MUCINOUS LOW-GRADE ADENOCARCINOMA ARISING IN AN INTRACRANIAL ENTEROGENOUS CYST

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. E972-E973 ◽  
Author(s):  
Marco Gessi ◽  
Federico G. Legnani ◽  
Emanuela Maderna ◽  
Cecilia Casali ◽  
Carlo L. Solero ◽  
...  

Abstract OBJECTIVE Enterogenous cysts (ECs) of the central nervous system are developmental malformations that occur in the spinal canal, posterior fossa, or cerebral hemispheres. They are usually benign lesions, and malignant transformation is rare. To date, only three cases of malignant transformation have been reported in the literature. We present a case of a cerebellopontine EC showing foci of epithelial dysplasia and malignant transformation into a low-grade papillary mucinous adenocarcinoma. CLINICAL PRESENTATION A 25 year-old man with a 6-year history of hypoacusia presented to our department with facial nerve deficit, visual disturbances, and gait instability. A magnetic resonance imaging scan demonstrated a multiloculated cerebellopontine angle cyst with supratentorial hydrocephalus. INTERVENTION A retrosigmoidal approach was used to achieve cyst removal. This was followed several months later by ventriculoperitoneal shunt placement. The cyst was adherent to the brainstem, cranial nerves, and vessels, and it resembled a thin encapsulated structure filled with mucinous-like substance. No solid component was identified. Histopathological examination revealed an EC with foci of malignant transformation in a mucinous papillary adenocarcinoma. Magnetic resonance imaging was performed 5 months postoperatively due to progressive clinical worsening; this scan revealed lesion recurrence with severe brainstem compression. Emergency surgery was performed, and a large decompression was achieved. Subsequent follow-up computed tomographic scans showed progression of the residual tumor. The patient's neurological condition rapidly worsened, ultimately resulting in death. CONCLUSION The present report suggests that a careful histological examination of all ECs after surgery should be made to exclude dysplastic foci or carcinomatous transformation. Although the clinical behavior of ECs with malignant trasformation is unpredictable, surgery remains the treatment of choice. The use of possible adjuvant chemo- or radiotherapy has not been established.

2019 ◽  
Vol 64 (No. 02) ◽  
pp. 92-99
Author(s):  
JH Song ◽  
TS Hwang ◽  
HC Lee ◽  
DH Yu ◽  
BJ Seung ◽  
...  

A seven-year-old Toy Poodle was presented for progressive ataxia and seizure episodes. Magnetic resonance imaging revealed inflammatory lesions in the cerebrum and brainstem. Management with imatinib mesylate, prednisolone and hydroxyurea were initiated and resulted in complete resolution of the clinical signs. In regular magnetic resonance imaging scans, the overall appearance of the lesions deteriorated but improved again after an increase in the imatinib mesylate dose. The patient had not shown any neurological signs until death and survived for 1052 days after initial presentation. On histopathological examination, the patient was diagnosed with disseminated granulomatous meningoencephalitis involving the cerebrum and brainstem. Immunohistochemical staining was performed on the five types of tyrosine kinase (PDGFR-α, PDGFR-ß, VEGFR-2, c-Kit and c-Abl proteins), which constitute therapeutic targets for conventional multitargeted tyrosine kinase inhibitors. The immunohistochemical analysis revealed that all these tyrosine kinases were expressed in the brain samples. The present report describes the first case of the use of imatinib mesylate therapy for granulomatous meningoencephalitis in the dog. Therapy with imatinib mesylate plus glucocorticoids appears promising as a new therapeutic intervention in meningoencephalitis of unknown aetiology.


Neurosurgery ◽  
2005 ◽  
Vol 56 (2) ◽  
pp. E411-E411 ◽  
Author(s):  
Eberval Gadelha Figueiredo ◽  
Marcos Gomes ◽  
Eduardo Vellutini ◽  
Sérgio Rosemberg ◽  
Raul Marino

Abstract OBJECTIVE AND IMPORTANCE: Angioleiomyomas (ALMs) are relatively rare, benign, vascular soft tissue tumors that occur most frequently in the extremities of middle-aged individuals. To date, only two cases of intracranial ALMs have been described, both with little emphasis on the clinical, surgical, and radiological aspects. Neither of these reported cases of ALM involved the cavernous sinus. Furthermore, there is no previous intracranial ALM magnetic resonance imaging scan described in the literature. This report presents the first case of cavernous sinus ALM, emphasizing the clinical, radiological, and surgical aspects. CLINICAL PRESENTATION: A 52-year-old man had a 2-year history of horizontal diplopia and frontal headache. Facial numbness and impaired visual acuity in the previous 6 months were also reported. Physical examination revealed paralysis of right Cranial Nerves III, IV, and VI. A decrease in optical acuity was also noted. Computed tomographic and magnetic resonance imaging scans demonstrated a mass lesion located in the right cavernous sinus, which enhanced homogeneously with administration of intravenous contrast medium. INTERVENTION: A total resection was performed via a right frontotemporal craniotomy and a pretemporal approach with peeling of the middle fossa. The postoperative course was uneventful. Histological examination identified the ALM, with no recurrence noted during follow-up. CONCLUSION: It is unknown why intracranial ALMs have not been reported more frequently in the literature. Although ALMs are a rare occurrence, misinterpretation of this lesion may also have contributed to the lack of reported cases. Before surgery, ALMs can be distinguished from meningiomas and schwannomas but not from hemangiomas. The prognosis of intracranial ALM is good, as suggested in this case as well as the two previously reported cases.


Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 753-758 ◽  
Author(s):  
Arthur J. Ulm ◽  
Anthony T. Yachnis ◽  
Daniel J. Brat ◽  
Albert L. Rhoton

Abstract OBJECTIVE AND IMPORTANCE The pituicytoma is a rare primary tumor of the neurohypophysis. Although histologically benign, the location and vascular nature of these tumors can make surgical resection difficult. We present a report of two patients with pituicytomas and review the literature regarding treatment and prognosis for this unusual lesion. Possible histogenetic relationships of this tumor with other pituitary neoplasms are presented. CLINICAL PRESENTATION Patient 1 was a 45-year-old man who presented with a 5-year history of decreased libido. He was found to have a 2-cm suprasellar mass on a magnetic resonance imaging scan. Patient 2 was a 48-year-old man who presented with multiple endocrine complaints. He was found to have an intrasellar mass on magnetic resonance imaging. INTERVENTION Patient 1 underwent a right frontal craniotomy, with a subtotal resection of the suprasellar mass through the lamina terminalis. The residual tumor was treated with fractionated stereotactic radiotherapy. The intrasellar mass in Patient 2 was resected via a transsphenoidal approach. On surveillance magnetic resonance imaging, the tumor was found to have recurred and expanded into the suprasellar space. The patient underwent a right frontal craniotomy for decompression and a subtotal resection of the tumor. The patient experienced a second recurrence 7 years after the initial procedure and was subsequently treated with fractionated stereotactic radiotherapy. CONCLUSION Pituicytomas are a distinct form of pituitary gland neoplasia that may recur if subtotally resected. These neurohypophysial tumors may contain a small subpopulation of previously unrecognized bcl-2-immunoreactive cells, whose role in the histogenesis of pituicytoma deserves further study.


Author(s):  
Pedro Clarós ◽  
Aymar Diandaga Maleka ◽  
Agnieszka Walag ◽  
Andrés Clarós

<p>The non-salivary and non-intestinal adenocarcinomas are glandular tumors that include cases of low grade with low metastatic potential and high-grade ones, with aggressive metastatic potential. We present a clinical case of a 47 years old patient, referred to an ENT specialist because of swelling of the inner corner of right eye. Computed tomography (CT) and magnetic resonance imaging showed a proliferation process. The histopathological examination of the tumor biopsy revealed a high grade, non-salivary and non-intestinal orbital adenocarcinoma. Afterwards we review the literature on the subject. The primary non-salivary and non-intestinal orbital adenocarcinoma is characterized by locoregional aggressiveness, making treatment difficult and often mutilating. The prognosis is generally unfavourable. The clinician must exclude a malignant process of lacrimal sac in any patient presenting with a mass of the inner corner of the eye, with the help of the CT associated with magnetic resonance imaging. At the slightest doubt, the biopsy must be obtained. The treatment is multidisciplinary.</p>


2013 ◽  
Vol 46 (3) ◽  
pp. 187-189
Author(s):  
Vagner Moysés Vilela ◽  
Hélder de Castro Marques ◽  
Rodolfo Elias Diniz da Silva Carvalho ◽  
Erika Zavelinske ◽  
André Geraldo da Silva Duque ◽  
...  

The present report describes the case of a 43-year-old diabetic patient with facial pain, protruding eyes, nasal congestion and decreased right vision (involvement of the ipsilateral cranial nerves III, IV and V). Computed tomography showed diffuse sinusitis at right, cribriform plate erosion and presence of a hypodense collection in the frontal lobe with peripheral enhancement. Magnetic resonance imaging confirmed the presence of a cerebral abscess. Samples were collected from the lesion, confirming hyphae compatible with mucormycosis.


2021 ◽  
pp. 197140092098866
Author(s):  
Daniel Thomas Ginat ◽  
James Kenniff

Background The COVID-19 pandemic led to a widespread socioeconomic shutdown, including medical facilities in many parts of the world. The purpose of this study was to assess the impact on neuroimaging utilisation at an academic medical centre in the United States caused by this shutdown. Methods Exam volumes from 1 February 2020 to 11 August 2020 were calculated based on patient location, including outpatient, inpatient and emergency, as well as modality type, including computed tomography and magnetic resonance imaging. 13 March 2020 was designated as the beginning of the shutdown period for the radiology department and 1 May 2020 was designated as the reopening date. The scan volumes during the pre-shutdown, shutdown and post-shutdown periods were compared using t-tests. Results Overall, neuroimaging scan volumes declined significantly by 41% during the shutdown period and returned to 98% of the pre-shutdown period levels after the shutdown, with an estimated 3231 missed scans. Outpatient scan volumes were more greatly affected than inpatient scan volumes, while emergency scan volumes declined the least during the shutdown. In addition, the magnetic resonance imaging scan volumes declined to a greater degree than the computed tomography scan volumes during the shutdown. Conclusion The shutdown from the COVID-19 pandemic had a substantial but transient impact on neuroimaging utilisation overall, with variable magnitude depending on patient location and modality type.


2009 ◽  
Vol 110 (4) ◽  
pp. 737-739 ◽  
Author(s):  
Joo-Hun David Eum ◽  
Astrid Jeibmann ◽  
Werner Wiesmann ◽  
Werner Paulus ◽  
Heinrich Ebel

Primary intracerebral manifestation of multiple myeloma is rare and usually arises from the meninges or brain parenchyma. The authors present a case of multiple myeloma primarily manifesting within the lateral ventricle. A 67-year-old man was admitted with headache accompanied by slowly progressing right hemiparesis. Magnetic resonance imaging showed a large homogeneous contrast-enhancing intraventricular midline mass and hydrocephalus. The tumor was completely resected, and histopathological examination revealed plasmacytoma. After postoperative radio- and chemotherapy, vertebral osteolysis was detected as a secondary manifestation of multiple myeloma.


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