A case of embolic episode resulting in cerebral infarction from an unknown source is reported. This occured in a young male. He had no cardiovascular risk factors. Diagnostic evaluation for identifying the source of embolism revealed a large, pedunculated and mobile thrombus arising from a nonaneurysmatic and nonatheroslerotic descending aorta. The thrombus was identified by transesophageal echocardiography, and was successfully removed by aortic thromboendarterectomy. We emphasize the importnace of transesophageal echocardiography as a reliable method for the diagnosis of thoracic aorta diseases and for identification of aortic thrombi. An aggressive surgical approach is recommended in the low-risk parient to prevent further embolic episodes.
Aorta, Thoracic ; Cerebral Infarction* ; Diagnosis ; Echocardiography, Transesophageal ; Embolism ; Endarterectomy ; Humans ; Male* ; Risk Factors ; Thrombosis*

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. A case is reported of a 51 year old woman with quadricuspid aortic valve associated with regurgitation. In the past, quadricuspid aortic valve was recognised at surgery or necropsy, but now transthoracic and transesophageal echocardiography play a pivotal role in diagnosing this rare valve malformation. On occasion the transthoracic echocardiogram cannot show the quadricuspid nature of the aortic valve, and transesophageal echocardiography must be performed.
Aortic Valve* ; Echocardiography, Transesophageal ; Female ; Humans ; Middle Aged*

BACKGROUND: The purpose of this study was to examine the reproducibility of both the diagnosis of endometrial hyperplasia (EH) or adenocarcinoma, and the histologic grading (HG) of endometrioid adenocarcinoma (EC). METHODS: Ninety-three cases of EH or adenocarcinomas were reviewed independently by 21 pathologists of the Gynecologic Pathology Study Group. A consensus diagnosis was defined as agreement among more than two thirds of the 21 pathologists. RESULTS: There was no agreement on the diagnosis in 13 cases (14.0%). According to the consensus review, six of the 11 EH cases (54.5%) were diagnosed as EH, 48 of the 57 EC cases (84.2%) were EC, and 5 of the 6 serous carcinomas (SC) (83.3%) were SC. There was no consensus for the 6 atypical EH (AEH) cases. On the HG of EC, there was no agreement in 2 cases (3.5%). According to the consensus review, 30 of the 33 G1 cases (90.9%) were G1, 11 of the 18 G2 cases (61.1%) were G2, and 4 of the 4 G3 cases (100.0%) were G3. CONCLUSIONS: The consensus study showed high agreement for both EC and SC, but there was no consensus for AEH. The reproducibility for the HG of G2 was poor. We suggest that simplification of the classification of EH and a two-tiered grading system for EC will be necessary.
Adenocarcinoma