Giant cell tumour of the temporal bone: Case report and review of the literature

This paper presents an expansile lesion of the temporal bone, in a 14-year-old boy, that was initially diagnosed as intra-osseous meningioma from CT appearance. At histopathology a final diagnosis of giant cell tumour was made. A brief review of the literature is presented for this rare case.     

Uterine arteriovenous malformation: A rare cause of uterine bleeding. Diagnosis and treatment

A case of uterine arteriovenous malformation following a dilatation and curettage is presented. Initial diagnosis with colour and pulsed Doppler ultrasound and treatment with transcatheter arterial embolization are described.     

Lipomatous meningioma associated with cerebral vascular malformation

A unique epileptic patient with intracranial neoplasm is reported in which a meningioma with lipomatous and osseous components was found associated with cerebral arteriovenous malformation at the same location in the right frontal lobe. The development of the leptomeningeal neoplasm may have been influenced by the underlying vascular anomaly. The cerebral arteriovenous malformation and altered hemodynamics also could have induced the sudden onset of clinical seizures, hemiparesis, and unconsciousness.     

Generalized skull vault thickening in association with a large arteriovenous malformation

Generalized thickening of the skull is unusual but has a number of recognized associations such as chronic severe anaemia, Paget disease and phenytoin therapy. We report a case of generalized skull vault thickening seen in association with a large arteriovenous malformation of the brain.     

Anomalous communication of external carotid and vertebral arteries with associated intracranial parenchymal arteriovenous malformation: Magnetic resonance angiography and angiographic findings

A case of anomalous communication of the external carotid and vertebral arteries via a pro‐atlantal intersegmental artery (PIA) with an associated intracranial parenchymal arteriovenous malformation (AVM) is presented. The course of the PIA is displayed by both conventional catheter angiography and by MR angiography (MRA). To our knowledge, neither an associated intracranial parenchymal AVM nor depiction of this congenital anomaly on MRA has been previously described. We also briefly review the embryology and anatomy of this anomaly.     

Radiation therapy for intractable bleeding in extremity arteriovenous malformation: Considerations on a clinical case

Arteriovenous malformations are rare clinicopathological entities with varied distribution and a constellation of symptoms. In the extremities they are usually associated with dermatological manifestations, such as angiodermatitis with a potential risk of torrential haemorrhage. Surgical resection is a morbid procedure. Transcatheter embolization and sclerotherapy is an attractive alternative to surgical resection. However, proper case selection is a prerequisite and may not be possible in all the cases. The case reported here is a paradigm of a complex and extensive vascular malformation with torrential haemorrhage where a unique therapeutic approach of radiation therapy was used as an alternative to morbid surgery after embolization and sclerotherapy failure.     

Management of scrotal arteriovenous malformation with transcatheter embolisation coils and percutaneous sclerotherapy under angiographic guidance

Arteriovenous malformations of the scrotum are infrequent and are usually treated by a combination of endovascular embolisation and surgery. We present a case of scrotal arteriovenous malformation treated effectively by a combination of endovascular and direct percutaneous techniques.     

Primary intracranialRhabdomyosarcoma: Case report and review of the literature

Summary Invasion of the meninges is a relatively common complication of head and neck rhabdomyosarcoma (RMS), while RMS arising primarily within the brain or meninges is rare. We report the case of an 11-year old child with a primary “primitive” frontal lobe tumor, subsequent leptomeningeal spread and fatal intratumoral hemorrhage; the diagnosis of RMS was discovered only at postmortem examination. The literature contains a total of 34 reported cases of primary intracranial RMS. This tumor has been observed to arise in a variety of central nervous system (CNS) locations in patients of all ages, but most commonly within the posterior fossa of children. Leptomeningeal dissemination and spontaneous intratumoral hemorrhage are important clinical features. Postoperative chemotherapy and craniospinal radiation may improve the anticipated poor prognosis of patients treated with surgery and radiation alone. The diagnosis of RMS may be missed unless electron microscopic and specific immunohistochemical studies are applied to “undifferentiated” or “primitive” CNS tumors.     

Three‐dimensional gadolinium‐enhanced magnetic resonance angiography of pulmonary arteriovenous malformation

Pulmonary arteriovenous malformations (AVMs) are rare vascular malformations of the lung. Although most patients are asymptomatic, AVMs can bleed and result in haemoptysis and haemothorax. We describes a case of pulmonary AVMs in a patient with Osler–Weber–Rendu syndrome with 3‐D contrast‐enhanced MR angiography. Magnetic resonance angiography provided accurately and non‐invasively the number and size of the feeding arteries and draining veins.     

Anomalous unilateral single pulmonary vein: Two cases mimicking arteriovenous malformations and a review of the literature

Total anomalous pulmonary venous drainage is a rare congenital anomaly. It usually involves a pulmonary to systemic venous shunt and most cases have a septal defect in order to survive. Anomalous pulmonary venous drainage with pulmonary venous shunting is an extremely rare and entirely benign entity. We present two such cases, in which there was atresia of the left superior pulmonary vein and drainage via a tortuous collateral vein to the left inferior pulmonary vein. This collateral was mistaken on plain film and CT for a pulmonary arteriovenous malformation. Awareness of this anomalous unilateral single pulmonary vein and its radiological appearances may help in avoiding unnecessary pulmonary angiography.     

First use of Micro Vascular Plugs in Australia: Endovascular treatment of pulmonary arteriovenous malformation

This report describes the first Australian experience with the Micro Vascular Plug System (MVP), as a permanent embolic device for the treatment of pulmonary arteriovenous malformations (PAVMs). MVPs deployed in small vessels between 2 mm and 5 mm are demonstrated to be feasible, safe and effective treatment for PAVMs.     

Giant condyloma acuminatum (Buschke-Lowenstein tumor) involving a pilonidal sinus: a case report and review of the literature

Giant condyloma acuminatum or Buschke-Lowenstein tumor has been reported to involve many areas about the perineum. The majority of previous documentations have implicated the coronal sulcus, prepuce, and fossa navicularis of the penis as the most likely foci to support growth. Authors have contributed multiple cases of perianal and rectal involvement as well as rare reports of inguinal, bladder, and endocervix-low uterine segment tumors. A case of giant condyloma acuminatum involving a chronic pilonidal sinus overlying the sacrum is described. Wide surgical extirpation was found to be a curative means of management.     

淋巴结外Rosai-Dorfman病二例报告并文献复习

为了探讨淋巴结外Rosai-Dorfman病的病理学特征、临床表现、诊断、治疗及预后,对2例结外Rosai-Dorf-man病行HE和免疫组织化学染色观察,并对其进行随访。结果显示,光镜下见病灶内有大量含嗜酸性胞质的组织细胞,胞质中可见被吞噬的淋巴细胞、浆细胞或中性粒细胞,S-100和CD68染色( )。治疗方法多样,疗效及预后不同。初步研究结果提示,结外Rosai-Dorfman病是一种少见的组织细胞增生性病变,有一定的病理学特征。由于其临床表现多样,导致诊断较难,治疗效果不尽相同。     

Direct sac puncture and N‐butyl cyanoacrylate embolization of medial canthal arteriovenous malformation supplied by the external carotid artery and the internal carotid artery branches

We report a periorbital arteriovenous fistula that was treated with direct sac puncture N‐butyl cyanoacrylate embolization under controlled inflow and outflow. The efficacy of this technique in a periorbital lesion is discussed.     

Haemangioma or vascular malformation of the tympanic membrane? a case report and review of literature

Benign vascular lesions are rarely found on the tympanic membrane. We report a case of such a lesion in a novel location, with review of the relevant literature. We also highlight the significance of accurate classification of such lesions, proposing adoption of more pathophysiologically-correct nomenclature of “haemangioma” and “vascular malformation”.     

Dynamic CT angiography for cyberknife radiosurgery planning of intracranial arteriovenous malformations: a technical/feasibility report

Background.

Successful radiosurgery for arteriovenous malformations (AVMs) requires accurate nidus delineation in the 3D treatment planning system (TPS). The catheter biplane digital subtraction angiogram (DSA) has traditionally been the gold standard for evaluation of the AVM nidus, but its 2D nature limits its value for contouring and it cannot be imported into the Cyberknife TPS. We describe a technique for acquisition and integration of 3D dynamic CT angiograms (dCTA) into the Cyberknife TPS for intracranial AVMs and review the feasibility of using this technique in the first patient cohort.

Patients and methods.

Dynamic continuous whole brain CT images were acquired in a Toshiba 320 volume CT scanner with data reconstruction every 0.5 sec. This multi-time-point acquisition enabled us to choose the CT data-set with the clearest nidus without significant enhancement of surrounding blood vessels. This was imported to the Cyberknife TPS and co-registered with planning CT and T2 MRI (2D DSA adjacent for reference). The feasibility of using dCTA was evaluated in the first thirteen patients with outcome evaluation from patient records.

Results.

dCTA data was accurately co-registered in the Cyberknife TPS and appeared to assist in nidus contouring for all patients. Imaging modalities were complementary. 85% of patients had complete (6/13) or continuing partial nidus obliteration (5/13) at 37 months median follow-up.

Conclusions.

dCTA is a promising imaging technique that can be successfully imported into the Cyberknife TPS and appears to assist in radiosurgery nidus definition. Further study to validate its role is warranted.     

Efficacy and morbidity of arc-therapy radiosurgery for cerebral arteriovenous malformations: a comparison with the natural history

PURPOSE: To report the results of arc-therapy radiosurgery for cerebral arteriovenous malformation (AVM) and to compare the adverse event rate with the rate expected from the natural history. METHODS AND MATERIALS: We performed a retrospective study of our 118 first patients with a mean follow-up of 46 months (range, 5-105 months). The AVMs had features indicating a poor prognosis at initial presentation and had already been treated by previous embolizations in 88% of patients. The mean volume of the targets was 7.4 cm3 (range, 0.3-28.3 cm3). The mean minimal and maximal dose was 17.7 Gy (range, 10-25 Gy) and 24.5 Gy (range, 17-36 Gy), respectively. RESULTS: The crude and 5-year actuarial rate of cure (total obstruction of the AVM shunt at angiography) was 54% (60 of 112) and 77%, respectively. The only independent prognostic factor of cure was the AVM volume (crude cure rate 67% for <7 cm3 vs. 35% for > or =7 cm3; p = 0.001). No patient died. Transient and permanent complications and hemorrhage occurred in 5%, 1.7%, and 6% of patients, respectively. The annual risk of an adverse event (hemorrhage or complication) was 3.9%. CONCLUSION: The results of our series showed that radiosurgery, performed alone or after prior shrinkage of the AVM by embolization, is both effective and well tolerated, with a rate of adverse events comparable to that expected from the natural history.     

Breast carcinoma with osteoclast-like giant cells: a case report and review of the Japanese literature

A 41-year-old premenopausal woman with a 3.5 cm freely mobile mass in the upper outer quadrant of the right breast was admitted to our hospital. Fine needle aspiration showed malignant epithelial cells and many multinucleated osteoclast-like giant cells (OGCs). Excisional biopsy revealed an invasive ductal carcinoma. A right modified radical mastectomy was subsequently performed. Macroscopically the tumor was well circumscribed with a dark brown cut surface. Microscopically, the tumor was a grade 2 invasive ductal carcinoma with many multinucleated OGCs adjacent the tumor cells and hemorrhage and infiltration of inflammatory cells in the stroma. The intra-mammary metastasis also contained OGCs and stromal reactions. By enzyme immunoassay, the tumor cells were negative for estrogen receptor but positive for progesterone receptor. The tumor cells were negative for both c-erbB-2 and p53. The OGCs showed positive immunostaining with the monoclonal antibody CD68, demonstrating a histiocytic origin. Lymph nodes were free of metastasis. We also review the Japanese literature concerning breast carcinoma with OGCs.