Malignant transformation of craniopharyngioma: case report and review of the literature

Craniopharyngioma is considered to be a benign intracranial tumor. Malignant transformation of craniopharyngioma has rarely been described. In this article, we report a case of ameloblastic carcinoma arising from a previously benign craniopharyngioma in a 42-year-old woman. The patient was diagnosed with craniopharyngioma in August 2004 and underwent surgical resection of a typical craniopharyngioma, the pathological result was craniopharyngioma, papillary and adamantinomatous types. During the subsequent 5 years, this patient experienced two recurrences, for which surgical resections were performed without radiotherapy. The last two pathologic diagnoses were malignant craniopharyngiomas and there was more apparent sign of malignancy in the third pathologic section. The exact pathogenesis and the biological behavior of malignant change in craniopharyngioma are not yet clear. We review the relevant literature of malignant craniopharyngioma. Histopathologic, clinical and imaging features of malignant craniopharyngioma and the possible effect of radiotherapy on the carcinogenesis are discussed.     

Pathological analysis of 1458 cases of tumor in the sella turcica region

The sella turcica region is an anatomical site preferential for various types of intracranial tumors. Pathological analysis of 1458 cases of tumor in this region is presented. They comprised 20.16% of the intracranial tumors. Among them, 846(59.1%) were pituitary adenomas, 433(29.7%) craniopharyngiomas, 91(6.2%) meningiomas and 42(2.9%) germinomas. In pituitary adenomas, chromophobe adenoma was predominant, mixed cell adenoma next and no basophilic adenoma was observed. Of craniopharyngiomas they were divided into cystic, partly solid and cystic, and calcified types grossly and histologically into adamantinomatous, squamous and calcified types. In this kind of tumor, well differentiated cells were consistent to the clinical benign course. For meningiomas, histologically meningotheliomatous type was most common in this region. In previous reports, germinomas in the sella turcica region were so-called ectopic pinealoma. Now it is well known that this tumor arises from germ cells, hence, the synonym "ectopic pinealoma" is obsolete. The germinomas in the sella turcica region accounted for 44.68% of all intracranial germinomas. Microscopic picture of this tumor was similar to those of seminoma of the testicle and dysgerminoma of the ovary. Although gliomas, teratomas, giant cell tumors and chondromas were uncommon in the sella turcica region, the authors believe that they should be considered in the differential diagnosis of tumors in the sella turcica region.     

Paraganglioma in the nasopharynx

A 50-years old male presented with swollen right eyelids, bleeding per nostrils and a vague left post-auricular swelling for4 months. Posterior rhinoscopy revealed one pinkish polypoidal mass in the posterior nare and roof of nasopharynx. FNAC from the post-auricular swelling suggested metastatic undifferentiated carcinoma. Incisional biopsy was done from the nasopharynx and histopathological examination proved it to be a malignant paraganglioma. The case is reported for its rarity.     

Acoustic biast trauma

A 50-year old male presented with swollen right eyelids, bleeding per nostrils and a vague left post-auricular swelling for 4 months. Posterior rhinoscopy revealed one pinkish polypoidal mass in the posterior nare and roof of nasopharynx. FNAC from the post-auricular swelling suggested metastatic undifferentiated carcinoma. Incisional biopsy was done form the nasopharynx and histopathological examination proved it to be a malignant paraganglioma. The case is reported for its rarity.     

Panhypopituitarism resulting from Hodgkin's disease of the nasopharynx

Nasopharyngeal involvement by Hodgkin's Disease is rare and may result in deafness, headaches, nasal obstructions and other symptoms. Compression of the pituitary gland with resultant panhypopituitarism has not been reported in nasopharyngeal Hodgkin's Disease. This paper documents a patient in whom Hodgkin's Disease of the nasopharynx eroded the bony sella turcica and compressed the pituitary gland causing anterior pituitary insufficiency. The patient presented with a skull x-ray and history compatible with a pituitary neoplasm. The diagnosis was established only by surgical exploration.     

Aggressive Giant Pituitary Adenoma Presenting as a Nasopharyngeal Mass: Magnetic Resonance Imaging and Pathologic Findings

We report a giant pituitary adenoma with aggressive histologic features that prominently invaded the nasopharynx. Magnetic resonance imaging (MRI) demonstrated a large heterogeneous nodular mass that was hypointense to isointense on T1-weighted images and mixed hypointense, isointense, and hyperintense on T2-weighted images. The mass measured 7.5×5×7cm, extending from the nasopharynx posteriorly through the clivus, and superiorly through the paranasal sinuses, and sellar-suprasellar region. After contrast administration, heterogeneous nodular enhancement was noted. A nasopharyngeal neoplasm extending into the sella was suspected because voice change and nasal speech long preceded the patient's visual symptoms. A biopsy disclosed an aggressive, infiltrating, hemorrhagic tumor, which was diagnosed as a non-secreting pituitary macroadenoma. This report indicates that pituitary adenomas may grow invasively to tremendously large sizes resulting in their initial presentation as nasopharyngeal masses.     

An unusual foreign body in oesophagus

A young male presented with visual complaints of one year duration, epistaxis and nasal blockage of 3 months duration. He had bilateral proptosis and bitemporal hemianopia and a mass near the; roof of nasal cavity. Skull skiagram showed enlarged sella and computed tomography showed erosion of sella and a central mass. Partial excision of supra and parasellar tumour was done which on histopatho-logical examination revealed Esthesioneuroblastoma. This was followed by radiotherapy and CCNU twice, at 6 weeks interval. He is doing well after 1 year and 9 months of follow up.     

Primary choroid plexus papilloma of the sellar region

BACKGROUND: Choroid plexus papillomas are rare tumors of the central nervous system and are usually confined to the ventricle system. We describe a choroid plexus papilloma located in the sella turcica that was identified pathologically. CASE DESCRIPTION: A 49-year-old woman with a 5-year history of progressive visual deterioration in the left eye was admitted to our hospital. Neurological examination found no abnormality except for the perception of light and secondary optic atrophy in her left eye. Careful endocrine testing did not show any hormone excess or deficiency of the pituitary and target glands. Magnetic resonance imaging demonstrated a hemorrhagic mass in the sellar region, which occupied the entire sella turcica and extended to the suprasellar cistern. The mass was excised via an endonasal trans-sphenoidal approach. Histologic examination proved that the lesion was a choroid plexus papilloma. CONCLUSION: Choroid plexus papillomas arising in and occupying the sella are rare, although some radiographic patterns of ectopic choroid plexus papillomas have been reported. A review of the current literature revealed no similar cases of a choroid plexus papilloma. We discuss the different radiological appearances of choroid plexus papillomas, the differential diagnosis, and treatment.     

Cutaneous matastasis from sino-nasal malignant melanoma — a rare case report

To report a case of disseminated cutaneous metastasis from malignant melanoma of sino-nasal region. A 53-year-old man from rural parts of West Bengal presented with progressive nasal obstruction. CT scanning was done to know the extent of the mass and punch biopsy from the mass was performed. Malignant melanoma of sino-nasal region was diagnosed and chemotherapy was started. The patient developed cutaneous deposits after two cycles of chemotherapy. The patient developed cutaneous deposits during the course of chemotherapy. Excision biopsy from cutaneous deposits revealed malignant melanoma. A rare case of diffuse cutaneous metastasis of malignant melanoma is presented here along with review of literature.     

Primary adenocarcinoma of cervical esophagus

Most upper esophageal malignancies are squamous cell carcinomas, rarely adenocarcinomas arising from Barrett's esophagus and very rarely adenocarcinomas from heterotopic gastric mucosa without evidence of Barrett's especially in the cervical part of the esophagus. We report a case of adenocarcinoma of the polypoid type in the upper esophagus (cervical esophagus) arising from ectopic gastric mucosa, in a 60 year-old man who presented with progressive dysphagia. Accurate diagnosis by esophagogram revealed a large mass in the cervical esophagus; CAT scan showed intraluminal mass at the level of thoracic inlet, esophagogastroscopy showed a fleshy polyp (3.2cm x 3.0cm) at 20 cm from the incisors with a biopsy confirming moderately differentiated adenocarcinoma with no evidence of Barrett's esophagus. Through a left cervical approach and resection of medial third of clavicle, the tumor was removed by partial esophagectomy followed by lymph node dissection, and proved to be T1NOMO, stage I (AJCC staging 6th ed.). Post operatively, the patient received chemoradiation with no evidence of recurrence or metastasis in six years of follow up. It seems this tumor has a much better prognosis than adenocarcinomas arising from Barrett's. To our knowledge only 19 cases have been reported in literature so far.     

Benign multicystic peritoneal mesothelioma in a cesarean-section scar presenting as a fungating mass

We report a case of a benign multicystic mesothelioma, which presented as a fungating mass through the anterior abdominal wall and arose in a cesarean-section scar without direct peritoneal involvement. A wide local excision was done and the diagnosis was confirmed by histopathology and immunohistochemistry. The postoperative course was uneventful and the patient is asymptomatic at 3 years' follow-up. Although a history of previous abdominal surgery has been reported in a patient with benign multicystic mesothelioma, to the best of our knowledge, there is no report of a benign multicystic mesothelioma arising in a cesarean-section scar or presentation as a fungating skin mass. This unusual presentation may point to a traumatic or inflammatory etiology, although seeding of the wound during the previous surgeries is a more likely postulate. A pertinent review of the literature on benign multicystic mesothelioma is also presented.     

Gallbladder adenocarcinoma and paraneoplastic parathyroid hormone mediated hypercalcemia

Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells. We present a case of 86-year-old female with metastatic gall bladder adenocarcinoma diagnosed eight months back who presented with generalized fatigue and poor oral intake and was found to be hypercalcemic with elevated parathyroid hormone levels. Imaging with technetium 99 m sestamibi scintigraphy with dual phase, subtraction thyroid scan (dual isotope scintigraphy), magnetic resonance imaging and ultrasonography did not demonstrate any parathyroid lesion in normal or ectopic sites. We believe that the tumor cells were the source of ectopic parathyroid hormone secretion as we had excluded all the other possibilities with extensive combined imaging thereby increasing the sensitivity of our testing. We report the first case of metastatic gall bladder adenocarcinoma with paraneoplastic ectopic parathyroid hormone secretion.     

Tracheal lymphoepithelioma-like carcinoma: a case report

Lymphoepithelioma like carcinoma is rare in locations other than nasopharynx. We report the second case of this tumour in trachea, in a young female patient, who was managed with concomitent surgery, radiotherapy and chemotherapy. The patient is disease free in the one-year follow up. The tumour presented difficulties during intubation for general anaesthesia and during surgery. Association with Epstein-Barr virus was not found in our case.     

Parenchymal anaplastic ependymoma with intratumoral hemorrhage: a case report

We report an unusual case of a 56-year-old woman with a supratentorial anaplastic ependymoma localized in the parenchyma without continuity with the ventricular system and brain surface. The patient presented with vertigo, and a calcified mass was detected in the left temporal parenchyma. Five years later, she had seizure of the right extremities. Computed tomographic scanning and magnetic resonance imaging revealed an enhanced mass with an intratumoral hemorrhage adjacent to the calcified mass. Subtotal removal of the tumor was performed. The histological analysis revealed that the tumor was an anaplastic ependymoma. After focal radiation therapy (50 Gy), the outcome was favorable, although the residual lesion was still seen on the images. Ependymomas usually arise from the cells lining the ventricular system and the central canal of the spinal cord. We discuss the summary of published cases of supratentorial ectopic ependymoma since the first case in 1995.     

Nasopharyngeal presentation of renal cell carcinoma

In this case report, we present a 50-year- old woman, who presented with severe headache as her only presenting clinical symptom due to nasopharyngeal mass. Histo-pathological evaluation of the biopsy from nasopharyngeal mass revealed clear cell carcinoma. On further evaluation, an asymptomatic mass was detected in the left kidney. The metastatic lesion was treated with palliative radiotherapy. A search of the literature revealed no reports of such unusual metastasis in the nasopharynx from a primary carcinoma of the renal origin.     

Rectal cancer in pregnancy: A diagnostic and therapeutic challenge

IntroductionThe occurrence of colorectal cancer during pregnancy is rare and is associated with diagnostic and therapeutic challenges. Herein, we report such a case of rectal cancer in pregnancy and review the literature.Case reportA 31-year-old multiparous, pregnant woman, in the 20th week of gestation, presented with rectal bleeding progressing to spasmodic abdominal pain and right flank vague pain. A flexible rectosigmoidoscopy showed a large ulcerative mass located in the rectosigmoid junction, 15 cm away from anal verge. Imaging studies and biopsy proved it to be rectal adenocarcinoma with single liver metastasis. The patient’s pregnancy was terminated and neoadjuvant therapy followed by curative surgery was performed. She is currently receiving adjuvant systemic therapy to eradicate potential micrometastatic disease.ConclusionThis case suggests that colorectal cancer can mimic the signs and the symptoms of pregnancy and tends to present at an advanced stage in pregnant women.     

Intracranial Masson tumor: case report and literature review

Intravascular papillary endothelial hyperplasia (IPEH) or Masson tumor has only been reported intracranially in 20 cases and can present as a congenital finding. This pathologic entity is an important diagnostic consideration when evaluating an infant with a congenital intracranial mass. We report a third case of a neonate who presented with the appearance of a metastatic brain tumor involving the orbit, sella, and cerebellum that was ultimately proven to be IPEH. A thorough literature review of IPEH is presented and we discuss this clinical entity and its management.     

A stromal Leydig cell tumor of the ovary occurring in a pregnant 15-year-old girl. Ultrastructural findings

The first case of stromal Leydig cell tumor of the ovary occurring during pregnancy is reported. A 15-year-old girl presented in labor at 36.5 weeks of gestation. The tumor mass was obstructing labor and the patient had to be delivered by cesarean section. Unique features of this case included the young age of the patient, the large size of the tumor, and the associated pregnancy. The tumor was encapsulated and showed the typical histologic and ultrastructural features of ovarian stromal Leydig cell tumor. The literature is reviewed, and the differential diagnosis is discussed.     

A mediastinal germ cell tumor mimicking an ectopic pregnancy

The objective is to report the case of a 36 year-old female with a primary mediastinal germ cell tumor mimicking an ectopic pregnancy. The patient under birth control pill presented, at seven weeks of amenorrhea, a β-human chorionic gonadotropin (β-hCG) level of 850 UI and uterine vacuity with left lateral uterine heterogeneous mass but no bleeding and no pain. She received left adnexectomy, uterine curettage and further treatment by methotrexate because of persistent high β-hCG markers. Computed tomography scan finally permitted to discover a voluminous anterior mediastinal tumor. We may recommend investigating patients with a simple chest X-ray that present with persistent increased β-hCG despite efficient ectopic pregnancy treatment.     

Papillary carcinoma in a supra hyoid thyroglossal duct cyst — an unusual presentation

Carcinomatous transformation of ectopic thyroid elements within the thyroglossal tract is a rare entity. We report a case of primary papillary carcinoma of thyroid presenting within the thyroglossal duct cyst in a 23 year old gentleman. The patient presented to us, as a case of suprahyoid thyroglossal cyst with sub-lingual involvement and he underwent surgical excision of the entire thyroglossal tract by Sistrunk’s approach. The post-operative histopathological diagnosis was of a papillary carcinoma within the thyroglossal duct cyst. Hence, the patient was evaluated for a malignant focus in the thyroid which proved negative. He was counseled regarding the possibility of developing Carcinoma in the thyroid gland and offered two options of further management viz., total thyroidectomy followed by life long thyroid suppression or watchful observation and follow up. As the patient belonged to the low risk group, he opted for the second option. He is presently kept under meticulous follow up and remains asymptomatic till date. We present the pre- and post-operative imaging, intra-operative findings, histo-pathological features and review the present world literature on this rare entity.