Atypical Presentations of Benign Retroperitoneal Schwannoma: Report of Three Cases with Review of Literature

We report 3 cases of benign retroperitoneal schwannoma, of whom one presented with flank pain with hematuria, one presented with headache and secondary hypertension and one presented with recurrent renal colicky pain. Two patients were treated by open surgical excision of the tumor with nephrectomy of the corresponding side because the tumors were densely adhered to the kidney and one case treated by laparoscopic resection of the mass only. The diagnosis of schwannoma was established postoperatively after histopathological examination and immunohistochemistry. All patients are doing well in follow-up.     

糖尿病患者合并肾损害3例及相关文献复习

目的：探讨老年糖尿病患者合并肾损害的临床特点。方法：报道我科3例糖尿病行肾活检患者的临床资料。结果：3例患者经肾活检分别诊断为糖尿病肾病、糖尿病肾病合并IgA肾病、糖尿病肾病合并膜性肾病。结论：糖尿病合并肾损害可有多种表现,对可疑糖尿病人群积极肾活检可能提高非糖尿病肾脏病变检出率。     

瘤样钙质沉着症(附3例报告及文献复习)

瘤样钙质沉着症较为少见，其发生原因仍未完全清楚，主要表现为关节附近无痛、质硬的肿块，较大时可压迫周围神经或影响关节功能，可自行破溃流出“白垩样物质”。Ｘ线表现为关节周围软组织中分叶状、结节状致密团块，常位于伸肌侧。治疗主要为手术切除，因病因不同而合并身体其他部位钙化者，则配合相关治疗。本文报告３例，为髋、肩、足部各１例，均采用手术切除，未见复发，且均未发现阳性家族史，亦无其他部位钙化，其中２例有明显外伤史，推测此病为一种局限性钙化症，与外伤有关     

Spontaneous Pneumothorax in Children with Osteosarcoma: Report of Three Cases and Review of the Literature

Spontaneous pneumothorax is a rare manifestation of primary lung cancer or metastasis. It is estimated that < 1% of all cases of spontaneous pneumothorax are tumor-associated and metastatic osteogenic or soft-tissue sarcomas are associated most commonly with pneumothorax especially in the setting of cytotoxic chemotherapy or radiotherapy. In this article, we report three pediatric cases with osteosarcoma that developed spontaneous pneumothorax during chemotherapy with a review of the literature. Two of them had lung metastasis at the time of the detection of pneumothorax and the remaining patient was found to have a bronchopleural fistula.

SPx is an emergency situation and early diagnosis and management can improve prognosis and quality of life of the patient however the optimal management has yet to be determined.     

Pulsatile Sternal Tumor: Report of Three Cases and a Review of the Literature

At our institution, 3 patients with pulsatile sternal tumor have been seen. Although ascending aortic aneurysm frequently is high on the list of differential diagnoses, the likelihood that this tumor is metastatic from either a primary renal or thyroid neoplasm is overwhelming. Of the 15 patients reported, 11 had metastases from a primary renal cell carcinoma, including all 3 of our patients. There were 2 patients with primary myeloma, the only histologically proved primary pulsatile sternal tumor.From the surgical standpoint, only the patient with metastatic renal cell carcinoma has a chance of cure. With the recent report of 2 5-year survivors and our own experience of 1 patient with a long asymptomatic interval following resection of the primary kidney tumor and the secondary sternal metastasis, the attitude of hopelessness for these patients should be challenged and an aggressive approach considered.     

Acinar Cell Cystadenoma of the Pancreas: Report of Three Cases and Literature Review

Introduction

Acinar cell cystadenoma (ACC) of the pancreas was first described as a distinct pancreatic cystic neoplasm in 2002.

Methods

We have encountered three cases of ACC at our institution in addition to the 15 cases reported to date in the world literature. The gender distribution in the total cohort of patients with ACC slightly favored females (61 % female), and the median age was 49.5 years.

Results

Almost half (53 %) of the cases were identified incidentally, while the remainder presented with abdominal pain. The median tumor diameter was 5 cm in size, and no patients have had documented disease recurrence or progression, even in the setting of an incomplete resection.

Conclusion

These findings suggest a relatively indolent biology, and that complete resections are curative. As we will show, surgical resection is warranted to treat symptoms and prevent local extension or malignant transformation.     

Malignancies Within Rhinophyma: Report of Three New Cases and Review of the Literature

Background

Rhinophyma, which represents the end stage of rosacea, is characterized by sebaceous hyperplasia, fibrosis follicular plugging, and telangiectasia. Although it is commonly labeled as an aesthetic problem, it may also determine airway obstruction and because of its nature to hide the growth of tumors. Due to the increasing number of reports of nonmelanoma skin types of cancer within rhinophyma, further concern about a higher incidence of malignancies in rhinophyma than in the skin of normal noses is reasonable.

Methods

We describe three male patients who developed malignancies (2 basal and 1 squamous cell carcinoma) associated with rhinophyma disease. The tumors developed over a mean of 23.3 years after primary diagnosis of rhinophyma. One case had a previous history of facial skin tumor. Surgical excision with clear margins allowed resolution in all three patients with a mean follow-up of 34.8 months.

Conclusions

These three new cases and the review of 43 cases reported in the literature call attention to the clinical features of carcinomas arising in the context of rhinophyma, raising further concerns about the possible association between these two entities. The need for histologic examination of all surgically removed tissue in patients with rhinophyma is highlighted. Several macroscopic changes, including ulceration, drainage, and a rapid growth pattern, should alarm the physician and should be considered as suspicious of a malignant degeneration. Unexpected clinical modifications of a preexisting long-lasting silent rhinophyma could indicate the possibility of hidden malignancy rather than a rhinophyma itself. Although evidence of an association between the two entities remains inconclusive, half of the malignancies reported in our review were incidental findings associated with rhinophyma. Thus, since rhinophyma should not be considered solely a cosmetic problem, we recommend that all specimens be reviewed by a pathologist and if malignancy is diagnosed, re-excision with clear margins should be achieved when necessary with periodic follow-up.

     

Osteosarcoma in One of Identical Twins: Three Cases Report and a Literature Review

BackgroundOsteosarcoma (OS) is the most common primary malignant bone tumor occurring mainly in children and young adults. OS is usually seen in sporadic cases, and it is an extremely rare phenomenon in blood relatives, particularly among identical twins.Case PresentationThe present study reports three cases of OS occurring in only one of identical twins. The first case is a high‐grade OS in the left proximal tibia of a 16‐year‐old girl, treated with neo‐adjuvant chemotherapy, en bloc resection, and reconstruction with a modular knee tumor prosthesis. The second one is a high‐grade OS of the left proximal tibia of a 6‐year‐old girl. The patient was treated with neo‐adjuvant chemotherapy, en bloc resection, and reconstruction with inactived autograft. The third one is a conventional OS of the right proximal tibia of a 20‐year‐old woman. She was treated with neo‐adjuvant chemotherapy, en bloc resection, and reconstruction with a custom‐made prosthesis.ConclusionsThe occurrence of OS in one of identical twins is a relatively rare event but may present the best opportunity to understand the genetic mechanisms underlying the tumorigenesis and progression of this disease in humans. A longer follow‐up period and regular imaging evaluation are needed to confirm whether the identical twin of these patients will suffer OS in the future.     

Intraoral Basal Cell Carcinoma,a Rare Neoplasm: Report of Three New Cases with Literature Review

Intraoral basal cell carcinoma (IOBCC) is an extremely rare entity that bears close microscopic resemblance to and is often confused with the peripheral ameloblastoma (PA). Basal cell carcinomas are thought to arise from pluripotential basal cells present within surface epithelium and adnexal structures, so theoretically they can arise within the oral cavity. Many of the early cases reported as IOBCC actually represent PA. Most of the well documented cases arise from the gingiva. The histologic features of basal cell carcinoma that help separate it from a PA include: tumor arising from surface epithelium, scattered mitotic figures and apoptotic cells, presence of mucoid ground substance and tumor infiltrating widely throughout the connective tissue and often exhibiting a prominent retraction artifact. Clinically IOBCC resemble carcinomas, compared to the benign and innocuous appearance of the PA and typically presents as surface ulcerations varying from rodent ulcer to an ulcerated erythroplakia appearance. This contrasts with the classic “bump on the gum” appearance of PAs with usually intact surface and appearing as small discrete, sessile, exophytic lesions. Importantly, the proliferative basaloid epithelium demonstrates positive immunoreactivity for the anti-epithelial antibody, Ber-EP4, a cell surface glycoprotein. The IOBCC has the potential for local recurrence and aggressive behavior and should be treated with wide surgical excision and close clinical follow up. We present 3 rare cases of IOBCC and discuss the salient histologic, immunohistochemical and clinical features.     

Carcinoma Associated with Renal Tuberculosis: A Report of Two Cases,with a Brief Review of the Literature

Two cases of carcinoma and renal tuberculosis occurring in the same kidney, a rare association, are reported. The tuberculous process was apparently overshadowed by the more obvious coexistent tumour, and detected as an incidental finding. A possible explanation for the extremely rare association of carcinoma and renal tuberculosis is discussed.     

Coagulopathy Induced Spinal Intradural Extramedullary Haematoma: Report of Three Cases and Review of the Literature

Summary  In a retrospective review of 3 patients operated for coagulopathy induced spinal intradural-extramedullary haematoma the literature regarding coagulopathy induced spinal haemorrhage is reviewed and the etiology of these rare spinal subdural and subarachnoid haemorrhages is discussed.  Spinal intradural haematomas are usually related to trauma or a previous lumbar puncture. A review of the literature revealed only a handful cases of spinal intradural haemorrhages occurring secondary to an underlying haematological disorder or an iatrogenic coagulopathy.  Coagulopathy induced spinal haemorrhage should be included in the differential diagnosis of acute paraparesis in patients with co-existent haematological disorders or undergoing anticoagulation therapy. Due to the often mixed subdural and subarachnoid bleeding patterns we have termed this entity spinal intradural-extramedullary haematoma.     

Thoracic Intradural Extramedullary Lipomas. Report of Three Cases and Review of the Literature

Summary. Summary. Background: Indication for surgery and the surgical strategy for treatment of spinal intradural lipomas are still discussed controversially. Among spinal lipomas the cervicothoracic region is rarely affected. We report on our experience with spinal decompression for the treatment of three intradural thoracic lipomas. Findings: Three adult patients with extramedullary intradural lipomas of the thoracic spinal cord demonstrated progressive neurological symptoms and signs without evidence of growth of the lipoma. All patients underwent surgery with decompression of the affected spinal levels. No attempt was made to reduce the size of the lipomas. Postoperatively, each patient demonstrated significant clinical improvement. Interpretation: Attempts to remove lipomas are associated with significant risks of surgical morbidity. Lipomas are hamartomas which change their size according to alterations of body fat. Therefore, decompression of the affected spinal levels is sufficient to achieve significant neurological improvement.     

Isolated Pancreatic Transection Due to Blunt Abdominal Trauma: Report of Three Cases and Literature Review

Abstract Pancreatic injuries caused by blunt abdominal trauma are rare occurrences consisting a small percentage of all pancreas injuries. Due to difficulties in diagnosis evaluation and associated injuries, blunt pancreas traumas are severe clinical cases with high mortality rates. We would like to discuss three cases admitted to our hospital last year, and current literature on diagnosis, management and surgical approach of blunt pancreas injuries. The incidents resulted from a traffic accident, a parade horse stamping the groom and a football game, in which the latter patient unfortunately died. These cases illustrate the importance of careful diagnosis, interpretation of findings and therapy planning of the acutely injured patient suffering blunt pancreatic trauma.     

Bronchial Lipoma:Three Cases and Review of the Literature

Three cases of bronchial lipoma are described, all in men and all localized in the right bronchus of the upper lobe. Extirpation of the upper lobe was performed in all three cases. The number of collected cases of bronchial lipoma is hereby brought to 51. The earlier literature is surveyed, and some of these cases are reported on with regard to sex, age, localization, and treatment. It is concluded that lobectomy may be the most effective treatment where the lipoma occludes only one bronchial lobe. When the lipoma is localized in the main bronchus or more centrally one should wait for the regression of any possible changes in the lung parenchyma after local removal of the tumor.     

Solitary Schwannoma of the Olfactory Groove: Case Report and Review of the Literature

Schwannomas of the olfactory groove are rare tumors. Only 10 have been reported in the past century. The case of a 59-year-old woman with an isolated olfactory schwannoma with cribriform plate erosion is presented.