Does craniopharyngioma metastasize? Case report and review of the literature

OBJECTIVE AND IMPORTANCE: A rare case of recurrent craniopharyngioma at an ectopic location is described. This recurrence suggested cerebrospinal fluid seeding. CLINICAL PRESENTATION: A 65-year-old man presented for follow-up of persisting visual field defect. He had undergone total resection of a suprasellar craniopharyngioma via a subfrontal approach 3 years before presentation. Recent magnetic resonance imaging scans revealed a contrast-enhancing tumor with cystic and solid components at the right temporal lobe. The primary tumor bed was intact. INTERVENTION: A temporal craniotomy was performed for total resection of the tumor. Intraoperative findings revealed that the recurrent tumor was anatomically unrelated to the previous surgical track. Histological studies of the tumor specimen demonstrated a benign craniopharyngioma. Cerebrospinal fluid spreading was suspected to be the sole route for the recurrence. CONCLUSION: The case presented here and a review of reports on remote recurrence of craniopharyngioma suggest that care is required during intraoperative handling of the tumor and that long-term follow-up should be performed even in patients whose primary tumor was resected completely.     

Is low-dose methotrexate nephrotoxic? Case report and review of the literature

Methotrexate (MTX) has become the most commonly prescribed disease-modifying anti-rheumatic drug. However, toxicity is an important drawback of MTX therapy and permanent discontinuation of MTX for adverse effects occurs in 1 patient out of 10. Although high-dose MTX is known to be nephrotoxic, data on low-dose MTX renal effects are scanty. We report an insidious and progressive deterioration of renal function during long-term low-dose MTX in a 59-year-old woman. Kidney biopsy revealed advanced kidney fibrosis with extensive interstitial and glomerular fibrosis, and vascular sclerosis. We suggest that patients on low-dose MTX therapy even alone, should be periodically monitored for creatinine levels.     

Esthesioneuroblastoma of the pituitary gland: a clinicopathological entity? Case report and review of the literature

Esthesioneuroblastoma (olfactory neuroblastoma) is a rare, malignant neoplasm that typically arises in the nasal vault, invades adjacent tissues, and causes locoregional (cervical lymph nodes) and distant metastases. Only two cases of tumors arising in the sellar region that had the histological characteristics of esthesioneuroblastoma have been reported in the literature to date. The authors present the case of a 35-year-old woman with secondary amenorrhea and a rapidly growing tumor located in the adenohypophysis. After total removal of the lesion through a transseptal-transsphenoidal approach, the histological examination revealed an esthesioneuroblastoma Grade II/III according to Hyams. Considering the particular location of the lesion and the absence of residual tumor on postoperative magnetic resonance imaging, no adjuvant therapy was performed. The patient remained free from tumor recurrence 2 years postoperatively. Because all published cases of this esthestoneuroblastoma have been large neuroblastic tumors of the pituitary gland arising in middle-aged women, pituitary neuroblastoma might represent a rare, specific clinicopathological entity.     

Transhiatal esophagectomy in Boerhaave syndrome – Case report and literature review

IntroductionBoerhaave syndrome or spontaneous rupture of the esophagus wall is a rare life-threatening condition. It is more common in male gender and is due to a very swift rise in intraluminal pressure during vomiting. The patient usually presents with chest pain after vomiting. In some cases, there is subcutaneous emphysema in the neck or upper chest. Due to its rarity, the diagnosis is often not straightforward. Chest radiography can reveal pneumothorax, pleural effusion or pneumomediastinum, but diagnosis is more likely possible with an oral contrast X-ray study.Case presentationThis paper reports a clinical case with surgical approach, in a 68-years old patient with a 48 h period between onset of symptoms and diagnosis of a Boerhaave syndrome. Firstly, the patient was admitted with a presumptive diagnosis of pneumonia. The patient was with chest pain, fever and vomiting. An emergent transhiatal esophagectomy was performed with primary anastomosis with no significant post-operative morbidity and allowing for the patient to return to previous daily routine with a good quality of life.Discussion and conclusionBoerhaave syndrome is a rare life-threatening surgical condition. Surgery is the most effective treatment. It is necessary to have a high index of suspicion. Treatment should promptly start because prognosis is related with time from diagnosis, with increasing mortality rate if no treatment is performed.     

Lemierre’s syndrome or re-emerging disease: Case report and literature review

IntroductionLemierre's syndrome is a rare and potentially fatal entity characterized by the spread of an oropharyngeal infection, with secondary suppurative thrombophlebitis of the internal jugular vein and septic emboli.Presentation of caseWe discuss the case of a 52-year-old male who developed Lemierre’s syndrome following peritonsillar abscess. He presented with submandibular and submental swelling extending into the neck. His management included; incision and drainage of the abscesses; and prolonged anticoagulant therapy.ConclusionThe incidence of Lemierre's disease appears to be increasing, perhaps due to ignorance of the disease by many clinicians, and diagnosis is often delayed with potentially fatal consequences.     

Esophagogastro-Roux-en-Y jejunostomy: a surgical option in recurrent achalasia? Case report and review of the literature

Recurrent obstructive symptoms after cardiomyotomy for achalasia occur in approximately 10 per cent to 15 per cent of patients, but only some require reoperation. Reoperative procedures for achalasia vary, and in general, have less success in relieving symptoms than the initial procedure. We present the case of a 37-year-old male with a 15-year history of recurrent achalasia, with symptoms of heartburn and progressive dysphagia after meals. He underwent several esophageal dilatations, botox injections, and two transthoracic Heller myotomies before the transabdominal esophagogastro-Roux-en-Y jejunostomy was performed. This case represents another surgical option for management of the challenging problem of recurrent achalasia.     

Metastatic myxoid liposarcoma in the mesentery: what is debated? Case report and a review of the literature

Myxoid liposarcoma, unlike other types of liposarcoma, has an unusual propensity to metastasize to extrapulmonary sites including the abdominal cavity. Metastatic myxoid liposarcoma is an important condition because it may indicate distant micrometastatic disease. We report the case of a 47-year-old woman with a metastatic myxoid liposarcoma in the mesentery. Surgical excision with a tumor-free margin was achieved, but cardiac and liver metastases developed. We review the available literature and discuss what is still debated about this disease.     

The Chilaiditi Syndrome: Another Greek Tragedy? Case report and short review of literature

The Chilaiditi syndrome is a rare disorder, characterized by a broad spectrum of (gastro-intestinal) symptoms due to an interposition of a segment of bowel between the liver and the diaphragm. This anatomical variation is diagnosed through abdominal x-ray and is known as the Chilaiditi sign. Since the syndrome can lead to severe complications, such as perforation, intestinal obstruction or bowel ischemia, awareness of this syndrome is essential for every general surgeon. Knowledge of predisposing factors is necessary to treat possible complications accordingly. Conservative management often is sufficient. Surgical intervention is reserved for those who do not respond to conservative line of management or those with severe complications.     

Frontal giant cell glioblastoma: radio-induced tumor? Case report and literature review

The current WHO classification recognizes two distinct variants of glioblastoma multiforme (GBMs): giant cell glioblastoma (GCG) and gliosarcoma, based on histological heterogeneity. Unlike conventional GBMs, GCGs preferentially occur in younger individuals and are associated with a better prognosis, a few reports documenting prolonged survival up to 17 years after diagnosis. However, transformation to gliosarcoma is possible and has been already reported. Radio-induced glioblastoma, which meets Cahan's criteria for radio-induced tumor, is very rare; the first case was published by Kleriga et al. We report a rare case observed in a 46-year-old man with a past history of right nose leiomyosarcoma treated 40 years earlier by surgery and interstitial and external beam radiation. At admission, the patient presented left hemiparesis revealing a right frontal GCG confirmed by pathology after cranial surgery. We describe this case firstly because of its rare histological variety and discuss its clinical, radiological, histopathological, therapeutic and prognostic characteristics with literature data. Secondly, because of its occurrence 40 years after external radiotherapy, which could suggest the hypothesis of radio-induced glioblastoma.     

Adrenal incidentaloma does it require surgical treatment? Case report and review of literature

INTRODUCTIONAdrenal incidentalomas have a prevalence of at least 5% in the general population. Among these adrenal myelolipoma are rare nonfunctioning tumors of adrenal with an incidence of 0.1–0.2% as documented in CT and autopsy series. We report such a rare case of adrenal myelolipoma incidentally detected while evaluating a case of chronic nonspecific flank pain.PRESENTATION OF CASE38-year-old obese female patient, known hypertensive on treatment presented with nonspecific right flank pain since 1 year. Ultrasonography and Computed tomography of the abdomen showed right adrenal gland mass with fat density measuring 6.3 cm × 6.2 cm × 5 cm. Patient underwent right side adrenalectomy, post operatively patient had an uneventful recovery. Histopathological examination of the specimen revealed features of adrenal myelolipoma.DISCUSSIONMyelolipoma is an uncommon, benign; tumor like lesion composed of mature adipose tissue admixed with hematopoietic cells. Most myelolipomas appear as unilateral adrenal masses. Adrenal myelolipomas are usually small and asymptomatic. CT or MRI detects the areas of gross fat with in the lesion. These tumors can present as acute abdomen following tumor hemorrhage which is more likely in myelolipomas greater than 4 cm in size, hence warrants adrenalectomy.CONCLUSIONadrenal myelolipoma are rare benign tumors, incidentally detected on CT. CT or MRI is diagnostic. Large myelolipoma warrants surgery due to the risk of hemorrhage.     

Rare presentation of Wegener’s granulomatosis in the pituitary gland: Case report and literature review

IntroductionWegener’s granulomatosis (WG) is a systemic vasculitis that can affect a variety of organs including ear, nose and throat, lungs and kidneys. However WG is unusual in the pituitary and rare in the central nervous system.Presentation of caseA 56-year-old male with likely WG presented with polyuria and polydipsia despite six months of conservative medical management. MRI scanning revealed an enlarging heterogeneously enhancing pituitary gland. Following endoscopic transsphenoidal pituitary biopsy and debulking, final tissue pathology was diagnostic for WG in the pituitary gland.DiscussionDiagnosis remains difficult but most patients present with central diabetes insipidus (CDI) as well as varying degrees of hypopituitarism on a background of disease activity in other organs. Clinical judgment needs to balance the need for invasive surgical tissue diagnosis with increasing immunosuppressive therapy.ConclusionIt is important to consider this rare complication of WG to ensure timely diagnosis and management.     

Case report of Kummell’s disease with delayed onset myelopathy and the literature review

European Journal of Orthopaedic Surgery & Traumatology - Kummell’s disease is an avascular necrosis of the vertebral body, secondary to a vertebral compression fracture. This entity is...     

Nebulized voriconazole in infections with Scedosporium apiospermum — Case report and review of the literature

Scedosporium infections are rare complications in immunocompromised patients or patients with chronic pulmonary disease. While Scedosporium prolificans is resistant to most antimycotics, Scedosporium apiospermum is usually sensitive to voriconazole and posaconazole. Pharmacokinetics and efficacy of nebulized voriconazole have been described in a murine model previously. We report for the first time the safe and effective use of nebulized voriconazole for the treatment of severe pulmonary infection with Scedosporium apiospermum in an adolescent with cystic fribrosis.