Sarcoidosis presenting as an intramedullary spinal cord mass

A patient with sarcoidosis of the spinal cord showing cord enlargement upon myelography is presented. The literature regarding spinal cord involvement with sarcoidosis, the indications for operation, and treatment is reviewed.     

Sarcoidosis presenting as an isolated extradural thoracolumbar lesion mimicking tumour

A 44-year-old woman presented with a single large extradural spinal lesion, mimicking schwannoma, as the first and only manifestation of sarcoidosis. She underwent total macroscopic excision. Four months later she was neurologically intact, with no radiological evidence of recurrence.     

Leigh's disease presenting as an intramedullary mass lesion.

An unusual presentation of Leigh's disease consisting of rapid progression of leg weakness in a young child is discussed. Magnetic resonance imaging revealed an intramedullary mass lesion of the conus medullaris. Surgical exploration revealed only necrosis and inflammation. Subsequent studies revealed pathology in the cerebrum as well as the spinal cord. Metabolic abnormalities confirmed the diagnosis of Leigh's disease. The differential diagnosis of intramedullary mass lesions demonstrated by magnetic resonance imaging should include metabolic, inflammatory, and ischemic processes as well as neoplastic disease.     

Cervical intradural extramedullary cavernoma presenting with isolated intramedullary hemorrhage

Among cavernomas of the central nervous system, spinal ones are rare. The true incidence of spinal cavernomas is unclear, but with widespread use of magnetic resonance imaging the number of cases is increasing. Furthermore, cavernomas represent only 5-12% of all vascular anomalies of the spinal cord, with a mere 3% reported to be intradural and intramedullary in location. Cervical spine intradural extramedullary cavernomas are very seldom seen, and only 4 cases have been reported in world literature previously. In this report, a unique case of an intradural extramedullary spinal cavernoma was surgically treated in a patient who presented only with an intramedullary hemorrhage.     

Myelopathy presenting as an intrinsic spinal cord tumor

Two patients are presented who became progressively quadriplegic with myelographic appearances suggesting intrinsic spinal cord tumors. In both cases, laminectomy and biopsy of the spinal cord disclosed non-neoplastic conditions (neuromyelitis optica and acute necrotic myelopathy) confirmed at autopsy. Since surgery is not helpful in such cases, the problems of differentiation between such lesions and intraspinal tumors are reviewed.     

Sarcoidosis presenting as recurrent left laryngeal nerve palsy.

A patient with sarcoidosis presented with hoarseness caused by mediastinal lymph nodes compressing the left recurrent laryngeal nerve. The response to corticosteroids was dramatic and complete.     

Metastatic prostatic carcinoma presenting as an oncocytic tumor.

We discuss a 63-year-old man who presented with a metastatic tumor in an inguinal lymph node. By light microscopy, the tumor cells were characterized by a finely granular eosinophilic cytoplasm. A diagnosis of metastatic oncocytic carcinoma was made based on the results of an ultrastructural examination, which showed the cytoplasm of the tumor cells to be filled with mitochondria. Results of immunocytochemical studies showed positive reactivity for prostatic acid phosphatase and prostate-specific antigen. A transurethral resection of the prostate showed an oncocytic adenocarcinoma of the prostate, apparently the first of its kind, which was demonstrated to be the site of origin of the inguinal lymph node metastasis.     

Primary retroperitoneal teratoma presenting as an adrenal tumor in an adult

Primary teratomas in the retroperitoneum are rare in adults. Most teratomas in this region are secondary to germ cell tumors of the testes or ovaries. We describe a case of mature cystic teratoma that was clinically suggestive of an adrenal myelolipoma. Resection was attempted using laparoscopy but was converted to open adrenalectomy to ensure complete resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 18 months.     

Pituitary tumour presenting with trigeminal neuralgia as an isolated symptom

Invasion of the cavernous sinus by pituitary adenoma may cause involvement of cranial nerves III, IV, V and VI. However, trigeminal neuralgia as an isolated, initial symptom is very unusual. A patient with a pituitary adenoma, who had intractable trigeminal neuralgia as the only complaint which resolved following surgical removal is presented.     

Posttransplant lymphoproliferative disorder presenting as an isolated skin lesion.

A case of posttransplant lymphoproliferative disorder (PTLD) presenting as an isolated skin lesion is reported. An initial superficial biopsy of the lesion was diagnosed as squamous cell carcinoma. After pathologic review of the biopsy and staining for immunoglobulins and Epstein-Barr virus (EBV) DNA, the correct diagnosis of PTLD was made. The patient had no systemic manifestations of lymphoma and the skin lesion was successfully treated with excision. Isolated skin lesions should be included among the potential sites for PTLD and histologic skin specimens from posttransplant immunosuppressed patients should be examined carefully for PTLD.     

Spinal subependymoma presenting as an extramedullary tumor: case report

A rare case of cervicothoracic subependymoma in a 25-year-old man is described. The tumor appeared as an extramedullary mass lesion, but a discrete, less well-demarcated portion was observed in the lateral part of the cord at the T2 level. Previous reports of spinal subependymomas are reviewed, and nosological possibilities of extramedullary presentation are discussed.     

Sarcoidosis presenting with chylothorax.

A patient in whom chylothorax was the presenting feature of sarcoidosis is reported. Mediastinal lymphadenopathy was shown by computed tomographic scanning. Obstruction of the thoracic duct by enlarged lymph nodes or fibrosis is the probable cause of chylothorax in this case. The association of chylothorax and sarcoidosis is extremely rare.