Multimodality treatment of adrenal ganglioneuroblastoma: a case report

We present adult adrenal ganglioneuroblastoma with giant regional lymph node metastasis. The patient was a 21-year-old male, who had a left adrenal tumor diagnosed by ultrasonography incidentally. He was moderately developed and physical examination was almost normal. Blood pressure was within the normal range. Only the value of the vanilmandelic acid, which was 68.7 mg/day, in the urine was abnormal. Other laboratory data were almost normal. Neither chemical nor physical hormonal disorders were present. We carried out the radical surgical treatment by trans-thoracoabdominal approach under the diagnosis of left adrenal neuroblastoma. Pathological diagnosis was ganglioneuroblastoma. After the operation, the patient received both systemic chemotherapy of vincristine and cyclophosphamide and immunotherapy of OK-432 by subcutaneous administration. Furthermore, 40 Gy of the regional irradiation of 60Co to the operative space after the surgery was performed. At eight months after the operation, he is alive with no evidence of disease. Ganglioneuroblastoma is a neuroblastic tumor including neuroblastoma, which commonly occurs in childhood. The prognosis of the neuroblastic tumors which occur either in the adrenal gland of a young child or in an older child is poor. On the other hand, the biological activity of the adult neuroblastic tumors is different from that of the pediatric neuroblastic tumors. In the adult, the adrenal ganglioneuroblastoma does not always have a poor prognosis. The multimodality treatment which we performed is effective for the neuroblastic tumor. Ultrasonography is both effective and adequate for the screening of the retroperitoneal lesion such as in our case.     

Myxopapillary ependymoma of the filum terminale with a holocord cyst: a case report

This paper describes a case of myxopapillary ependymoma of the filum terminale with a holocord cyst. A fifteen-year-old boy was admitted because of dysarthria, dysphagia and tetraparesis. He also suffered from severe lumbago and ankle pain for three years. On admission his vital signs were stable and neurological examination revealed lower cranial nerve palsies (from 9th through 12th), tetraparesis, bilateral impairment of vibratory and position sense of the lower extremities and urinary incontinence. All deep tendon reflexes were hypoactive bilaterally. Babinski reflex and Lasègue sign were negative bilaterally. The spine roentgenograms revealed widening of the interpedicular distance from C 1 to L5 except L2, 3 vertebrae. Lumber puncture at the L 1-2 interspace revealed a cyst at the site and the protein content of the cyst fluid was 2400 mg/dl. MRI demonstrated a syrinx extending from the medulla to the entire cervical cord. From these results, it was concluded that the medulla and the entire spinal cord were occupied by the tumor and some parts of the lesion were cystic. First Operation: After a suboccipital craniectomy and a laminectomy from C 1 to Th 2, the medulla and the cervical cord were decompressed by evacuating the cyst at the 4th cervical segment. After the first operation, the C 1-2 myelography and MRI confirmed that the medulla and the spinal cord above the Th 11 vertebra were decompressed and the lower end of the cyst was extending to the Th 11 level. Second Operation: After a laminectomy from Th 12 to L4, a solid tumor arising from the filum terminale was completely removed.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case report: Adrenal ganglioneuroblastoma in a 59-year old man

Ganglioneuroblastoma is a common type of tumor in children, but is rarely seen in adults. We present here a case of adrenal ganglioneuroblastoma in a 59-year old man.     

Retroperitoneal ganglioneuroblastoma resected 8 years after mass screening: a case report

An 8-year-old girl presented with abdominal tumor that was discovered incidentally. At surgery, the tumor originated from the retroperitoneal sympathetic trunk; and the histologic diagnosis was ganglioneuroblastoma, nodular (GNBn), unfavorable histology on Shimada's classification, International Neuroblastoma Staging System (INSS) stage 1.This patient was found positive for neuroblastoma (NB) by mass screening at 6 months old. There was no tumor detected, and tumor markers decreased to normal range by 18 months of age. We examined her previous computed tomographic films retrospectively and noticed a mass in the same region indicating that the tumor had been there for 8 years without treatment.This is the first report of infantile mass screening-positive NB appearing after long-term follow-up with unfavorable histology. And the follow-up interval was the longest ever reported. This case is suggestive of considering the natural history and treatment strategies for infantile NBs, and the relationship between infantile NB and ganglioneuroblastoma, nodular. It is important to follow mass screening-positive cases of NB over the long term if wait-and-see policy is adopted.     

Scoliosis associated with ganglioneuroblastoma: a case report with 17-year follow-up.

We describe the case of a 12-year-old boy with scoliosis due to a malignant ganglioneuroblastoma. He had a successful outcome, as was noted by 17-year follow-up of tumor resection and spinal fusion.     

Primary retroperitoneal ganglioneuroblastoma in an adult

A case of retroperitoneal ganglioneuroblastoma in a 60-year-old man is reported. This retroperitoneal tumor was surgically removed and pathologic diagnosis was ganglioneuroblastoma. Ganglioneuroblastoma usually occurs in children and is extremely rare in adults. The characteristics are described of an unusual tumor based on the published reports.     

Primary clival mucocele: case report

A 40-year-old man presented with a history of diplopia due to left abducens nerve palsy persisting for a few days. Neuroimaging examinations revealed a cystic mass in the clivus and erosion of its posterior wall. Drainage of the lesion was accomplished through a small bone defect in the anterior wall of the clivus using the endoscopic endonasal transsphenoidal approach. This procedure improved the symptoms of the patient. Intraoperative and histological findings led to a diagnosis of mucocele. A mucocele localized only in the clivus is uncommon and the pathogenesis may be closely related to pneumatization of the clivus.     

Primary intrasellar schwannoma: case report

A case is presented of a primary intrasellar and suprasellar schwannoma mimicking a pituitary tumor clinically, endocrinologically, and radiographically.     

Primary pulmonary nocardiosis: case report

Hamal, P. B. (1974).Thorax, 29, 382-386. Primary pulmonary nocardiosis: a case report. A case of fulminating pulmonary nocardiosis is reported. Diagnosis was made before death but too late for treatment to be effective. At necropsy extensive multiple pulmonary abscesses with involvement of the pleura, resulting in an empyema, were discovered. One cervical node showed a similar abscess. No brain lesions nor involvement of other organs was seen. Gram-positive organisms were seen in the lesions but acid-fastness could not be demonstrated.     

Primary spinal melanoma: case report

We report a case of primary melanoma of the thoracic spinal cord revealed by progressive bilateral lower extremity weakness associated with sensory loss and urinary dysfunction. The preoperative MRI revealed an intramedullary tumour from T7 to T9. Treatment was by complete surgical excision without radiotherapy. Histopathology and immuno-histochemical studies confirmed the diagnosis. The postoperative course was satisfactory with no sign of recurrence after 28 months of postsurgical follow-up. Primary spinal melanomas are rare intramedullary tumours that can be cured by appropriate surgical treatment.     

原发性股骨转子下黄色瘤1例

1 病例资料患者,男,67岁,于2010年4月30日因右大腿上段疼痛不适13 d,行走跛行2 d转诊我院.2010年4月17日患者出现右大腿上段疼痛,予口眼止痛药等对症治疗,症状未能缓解.骨盆X线平片示:右股骨上段椭圆形占位病变,见图1.查体:右大腿上段未见局部膨隆及静脉充盈,局部无压痛,右股骨转子部叩击痛阳性,双下肢肌力及感觉正常,4字试验阴性.辅助检查:肝肾功能各项指标均正常.     

Primary omental torsion: A case report

A patient presented with an acute abdomen at the Emergency Department.The patient,a 69-year-old man,was admitted and underwent surgery with a provisional diagnosis of acute appendicitis.During surgery,omental torsion was diagnosed and the involved omentum was removed.The patient had no previous surgical history.Omental torsion is a rare cause of acute abdomen in children and adults who may present with various signs and symptoms;a preoperative diagnosis may therefore be difficult and can usually only be established during surgery.     

Primary renal osteosarcoma: A case report

Primitive renal osteosarcoma is a rare sarcoma of the kidney with only 27 cases reported in the literature. Its histogenesis is poorly understood. It occurs at an older age between the fifth and seventh decade of life with a male predominance. The clinical features are similar to other renal diseases. Imaging shows calcifications within a lumbar or flank mass. Histology describes a sarcomatous proliferation producing osteoid, most often at an advanced stage (pT4), which implies a poor prognosis. We report on the clinical and pathologic features of a case of primary renal osteosarcoma in a 56-year-old man with stage IV disease. This is the 28th case of primitive renal osteosarcoma reported in the literature, confirming the highly malignant nature of this tumor and the need for early diagnosis.     

Primary cutaneous mucormycosis: a case report

The authors report the clinical history of a patient having presented a cutaneous mucormycosis at the waning of a traumatic dilapidation post of the left lower limb. Mucormycosis is an opportunistic fungal infection due to fungi of the group of mucorales present in the environment. There are various clinical forms of the disease; it occurs generally in a predisposed environment. The diagnosis is based on the mycologic and pathologic examination. The therapeutic approach must be multidisciplinary; the vital and functional prognosis depends on early diagnosis and treatment.     

原发性跟骨结核1例

正患者,女,21岁,因左踝及左足跟部红肿、疼痛半年,加重2周于2013年6月19日就诊。患者自述半年前无明显诱因出现左踝及左足跟部肿痛,症状渐进性加剧,于当地医院行消肿、止痛对症治疗,未见明显改善。近2周左踝及左足跟部肿痛加剧明显,遂来我院就诊。患者无发热、咯血、盗汗等全身不适症状,否认肺结核及其他结核病史。查体:左足跟外     

Primary ovarian leiomyoma: A case report

INTRODUCTION

Primary ovarian leiomyoma is a rare benign tumour of the ovary seen in women between 20 and 65 years old. It is usually diagnosed incidentally during pelvic examination or pathologic examination after surgery.

PRESENTATION OF CASE

We describe a case of unilateral, ovarian leiomyoma. Transvaginal ultrasonography and magnetic resonance imaging (MRI) revealed a right adnexial mass. Unilateral salpingo-oophorectomy was performed, and histological examination revealed a leiomyoma arising primarily in the ovary. The diagnosis was confirmed immunohistochemically.

DISCUSSION

The tumour may be asymptomatic or may manifest with lower abdominal pain like in our case. The definitive diagnosis of these lesions is difficult prior to surgical removal. Because there is no pathognomonic symptoms or characteristic imaging findings. The correct diagnosis of an ovarian leiomyoma requires identification of the smooth muscle nature of the tumour.

CONCLUSION

This rare tumour of the ovary should be considered in the differential diagnosis of solid ovarian masses. An immunohistochemical analysis is recommended for definitive diagnosis.     

Primary tracheal schwannoma: a case report

We present a rare case of primary tracheal schwannoma in a 49-year-old man who had experienced obstructive airway symptoms for 4 years. Computed Tomography (CT) showed an intratracheal polipoid mass lesion originating from the left lateral wall. Fibre-optic bronchoscopy revealed the diagnosis of an intratracheal poylpoid mass obstructing 70% of the lumen. After diagnosing a benign lesion by punch biopsies with bronchoscopy, thoracotomy was performed and the tumour was totally excised. Histopathological examination revealed a benign neurogenic tumour of schwann cell origin.     

Primary hepatic lymphoma: A case report

INTRODUCTIONPrimary hepatic lymphoma is a rare malignancy which misdiagnosis and mistreatment is very frequent. Differential diagnosis of the hepatic lesion, based on the noninvolvement of blood vessels, includes: fatty infiltration, cirrhosis, amyloid infiltration, primary hepatomas, and metastatic neoplasms.PRESENTATION OF CASEWe describe a case of a 69-year-old man who presented with 15% weight loss and general fatigue over the previous 9 months. Physical examination revealed hepatomegaly without lymphadenopathy or splenomegaly. Magnetic resonance imaging showed a 13 cm × 9 cm × 11 cm tumor on the right liver associated with normal levels of alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA). After two negatives ultrasonography-guided needle liver biopsies, the third one showed diffuse infiltration of large sized lymphoid cells. Immunohistochemical findings demonstrated the B-lymphocyte lineage of the tumor. The patient received R-CHOP therapy (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab) with good response.DISCUSSIONIt is important to recognize PHL because it responds favorably to chemotherapy and may have a better prognosis than hepatocellular carcinoma or metastatic disease of the liver. When imaging findings on CT scans and MRI are nonspecific, a biopsy is needed not only for a definitive diagnosis but also for identifying the immunophenotype of the PHL. This type of lesion is highly chemosensitive and early aggressive chemotherapy may result in sustained remission.CONCLUSIONThis case emphasizes the importance of effective recognition of PHL considering its good response to chemotherapy and the possibility of sustained remission if early aggressive treatment is implemented.     

Primary intrasellar germinoma: case report.

Intracranial germinomas arising primarily within the sella turcica are extremely rare. Preoperative diagnosis is difficult to establish even with sophisticated procedures. Diabetes insipidus is the main clinical manifestation. The authors report a case of an apparently primary intrasellar germinoma causing subclinical pituitary apoplexy in a 12-year-old boy. The transsphenoidal approach and appropriate radiotherapeutic management were employed with a good outcome.