Carcinoid tumor in a presacral teratoma associated with an anterior sacral meningocele: case report and review of the literature

We report a case of a presacral teratoma containing a malignant carcinoid component associated with an anterior sacral meningocele that presented in a 35-year-old woman. The clinical, radiographic, and pathological features of these rare tumors, of presacral meningoceles, and of the hereditary presacral teratoma syndrome are discussed.     

Posterior sagittal approach for Currarino syndrome with anterior sacral meningocele: a case report

The authors report a case of Currarino syndrome with anterior sacral meningocele, tethered cord, and anorectal stenosis that was treated by posterior sagittal approach. Initially, a diverting colostomy was performed. Two months later, excision of the meningocele, untethering of spinal cord, and anorectoplasty were performed simultaneously without complication. Posterior sagittal approach seems to be very beneficial for excision of the presacral mass and reconstruction of the anus.     

Anterior endoscopic treatment of a huge anterior sacral meningocele: technical case report

OBJECTIVE AND IMPORTANCE: Anterior endoscopic treatment of a huge anterior sacral meningocele, a rare example of spinal dysraphism, is described. CLINICAL PRESENTATION: A 43-year-old woman presented with severe headache and fever, increasing abdominal pain, and a several-year history of right lower-extremity radicular pain. She exhibited meningeal irritation signs and Currarino's triad. Lumbosacral myelograms and magnetic resonance imaging scans revealed a huge anterior sacral cyst connected with the spinal subarachnoid space. INTERVENTION: A straight rigid endoscope was introduced into the meningocele through a small abdominal incision. The fistula between the meningocele and the spinal subarachnoid space was obliterated with multiple fat grafts harvested from the abdomen. CONCLUSION: An anterior endoscopic procedure is an alternative for the treatment of a huge anterior sacral meningocele.     

Anterior sacral meningocele: review of the literature

Penetrating injury of the upper cervical spinal cord is usually caused by missiles. An unusual case of injury to the upper cervical spinal cord by a speargun is reported. Surgical treatment was uneventful, and the patient made good neurological progress within 2 days after the operation. On the fifth day he became confused and had a temperature of 40°C. A diagnosis of Branhamella catarrhalis meningitis was made. The patient's condition continued to deteriorate despite parenteral broad-spectrum antibiotic therapy, and he died 15 days after the injury.     

Management of a parturient with an anterior sacral meningocele

Anterior sacral meningoceles are rare disorders featuring anterior herniation of the meninges through a sacral defect or foramen. They are frequently misdiagnosed as ovarian or abdominal cysts and surgical exploration has resulted in meningitis. In pregnancy it represents an obstacle to delivery of the fetus and rupture of the meningocele during vaginal delivery is a significant risk. The successful multidisciplinary management of a primiparous patient with an anterior sacral meningocele and previous abdominal surgery is presented.     

Cryosurgery in the excision of a giant local recurrent sacral chordoma: a case report and literature review

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Purpose

Chordoma is a low-grade malignant tumor with recurrence and metastasis tendency that originates from embryonic notochordal remnants. The sacrococcygeal region is the most commonly involved site. The aim of this paper is to report the results of the use of cryosurgery in the excision of a giant recurrent sacral chordoma and review of pertinent literature.

Methods

A 64 years old female patient with a locally recurrent sacral chordoma came to our attention after ten interventions performed at another institute. A surgical treatment was performed using argon cryosurgery.

Results

In this case, it was not possible to perform a marginal or wide excision, but it was intralesional with the removal of three major blocks. The fragments sent for the histological analysis measured total 35 × 30 × 8 cm with a weight of 4.260 g.

Conclusions

Given the gelatinous structure of the tumor and the possibility of contamination of operatory field, cryosurgery may be indicated when previous surgeries and the dimensions of tumor mass do not allow a resection with negative margins improving radiotherapy efficacy in the local control of tumor.

     

A rare anterior sacral osteochondroma presenting as sciatica in an adult: a case report and review of the literature

Background contextOsteochondroma is the most common primary benign bone tumor and is usually located in the metaphyses of long bones and rarely in the spine or anterior sacrum. To the best of our knowledge, en bloc excision of a solitary osteochondroma of the anterior sacrum in an adult patient has not been previously reported in a peer-reviewed journal.PurposeThe purposes of this study were to document the first report of an osteochondroma of the anterior sacrum along with the clinical course and operative management and review the literature on solitary osteochondroma of the sacrum.Study design/settingThe study setting is an academic institution. This is a case report and review of the literature.Patient sampleThe patient is an adult female.Outcome measuresThe outcome measure is the visual analog score for pain.MethodsA 54-year-old woman presented with 9/10 disabling low back and radicular pain in the left lower extremity. Radiologic studies showed a pedunculated mass occurring from the anterior sacrum thought to be causing nerve root compression. The patient received en bloc excision of the mass through an abdominal retroperitoneal approach. We also conducted a literature review of solitary sacral osteochondroma in peer-reviewed journals.ResultsHistologic studies confirmed the mass to be an osteochondroma without pathologic signs of malignant transformation. The patient complained of dysesthesia in the left leg after surgery, which progressively improved completely over 8 months after the operation. At the 2-year follow-up, there was no evidence of local recurrence and she was pain free. A literature review revealed one previous case of en block resection of a solitary osteochondroma, but it involved the posterior sacrum.ConclusionsSolitary osteochondroma can rarely present in the sacrum as low back pain and sciatica. In general, when osteochondroma causes pain in an adult, we should think that some structure is impinged or that it could have initiated a malignant transformation, so en bloc excision should be used to remove the tumor and histologic studies performed to assess for malignant transformation. Battered nerve root syndrome may take up to 8 months to resolve.     

Intrathoracic giant meningocele developing hydrothorax: a case report

A 67-year-old woman with neurofibromatosis type 1 presented with progressive dyspnea. Radiologic evaluation and magnetic resonance imaging revealed progression of a giant meningocele associated with hydrothorax. Laminoplasty with incision of the meningocele and dural plasty was performed, although nerve rootlets were killed. Microsurgical incision of the neck of the meningocele is a favorable operation even in large meningoceles such as the present case.     

Anterior sacral meningocele. A case report

A case of anterior sacral meningocele in a 6-year-old girl is reported. The laminotomies of L5, S1, and S2 vertebrae were performed through a median posterior approach. The communication between the subarachnoid space and the meningocele was closed using dural fibrin patch, which has not yet been described in the literature. The relevant literature is reviewed.     

Hereditary occurrence of anterior sacral meningocele: report of ten cases

Anterior sacral meningocele is a rare and often occult disorder that is important to diagnose. It usually occurs sporadically, and familial case reports are rare. This report describes ten documented cases of anterior sacral meningocele in one family. Spanning five generations, it is the largest such series ever reported. In most cases, computerized tomography (CT) was employed to make the diagnosis. There was a high incidence of associated anomalies. The mode of transmission appears to be autosomal dominant with variable penetrance, similar to several other reported series.     

Rectothecal fistula secondary to an anterior sacral meningocele

A rectothecal fistula secondary to anterior sacral meningocele is an extremely rare disease. To the authors' knowledge, only 2 cases have been reported in the English-language literature. It can cause symptoms by compressing adjacent structures, causing urinary difficulties and constipation. The authors report an unusual case of a patient in whom this condition was diagnosed as an incidental finding. The patient had a sacral myelomeningocele with secondary meningitis to a rectothecal fistula. The authors will briefly review the diagnosis, the various treatments, and the surgical approach to treat this infrequent entity.     

Laparoscopic treatment of anterior sacral meningocele

BACKGROUND: Anterior sacral meningocele is a rare congenital malformation, whose open surgical treatment is well accepted. We present a laparoscopic approach as an adjunctive approach. METHODS: Five women who underwent laparoscopic transperitoneal surgery were clinically, radiologically, and surgically evaluated. RESULT: All 5 patients underwent laparoscopic transperitoneal surgery and showed satisfactory results. They had no major complications. Three patients had headaches as minor complications, but it was gone in at most 3 days. Decrease in operative time, blood loss, and length of hospitalization were the advantages of the procedure. CONCLUSIONS: The laparoscopic approach to treating anterior sacral meningocele was feasible and safe, with only minor complications.     

肝细胞癌骶骨转移1例报告并文献复习

肝癌位居世界常见恶性肿瘤第6位,其死亡率居第3位,绝大多数为肝细胞癌(HCC)。近年来,肝癌诊断和治疗策略有所改善,患者生存时间得到延长,但5年生存率仍较低(16%),若发生肝外转移,生存率仅为4%[1-2]。有文献报道,HCC肝外转移发生率为15%~17%[3],除转移至肺、淋巴结、肾等,还可转移至皮下组织及骨骼肌肉系统[4]。在脊柱转移瘤中,骶骨转移瘤较胸椎(60%~80%)、腰椎(15%~30%)、颈椎(10%~15%)转移瘤发生率低[5-6]。肝癌骶骨转移发生率低,在局部呈多灶性、小片状、巨块状、虫蚀样改变,常累及骶孔,常见溶骨性破坏,破坏区无钙化,边缘不清晰。肿瘤若累及骶神经,可表现为运动感觉障碍及腱反射异常。本院2018年9月收治HCC骶骨转移患者1例,本研究组根据其临床表现,影像学、实验室及病理学检查并结合文献复习,探讨骶骨转移瘤的诊断,骶骨解剖结构、生物力学与手术治疗的关系及临床疗效评价,现报告如下。     

Retroperitoneal giant schwannoma: a case report and review of the literature

Schwannomas are rare tumours that originate in the neural sheath and account for only a small percentage of all retroperitoneal tumours. They are usually solitary, circumscribed and encapsulated lesions eccentrically located on proximal nerves or spinal nerve roots. Presentation is typically varied and non-specific, ranging from abdominal pain, an abdominal mass or an incidental finding. The preoperative diagnosis is difficult and laboratory tests are usually unremarkable. We report the case of a 66-year-old female presenting with abdominal pain in her left flank and with an ultrasonographic diagnosis of a left kidney mass. She was diagnosed as suffering from a giant retroperitoneal schwannoma after surgical exploration and complete excision. The role of CT scan and CT-guided needle biopsy is emphasised, in that ultrasonography and fine needle aspiration alone do not provide sufficient information regarding aetiology and malignancy. Radical surgical excision is curative but recurrences may occur. Careful follow-up is needed.