trimester. A dehydroepiandrosterone sulfate loading test induced a marked increase in maternal serum levels of androgens, whereas no such increase was observed in estrogens. The woman delivered vaginally a live full-term infant who exhibited female pseudohermaphroditism. Cord serum levels of estrogens were extremely low, while those of androgens were high. The aromatase activity of the placenta, determined by the conversion of [7-3H]androstenedione to 17 beta-[7-3H]estradiol and [7-3H]estrone, were less than 0.03 fmol/microgram protein.min (control, 9.6 +/- 2.2 fmol/microgram protein.min). The sulfatase activity of the placenta was 0.63 pmol/microgram protein.min compared to 0.46 +/- 0.16 pmol/microgram protein.min in controls. The rate of aromatization by normal control placentas was the same as that obtained during coincubation of samples of normal placentas and that of the patient. Thus, the presence of aromatase inhibitor in the patient's placenta was excluded.

Uterine leiomyoma associated with ascites and hydrothorax was apparently cured by total hysterectomy. This is believed to be the 15th recorded case of this type of Pseudo-Meigs’ syndrome and the first in a patient with severe curvature of the spine and dorsolumbar scoliosis. The association with ascites and hydrothorax was investigated using ^99mTc-labeled macroaggregated albumin.

In the patient reported here, a solid tumor lying between the vagina and the rectum was detected using various imaging techniques (ultrasonography and MRI), and S100 protein was found in the tumor cells. Thus, a schwannoma was the final diagnosis. This is a slow-growing neoplasm, and its early detection is difficult.

A large ovarian follicular cyst developed on day 43 of low-dose tamoxifen adjuvant therapy for a premenopausal breast cancer (total drug intake: 860 mg). The serum estradiol level increased to almost ten times the pretreatment level. However, the FSH and LH decreased slightly, and the serum progesterone level remained almost unchanged. It is hypothesized that tamoxifen acted directly on the ovaries to provoke excessive proliferation of the granu-losa cells in a follicular cyst, causing it to grow very large, and resulting in elevated E₂ levels.

The natural course of cerebral arteriovenous malformations during pregnancy is not well known. An inoperable cerebral arteriovenous malformation was diagnosed by angiography, computed tomography, and magnetic resonance imaging before pregnancy and followed by magnetic resonance imaging during pregnancy. No significant changes were detected in the size of the cerebral arteriovenous malformation during pregnancy, and healthy twins were born by cesarean section.