Geniculate ganglion meningioma

Primary ectopic meningiomas are rare, but may be seen in the head and neck region. The temporal bone and its neural foramen are rarely the site of a primary meningioma. This report describes the CT and MRI appearance of an ectopic meningioma arising at the anatomic location of the geniculate ganglion, and discusses the differential diagnosis as well as the possible origin of the tumor. Received: 24 February 1997 Accepted: 21 April 1997     

Cystic meningiomas in children: A diagnostic challenge

Two cases of cystic meningioma in children are presented. The MR imaging features of each case presented difficulties in differential diagnosis because of the cystic nature of the neoplasms and their location. Cystic areas in meningiomas are encountered more frequently in children than in adults. Meningioma must be included in the differential diagnosis of cystic intracranial tumors in children.     

Meningiomas in children and adolescents

PURPOSE: To review the diagnosis, treatment, and long-term outcome of children and adolescents with meningiomas diagnosed by a single institution and compare these findings with other published data. PATIENTS AND METHODS: A 25-year retrospective analysis of 18 patients with meningioma diagnosed at Children's Hospital Medical Center, Cincinnati, Ohio was performed. A literature review of published reports was undertaken to compare evaluation. treatment, and outcome for similar patients. RESULTS: Patients ranged from ages 19 months to 17 years at diagnosis. The most common symptoms were headache (5) and seizures (5), although most patients had multiple symptoms. The brain was the primary location of tumor in 17 patients, with the remaining tumor located in the spine. Comorbid diagnoses were common, including developmental delay, balanced chromosomal translocation, type I diabetes mellitus, neurofibromatosis, Klinefelter syndrome, and seizures. Eleven patients had gross total resection performed. Four patients had malignant meningiomas. Two patients were treated with radiotherapy only, one had chemotherapy only, and two underwent both. Karyotype abnormalities most commonly involved chromosome 22, but other abnormalities were present. Sixteen patients remain alive and two patients, having had malignant tumors, are dead of disease. Long-term sequelae include seizures, diabetes insipidus, blindness, neuropsychologic abnormalities, and multiple surgical procedures. Only three patients are self-described as being without problems. CONCLUSIONS: Based on this study and a literature review, the roles of surgery, radiation, and chemotherapy remain unclear. Long-term outcome for patients with meningiomas, especially as it relates to cognitive function, is rarely reported. This group of patients has a high incidence of morbidity associated not only with treatment but also with preexisting diseases. These data indicate the need for a national cooperative group study to better understand the evaluation, treatment, and outcome for children and adolescents who are treated for meningiomas.     

Fronto-orbitonasal intradiploic meningioma in a child

Intradiploic meningioma, which may be classified as a subgroup of intraosseous meningioma, is a rarely encountered disorder. To date, less than 10 cases have been reported. Here, we report a case of fronto-orbitonasal intradiploic meningioma. A 12-year-old female with exophthalmos and diplopia was operated on for a cranial intradiploic mass lesion. Histopathological evaluation of the specimen confirmed the diagnosis of intradiploic psammomatous meningioma. Her exophthalmos did not change, but the diplopia disappeared. This case is unique in that it is an extensive case of intradiploic meningioma of the orbital roof and frontal base in a child. Intradiploic meningiomas generally are of psammomatous type. Especially tumors adjacent to the orbita cause exophthalmos; cases located on the other side of the calvarium may not cause any symptom or sign other than headache or sometimes a mass on the scalp. Treatment, as with meningiomas located in the intracranial cavity, is total resection of the lesion.     

Intracranial meningiomas of childhood and adolescence

Meningiomas are rare intracranial neoplasms in childhood and adolescence, representing 0.4-4.1% of the pediatric-age tumors and 1.5-1.8% of all intracranial meningiomas. The goal of this study was to determine epidemiology, clinical and radiological features, and long-term outcome of childhood and adolescence meningiomas. Patients operated for intracranial meningiomas of childhood and adolescence between 1983 and 2003 at Gazi University School of Medicine, Department of Neurosurgery, were evaluated retrospectively. This study presents 11 cases (6 male, 5 female), ranging in age from 14 months to 17 years. Age and sex distribution, presenting symptoms, neurological examination results, location of meningiomas, radiological and histopathological findings, and prognosis were reviewed. The results were compared with those reported in the existing literature. Atypical and malignant meningiomas seem to be more common in childhood and adolescence with respect to adult meningiomas. Tumor location, completeness of tumor removal, and pathological grade are the most important prognostic factors.     

Meningeal Tumors of Infancy and Childhood

Seventeen meningeal tumors were examined for pathology with electron microscopy and immunohistochemistry including glial fibrillary acidic protein (GFAP), S-100 protein, muramidase, and factor VIII. These tumors included seven meningiomas, one hemangiopericytoma, three meningeal sarcomas (1 pleomorphic-cell type and 2 myxofibrosarcomas), two fibrous histiocytomas, and four malignant melanomas. Two of seven children with meningioma had a poor outcome despite the benign histological features of the tumor. S-100 protein was present in the two tumors. All three children with meningeal sarcoma had a rapid downhill clinical course, although the myxofibrosarcoma initially had a relatively benign histological appearance. The two children with fibrous histiocytoma did well despite the aggressive histological features. Muramidase was a good marker of such tumors. Because of the morphological difficulties associated with childhood meningeal tumors, both electron microscopy and immunohistochemistry can be of diagnostic benefit.     

Meningeal tumors of infancy and childhood

Seventeen meningeal tumors were examined for pathology with electron microscopy and immunohistochemistry including glial fibrillary acidic protein (GFAP), S-100 protein, muramidase, and factor VIII. These tumors included seven meningiomas, one hemangiopericytoma, three meningeal sarcomas (1 pleomorphic-cell type and 2 myxofibrosarcomas), two fibrous histiocytomas, and four malignant melanomas. Two of seven children with meningioma had a poor outcome despite the benign histological features of the tumor. S-100 protein was present in the two tumors. All three children with meningeal sarcoma had a rapid downhill clinical course, although the myxofibrosarcoma initially had a relatively benign histological appearance. The two children with fibrous histiocytoma did well despite the aggressive histological features. Muramidase was a good marker of such tumors. Because of the morphological difficulties associated with childhood meningeal tumors, both electron microscopy and immunohistochemistry can be of diagnostic benefit.     

Childhood atypical meningioma with perineural spread: MR findings

Meningiomas are uncommon in children. When they occur, they are frequently associated with neurofibromatosis type 2. Childhood meningiomas are generally large and commonly associated with cyst formation and an unusual location. Perineural tumor spread, occasionally associated with head and neck malignancies, is very rare in meningiomas. We present the MR findings of an atypical meningioma with perineural spread in a 4.5-year-old girl.     

Bilateral orbital granulocytic sarcoma (chloroma) preceding the blast phase of acute myelogenous leukemia: CT findings

Granulocytic sarcoma (chloroma) is an uncommon malignant neoplasm associated with myelogenous leukemias. Its appearance may precede the clinical manifestations of the acute leukemic phase by months to years. We report the CT findings of a case bilateral intraorbital granulocytic sarcoma which preceded the blast phase of acute myelogenous leukemia (AML) and led to its diagnosis. An awareness of granulocytic sarcoma and its CT appearance may expedite the diagnosis of AML or prompt close monitoring of those cases of granulocytic sarcoma antedating the appearance of AML.     

Paratesticular rhabdomyosarcoma presenting as thickening of the tunica vaginalis

Pediatric paratesticular primary malignant tumors are rare, and most of them correspond to rhabdomyosarcomas (RMS). Paratesticular RMS has a better prognosis than RMS originating in other locations, because of its favorable histology and possible early diagnosis. The diagnosis relies upon the US findings of a paratesticular hypervascular mass in an adequate clinical setting. We report the unusual appearance of an infiltrating RMS tumor in a 3-year-old boy. The tumor presented as thickening of the tunica vaginalis. Atypical US appearance and discordance with clinical features caused suspicion of a tumoral process, allowing early diagnosis and treatment.     

Pitfalls in diagnosing acute otitis media.

The diagnosis of AOM in the infant and child requires an accurate history with special reference to fever, pain, and respiratory symptoms and a careful examination with particular attention to the appearance and movement of the TM. The practitioner must be wary of relying too heavily on any single physical finding, but instead consider all the variables that influence and alter the history and physical examination as summarized in Table 4. These variables include the reliability of the history, the history of previous infections, the age of the child, the appearance of the EAC, and the appearance and mobility of the TM. The importance of a correct diagnosis is crucial because of the immediate treatment and follow-up dictated by the diagnosis and because of the potential long-term effects on the child's health and development, which are described in the remaining articles in this issue of Pediatric Annals.     

Childhood meningiomas. Experience in the modern imaging era.

Twenty children with meningiomas (ages 18 months to 17 years) received initial therapy at the Children's Hospital of Philadelphia between January 1975 and June 1991, accounting for 2% of children with primary brain tumors seen during that time interval. All were verified histopathologically, and none had had prior irradiation. Fifteen were male and 5 female. Fifteen tumors were intracranial, all located supratentorially. Two of these also had a component within the optic canal. One tumor was entirely within the orbit. Four meningiomas arose within the spinal canal. Associated conditions were neurofibromatosis (NF) type I (1 patient), NF type II (2 patients), and a facial alveolar rhabdomyosarcoma (1 patient). A gross total resection as documented by postoperative scan and operative note was accomplished in 12 patients. Four of these relapsed, at a mean of 3.5 years from initial surgery. In 4 patients a near-total resection (> 90%) was performed. Of these, 2 progressed at 9 months and 1.5 years. One of these died of complications associated with reoperation. In 4 patients a partial resection (50-90%) was performed. Two of these progressed at 4 months and 1 year, and the other 2 have been followed for less than 2 years. Five patients received radiation therapy (RT). One patient received RT as adjunctive therapy after primary surgery because of papillary histology. The other 4 had RT following reoperation for recurrence at a mean of 1.5 years from diagnosis (range, 7 months to 2 years). These 4 patients remain alive and with stable disease at a mean of 6 years from diagnosis (range 2-8.8 years).(ABSTRACT TRUNCATED AT 250 WORDS)     

Testicular infarction in the newborn: Ultrasound findings

Three patients with neonatal testicular torsion and infarction (two bilateral, one unilateral) are presented with a distinctive sonographic appearance. All five testes appeared inhomogeneously hypoechoic and each was surrounded by a brightly echogenic rim. Whereas surgical exploration was required in the past to establish the diagnosis of testicular infarction in the neonate, sonographic demonstration of the abnormality in the appearance of the testicular parenchyma permits nonoperative diagnosis. Because surgical salvage of the testis in the setting of neonatal extravaginal torsion is thought to be quite rare, the necessity of removing the testis is less clear when the diagnosis is established preoperatively.     

MRI of papillary meningiomas in children

We report two cases of papillary meningioma in children. The MRI appearance of this special type of meningioma is described for the first time. Both lesions were dura based and associated with cystic components. We review the literature pertaining to this type of meningioma and discuss the differential diagnosis of the MRI appearance. Because this is a malignant type of meningioma, early diagnosis and surgical intervention are important in the management of patients.

     

Sonographic diagnosis of intestinal polyps in children

Although colonoscopy is the modality of choice for the diagnosis of intestinal polyps, sonography may be the first diagnostic modality in the evaluation of children with this pathology. Graded compression sonography of the small and large bowel may be useful in diagnosing intestinal polyps. A specific diagnosis is possible in many cases as most polyps have a characteristic appearance. Although sonography is not intended to replace endoscopy in the diagnostic work-up of intestinal polyps, it is important for radiologists to be aware of this appearance as they can be the first in making the diagnosis of intestinal polyps using sonography. This paper was presented at the 44th Annual Meeting of the European Society of Pediatric Radiology, Barcelona, Spain, June 2007.     

A rare antenatally detected mass of the hand: tumour or congenital anomaly?

Tumour and tumour-like lesions of the hand can arise from various tissues and may present at birth. Rarely, anomalies of the hand may have an appearance mimicking a mass. We describe the imaging features of an antenatally detected floating thumb and describe its unusual mass-like appearance. While no hand tumour with similar imaging appearance has been reported, a few congenital lesions mimicking this appearance have been described. Awareness of these anomalies and identification of the typical imaging features of floating thumb allow diagnosis to be made with certainty.     

Metastatic osteosarcoma to the small bowel with resultant intussusception: a case report and review of the literature

Intussusception resulting from osteosarcoma metastasis to the small bowel is a rare diagnosis. This case report describes a patient with this diagnosis, demonstrates the CT appearance of this lesion, and reviews the literature.     

Prenatal MRI diagnosis of fetal cerebral tuberous sclerosis

Tuberous sclerosis (TS) is an autosomal dominant phakomatosis. A high percentage of spontaneous mutations leads to the diagnosis of new cases in normal families. This diagnosis is suspected at antenatal ultrasound on the discovery of multiple cardiac tumors. Antenatal cerebral ultrasound shows a normal appearance in affected fetuses. Eight fetuses with multiple cardiac tumors were studied with antenatal MRI with, in five cases, an abnormal appearance showing hyperintense subependymal and cortical nodules on TI-weighted images. Among the three remaining patients MRI was non-contributive in one due to movement artefact, one had abnormal postnatal MRI consistent with TS and one had a normal postnatal and clinical examination. We conclude that MRI is a valuable tool in making the diagnosis of TS in fetuses with multiple cardiac tumors.     

Osteoid osteomas: a pain in the night diagnosis

Osteoid osteoma is a common benign bone-forming lesion that is composed of a nidus of vascular osteoid tissue and woven bone lined by osteoblasts. It is frequently associated with considerable surrounding inflammation. The diagnosis is usually straightforward when imaging reveals a radiolucent nidus surrounded by variable degrees of reactive sclerosis. However, the diagnosis can be elusive when osteoid osteomas occur in atypical locations, as they may have a nonspecific and misleading appearance on different imaging modalities, particularly on MRI. The purpose of this pictorial essay is to review the typical and atypical features of osteoid osteomas on different imaging modalities, and the appearance of osteoid osteomas in different locations. We also review growth disturbances caused by osteoid osteomas and potential mimickers, with imaging characteristics that can aid in diagnosis.