Tumors originating from ceruminous glands are rare lesions of the external auditory canal. The lack of specific clinical and radiological signs makes their diagnosis challenging. We report the case of an exceptionally rare benign tumor, a syringocystadenoma papilliferum (SCAP), in an atypical location in the bony segment of the external auditory canal with uncommon clinical signs. The special traits of the case included the following: the most lateral component of the tumor was macroscopically cystic and a granular myringitis with an obstructing keratin mass plug was observed behind the mass. The clinical, audiological, radiological, and histological characteristics of the neoplasm are consequently presented. Intraoperative diagnosis of the epidermal cyst was proposed. The final diagnosis of SCAP was determined only by histological analysis after the surgical excision. The educational aspects of the case are critically discussed.
A 63-year-old woman residing in northern Lithuania was admitted to the Department of Neurosurgery at Republican Vilnius University Hospital with severe headache, progressive left-sided hemiparesis, and seizures. These symptoms, along with ataxia and left-sided facial nerve palsy, were present for several weeks and gradually worsened. The patient was diagnosed 6 years before with liver alveolar echinococcosis (AE) stage IV P4N4M1 with transdiaphragmatic bilateral pulmonary dissemination (►Figs. 1, 2).1 The case was considered nonsurgical, and treatment with albendazole 400 mg twice a day was initiated. This treatment resulted in elevation of hepatic enzymes, and the dose was reduced to 200 mg per day. The patient developed pruritus, headache, and cardiac Keywords► alveolar echinococcosis ► Echinococcus multilocularis ► cerebral alveolar echinococcosis AbstractThe fox tapeworm Echinococcus multilocularis causes human alveolar echinococcosis, commonly affecting the liver. However, in $1% of cases, systematic spread of the disease involves the brain as well. A patient had a 6-year history of liver and lung alveolar echinococcosis that was considered not suitable for surgery, and treatment with albendazole was introduced. After the appearance of neurologic disturbances, an intracranial mass lesion was demonstrated by radiologic imaging. The lesion was surgically removed, and histologic analysis revealed metacestode tissue of E. multilocularis. Despite the surgical resection of the lesion, the patient died of progression of systemic alveolar echinococcosis. The authors highly recommend implementing neurologic monitoring to the follow-up algorithm for patients with systemically disseminated alveolar echinococcosis. When neurologic symptoms occur, radiologic imaging of the brain should be obtained immediately. Surgery should be considered for all intracranial echinococcal lesions, unless the lesion is located in the eloquent brain area.
Only a few cases of papillary glioneuronal tumour (PGNT) with predominantly focal symptomatology are described in the literature. We report on the clinical, radiological, and histopathological features of PGNT. The intraoperative pathology revealed no tumour in the walls of the cyst, thus surgical resection of the nodule was performed leaving the cyst wall intact. There was no recurrence of tumour at the three-year follow-up, although a long-term follow-up is necessary.
Teratoma yra apibrėžiama kaip neoplazma, kuri susideda iš įvairių parenchiminių ląstelių, kilusių iš trijų germinacinių sluoksnių (ektodermos, mezodermos ir endodermos). Nugaros smegenų teratomos sudaro 0,1–0,5 % visų nugaros smegenų navikų. Taip pat šis navikas yra itin retas tarp suaugusiųjų. Intramedulinė spinalinė teratoma yra pats dažniausias šio naviko tipas. Pagrindiniai spinalinės teratomos požymiai yra skausmas, kojų silpnumas ir tirpimas, šlaplės ar išangės raukų jos sutrikimas, kai anksti pasireiškia sustiprėję refleksai ir šlapinimosi bei tuštinimosi kontrolės praradimas. Histologinis ištyrimas yra tikslios diagnozės nustatymo auksinis standartas. Teratoma diagnozuojama, stebint audinius, kilusius iš visų trijų germinacinių sluoksnių. Magnetinio rezonanso tyrimas yra auksinis diagnostikos standartas. Dėl naviko audinių įvairovės, MRT vaizduose stebimi nehomogeniško intensyvumo vaizdai T1 ir T2 sekose. Chirurginė rezekcija yra pirmo pasirinkimo gydymas šiam navikui ir dažniausiai atliekama laminektomijos metu. Operacijos tikslas daugeliu atvejų turėtų būti radikali rezekcija su nervų kompresijos sumažinimu, siekiant sumažinti neurologinių funkcijų pablogėjimą. Straipsnio autoriai pristato pirmą intradurinės intramedulinės spinalinės teratomos atvejį Lietuvoje, kuris, nors ir nepasireiškė būdingais simpto mais ir požymiais, tačiau buvo sėkmingai diagnozuotas ir gydytas, taip pat suaugusiųjų spinalinės teratomos literatūros apžvalgą.
InroductionThis case presents unexpected association between disease and symptoms. We believe that it should compel clinicians to rethink the known behaviors of the benign tumors, in particular meningioma which can gain independent metastatic potential. This report aims to increase the awareness of clinicians toward patients with this unusual and clinically isolated pattern, because metastases can remain misdiagnosed for a long period of time. This case contributes to medical knowledge, diagnostic and prognostic approaches. This is also the first case of metastatic meningioma reported in Lithuania. Case reportWe report a 66-year-old woman who presented with persistent productive cough, dyspnea, fever and weakness during physical activity. Chest radiographs revealed multiple small round shaped pulmonary nodules. Thoracoscopic resection and histopathology showed a benign meningioma. Magnetic resonance imaging (MRI) scan of the brain demonstrated a small dural-based mass in the left pontocerebellar angle connected with deep dilated cerebral venous network and superior petrosal sinus. Morphological findings of this tumor were consistent with a World Health Organization (WHO) grade I fibrous meningioma. 109Multiple pulmonary metastases from asymptomatic benign intracranial meningioma: a case report ConclusionMeningiomas are usually non-invasive tumors and do not metastasize and hence, are perceived as benign tumors. Patients with this uncommon and clinically isolated pattern of metastases can remain misdiagnosed for a long period of time, due to unexpected behavior of this particular tumor. This case report denies most of the criteria of possible risk factors for the development of metastases from a meningioma what allows to consider it as tumor with unpredictable behavior. Key words: meningioma, benign, asymptomatic, metastases Įvadas Šis klinikinis atvejis atspindi nenumatytą ligos pasireiškimą. Tikime, kad jis privers apgalvoti jau žinomą gerybinių navikų, tarp jų ir meningiomos, elgseną, kuri gali įgyti nepriklausomą metastazinį potencialą. Kadangi gerybinių navikų metastazės yra diagnozuojamos pavėluotai, šiuo pavyzdžiu siekiame plėsti klinicistų sąmoningumą ir budrumą nagrinėjant ligas, kurioms būdingos neįprastos klinikinės apraiškos. Tai pirmasis Lietuvoje aprašytas intrakranijinės meningiomos metastazavimo į plaučius atvejis. Klinikinis atvejisAprašome 66 metų moters atvejį. Ji skundėsi nuolatiniu produktyviu kosuliu, dusuliu, karščiavimu ir silpnumu, atsirandančiu fizinio krūvio metu. Krūtinės ląstos rentgenogramos parodė daugybinius, mažus, apvalios formos mazgus plaučiuose. Po atliktos torakoskopinės plaučių rezekcijos histopatologinio tyrimo būdu konstatuota meningioma. Atliktas galvos smegenų magnetinio rezonanso tyrimas, kurio išvada -kairiajame tilto ir smegenėlių kampe su dangalais susijęs, kontrastinę medžiagą gerai kaupiantis, smulkus navikas, išsiplėtusios giliosios smegenų venos. Histologiškai smegenų darinys, remiantis Pasaulio sveikatos organizacijos klasifikacija, yra I laipsnio fibrozinė meni...
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