A case of solitary bone cyst in the skull increasing in size after trivial head injury

A 12-year-old boy had been known to have a small swelling in the left high vertex for several years. After a trivial head hit to the site of the swelling, the swelling enlarged gradually. A bone window CT scan showed a lesion having bubble-like lytic change in the left parietal bone. Similar changes, but small, were able to be pointed out in a CT scan taken seven years previously. In the following 13 months CT scans eventually revealed sequential increases to 3.5 cm in diameter. Surgical exploratory resection of the mass was performed. Intraoperatively, partial destruction of the outer skull table and a simple cyst with serous yellowish brown colored fluid were identified. There was no finding adherent to the diploic structure. The bone defect after excision was reconstructed by using a titanium plate. The patient was followed up for 2 years after the surgery. Bone window CT showed bony development of normal appearance. Histological examination showed the cyst wall consisted of fibrous connective tissue but there were neither epithelial nor endothelial cells. The histopathological diagnosis of SBC was most likely. SBC is relatively common in long bones, but rarely in flat bones. Only several cases of the SBC of cranial bone have been reported. Although a craniectomy for total excision followed by cranioplasty by resin was common, in cases of children, cyst removal with titanium plate application would be an alterative. SBC increasing in size after head injury is extremely rare, but clinicians may need to be aware of cystic skull bone tumors increasing in size after head injury.     

A case of multiple primary tumors of the anterior skull base.

We report a case of synchronous olfactory bulb meningioma and undifferentiated carcinoma of the nose and paranasal sinuses that involved and destroyed the anterior skull base and mimicked intracranial invasion by a carcinoma. The heterogeneity of tissue types in the skull base gives rise to a diverse variety of benign and malignant neoplasms which have totally different prognoses. Synchronous development of benign and malignant primary tumors both originating from and involving the skull base at the same location is very rare and may cause confusion for both the skull base surgeon and neuroradiologist.     

A case of primary malignant lymphoma of the brain associated with acute hydrocephalus

A case of primary cerebral malignant lymphoma associated with hydrocephalus is reported. The patient was a 54 year-old male who enjoyed good health until the onset of headache and vomiting 4 weeks before admission. His consciousness was alert and neurological examination revealed severe papilloedema with retinal hemorrhage. No lymph node or abdominal tumor enlargement were noted. CT scan and MR images revealed no abnormal lesion except mild ventriculomegaly. CSF study revealed mild elevation of protein and sugar and cell count was 66/3. CSF cytology revealed atypical lymphoid cell with irregular nuclear contour and large nucleolus. Immunological marker studies of the tumor cell revealed increasing of anti J-5 (CD10), anti B-4 (CD19) and OKT-IA1. The patient was treated by a whole brain irradiation and chemotherapy after V-P shunt. It is 12 months since the operation, and the patient's condition is still good.     

A case of primary testicular malignant lymphoma associated with contralateral testicural recurrence after a seven-year interval

A 70-year-old male presented to our hospital in October 1999 complaining of right scrotal swelling. Right high ligation of testis was performed. Pathological examination demonstrated a diffuse large B-cell lymphoma (DLBCL) originating from the right testis. He underwent four courses of adjuvant chemotherapy consisting of CHOP (cyclophosphamide, doxorubicin, vincristin, prednisone) together with 40 Gy radiotherapy to the contralateral testis. Following this treatment he achieved complete remission. Seven years later in March 2006, he developed swelling of the left scrotum. He underwent left high orchidectomy based on the suspicion of a contralateral testicular malignant lymphoma. Pathological examination of the testicular specimen confirmed a diagnosis of DLBCL. He underwent chemotherapy and has survived without evidence of recurrence. We have summarized the cases of bilateral asynchrony primary testicular lymphoma.     

A case of malignant paraganglioma presenting with skull metastases

A non-functioning paraganglioma is usually benign, however, it may cause distant metastases. There is no histological appearance for the diagnosis of malignancy or absolute criteria for predicting malignant potential. Bony metastases from paraganglioma are known to occur, but, skull metastases are very rare. We report a case of intracranial metastases from a renal paraganglioma. A 61-year-old male presented with temporal headache and exophthalmos on the left side. Seven years prior, he underwent surgery to remove a mass in the right renal hilum, which was diagnosed as renal cell carcinoma at that time. Computed tomography and magnetic resonance imaging showed a ring-like enhanced mass in the left middle fossa, which destroyed the sphenoid bone and the lateral wall of the orbit. Another osteolytic lesion was revealed in the occipital bone. The fragile tumor was totally resected. Histopathological study revealed the Zellballen pattern with extensive coagulation necrosis. No apparent nuclear atypia or mitosis were present. Immunohistochemistry showed reactivity for synaptophysin and chromogranin A in the tumor cells. Review of the surgical specimen of the previously resected renal tumor revealed the same pathological and immunohistochemical findings as those of chief cells in the middle fossa tumor. Thus, this tumor was diagnosed as a malignant paraganglioma metastasized from renal paraganglioma. After six cycle chemotherapy with cyclophosphamide and vincristine, his condition was stable for two years, however, he died four years after the diagnosis of malignancy.     

Brain injury without head injury after multiple trauma

Watershed infarction has previously been described after cerebral trauma, when it is due to raised intracranial pressure or systemic hypotension. A case is reported, so far as is known for the first time, of bilateral watershed infarction following blunt systemic trauma, without injury to the head or neck. The importance of resuscitation in preventing secondary brain injury caused by systemic hypotension is highlighted. The advantages of HMPAO-SPET in detecting cerebral perfusion defects are discussed.     

A case of bilateral panophthalmoplegia caused by paranasal malignant lymphoma extending into the skull base]

A case of bilateral panophthalmoplegia developed after paranasal malignant lymphoma is described, and previously reported cases are reviewed. A 74-year-old female was hospitalized with the chief complaints of bilateral ptosis and bilateral deep orbital pain that had developed over a 10-day period. Neurological examination revealed bilateral dilated pupils, panophthalmoplegia, and hypalgesia in the area of the ophthalmic nerve on both sides. Laboratory studies and endocrinological examination were free from abnormal findings. Skull X-ray films showed a soft tissue lesion in the sphenoidal and ethmoidal sinus and this was associated with bony structure destruction in the surrounding area. Computed tomography demonstrated a heterogeneously enhanced mass lesion in the paranasal sinus extending into the intrasellar region and bilateral cavernous sinus. Meticulous investigation has so far revealed no distant lesions either in the thoracic or abdominal lesions. Subtotal tumor resection was undergone via the transsphenoidal route at which time tumor extension into the nasal cavity and sellar floor destruction were confirmed. Diffuse and mixed B-cell type malignant lymphoma was the pathological diagnosis. Postoperatively, improvement of abnormalities of pupils, panophthalmoplegia, and ptosis was achieved but this was only transient. Despite focal radiation therapy and repeated chemotherapy, the patient died 14-months after the diagnosis was made. On reviewing the literature, it is shown that the incidence of bilateral panophthalmoplegia among patients who develop disturbance of ocular movement is extremely low (0.4%).(ABSTRACT TRUNCATED AT 250 WORDS)     

全身多发性骨纤维异样增殖症合并动脉瘤样骨囊肿1例

1 病例资料 患者,女,24岁。主诉：双上肢左大腿反复疼痛9年。病史：9年前外伤后摄X线片见左股骨和胫骨病变,外院诊为骨纤维异样增殖症,行股骨和胫骨肿瘤刮除自体并异体骨植骨术。此后又发现多处病灶、外院于2001-2002年先后两次对左胫骨无端和左肱骨行肿瘤刮除异体骨植骨术。     

Unusual case of crescentic glomerulonephritis associated with malignant lymphoma. A case report and review of the literature

Renal lesions in non-Hodgkin's lymphoma are rare. Furthermore, to the best of our knowledge, only 5 cases of crescentic glomerulonephritis associated with non-Hodgkin's lymphoma have been previously described. We report a case of crescentic glomerulonephritis and renal failure which preceded the diagnosis of non-Hodgkin's lymphoma. Following steroid therapy there was a resolution of these histological findings a year later.     

胰头区恶性肿瘤术后预后因素的研究进展

目的探讨包含壶腹部、胆管下段、胰头部、钩突部和胰颈部5个部位在内的胰头区恶性肿瘤术后的预后影响因素。方法对近年国内外有关该区域恶性肿瘤研究的文献结果进行归纳综述。结果壶腹部、胆管下段、胰头部、钩突部和胰颈部恶性肿瘤的预后与其病变部位、肿瘤直径、神经侵犯、血管侵犯、淋巴转移、病理学及组织学分型和切缘状态存在相关性。肿瘤位置及病理学分型的不同使其神经血管侵犯率、淋巴转移率和R0切除率存在差异。结论通过对肿瘤病变部位、肿瘤直径、神经侵犯、血管侵犯、淋巴转移、病理及组织学分型和切缘状态的总结分析,可提高对该区域肿瘤的临床预判准确性,有利于术前选择恰当的手术方式,术后制定更为合理的辅助治疗方案,提高人们对该区域肿瘤治疗的针对性,改善预后,以便更好地服务于临床工作。     

A case of prostatic malignant lymphoma

A 65-year-old man was admitted for dysuria. He had been irradiated 60Co for malignant lymphoma of tonsils 2 years earlier. The findings of palpation of prostate, retrograde urethrogram and urethroscopy strongly suggested benign prostatic hypertrophy. Retropubic prostatectomy was performed and 18 g of "adenoma" was resected. By histological observation, the "adenoma" proved to be malignant lymphoma. This tumor belonged to follicular lymphoma, medium-sized cell type of LSG non-Hodgkin's lymphoma classification. After the operation, he left our hospital for a personal reason and received systemic chemotherapy at another hospital.     

A case of renal malignant lymphoma

Malignant lymphoma affects any organ of the body, but is rarely found in a urological organ. We found a case of renal malignant lymphoma. A 45-year-old male, who had been operated on for primary hepatic malignant lymphoma 9 months previously, was admitted to our clinic, complaining of high fever. X-ray and ultrasonographic examinations suggested a metastatic tumor in the right kidney. Right nephrectomy was performed, and pathohistological examination revealed primary hepatic malignant lymphoma in the right kidney.     

A case of malignant lymphoma of the epididymis

A 17-year-old man visited our hospital with the chief complaint of painless swelling of the left scrotal content. An elastic hard mass was palpable at the upper pole of the left testis. Left radical orchiectomy was performed. The tumor originated from the epididymis and did not involve the testis or the spermatic cord. Histologically, the tumor was diagnosed as a malignant lymphoma (non-Hodgkin's lymphoma, diffuse mixed cell type, B-cell type). No abnormalities were found in other organs. After establishment of the diagnosis of primary epididymal malignant lymphoma, 3 courses of chemotherapy (adriamycin, vincristine, cyclophosphamide, prednisolone) were performed. No evidence of recurrence or metastasis was found 26 months after surgery.     

A case of malignant lymphoma with bilateral adrenal involvement

Since the adrenal gland is a common site of metastatic disease, it is sometimes difficult to find the primary lesion only by diagnostic imaging. We report a case of non-Hodgkin's lymphoma with bilateral adrenal involvement, in which percutaneous needle biopsy was useful to determine the histology.     

A case of malignant lymphoma of the prostate

We report a case of primary malignant lymphoma of the prostate. A 76-year-old man was refer to our clinic with a chief complaint of dysuria. Based on a benign prostatic hypertrophy, transurethral resection of the prostate was performed. Histological findings showed diffuse, large cell type malignant lymphoma. His clinical stage was 1 A prostate (+) according to the Ann Abor classification. The combination chemotherapy with THP-COP was performed for 3 courses, followed by irradiation at 30 Gy. His prostate has showed no recurrence for 10 month after treatment. Primary malignant lymphoma of the prostate is rare. About 30 cases have been reported in the japanese literature. Preoperative diagnosis of malignant lymphoma of the prostate is difficult. All cases have been diagnosed after prostatic surgery or biopsy.