Lipomatous meningioma of the brain harboring metastatic renal-cell carcinoma: A case report

A 70-year-old woman presented with mild left hemiparesis and intermittent global headache. Magnetic resonance imaging showed a 6×6×6-cm tumor in the right frontal lobe, and abdominal computed tomography revealed a 8×8×7-cm mass lesion in the left kidney. Magnetic resonance imaging showed that the brain tumor consisted of a central hyperintense cystic component and an outer hypointense component. The patient underwent total surgical excision of the intracranial mass. Histological and immunohistochemical examination showed that the lesion was a lipomatous meningioma harboring metastatic renal-cell carcinoma. Both of these tumors are rare. The magnetic resonance imaging findings are indicative of but not specific to meningioma harboring metastatic tumor.     

Plasma cell granuloma of the lung (inflammatory pseudotumor)

A case of plasma cell granuloma (PCG) of the lung in a 54-year old man is reported. PCG is a rare benign lesion that usually presents as a solitary nodule in the lung (coin lesion) at routine X-ray examination. Microscopically it consists of a granulomatous tissue where the major components are mature plasma cells. The immunohistochemical demonstration of polyclonality of plasma cells, excluding the diagnosis of plasmacytoma, confirms the inflammatory pseudotumoral nature of this lesion, although the etiology remains obscure. The presence of lymphocytes, histiocytes, macrophages, blood vessels with prominent endothelial cells and peripheral sclero-hyalinized connective tissue may pose problems in the differential diagnosis with sclerosing hemangioma, pseudolymphoma, nodular amyloidosis, pulmonary hyalinizing granuloma, chronic abscess and neoplasms of true histiocytic origin. The term inflammatory pseudotumor is preferable in describing this type of lesion.     

The radiological excision of high risk and malignant lesions using the INTACT breast lesion excision system. A case series with an imaging follow up of at least 5 years

Purpose

To evaluate the efficacy of a BLES procedure as a primary excisional biopsy rather than a surgical wide local excision for treatment of a high risk or a malignant lesion.

Methods

41 patients underwent a BLES procedure in order to attempt to remove a small breast lesion using a 15 mm or 20 mm wand from August 2007 to January 2009. The lesions were either proven on prior core biopsy to show high risk or malignant pathology or were considered to be indeterminate or suspicious on ultrasound or mammography. The pathology was reviewed to include the final status of lesion excision. If margin involvement was demonstrated then a formal surgical excision was subsequently recommended. Follow up mammography or ultrasound was performed annually in patients following the final pathological diagnosis.

Results

9 patients had a primary diagnosis of atypia (columnar cell change with atypia or atypical ductal hyperplasia (ADH)), 23 patients had ductal carcinoma in situ (DCIS) and 9 had an invasive carcinoma (IC) at the original BLES pathology. Clear BLES margins of >1 mm were obtained in 3/9 atypia lesions, 15/23 DCIS and 0/9 IC. 12/13 low grade DCIS were completely excised. Subsequent surgical margin excisions were undertaken in 20 patients. After at least 5 years of follow up (mean 66 months), 1 lesion had recurred on imaging.

Conclusion

A BLES excision has potential as an alternative technique to traditional surgical wide local excision in the management of certain small breast lesions with high risk and low grade malignant potential.     

Oligodendroglial hamartoma: a potential source of misdiagnosis for oligodendroglioma

Various subtypes of intracerebral hamartomas, associated with seizure disorders, have long been described. We describe a cerebral hamartoma placed in the left frontal lobe, associated with drug-resistant epilepsy, composed exclusively of mature oligodendroglial cells. The patient was a 27-year-old right-handed male presenting with severe epileptic encephalopathy and symptoms of behavior dysfunction (disinhibition, rage attacks) associated with a left frontal lesion. Magnetic resonance imaging revealed a small area iso-hypointense compared to the gray matter in T1-weighted sequences not enhancing after gadolinium contrast injection in the left frontal site. On histology, a cortical lesion composed of large aggregates of oligodendroglial cells, with round central nuclei and clear perinuclear halos, was observed. Neither mitotic figures nor necrosis were present. Reactivity for Ki67 and P53 was not found. The lesion was well demarcated from the adjacent brain parenchyma and perineuronal satellitosis was not observed in the cortex. In conclusion, albeit extremely rare, recognition of oligodendroglial hamartoma and its distinction from other epileptogenic lesions as dysembryoplastic neuroepithelial tumor or above all oligodendroglioma have important therapeutic and prognostic implications.     

Hematogenous extraneural metastasis of the germinomatous component of a pineal mixed germ cell tumor

A 23-year-old man presented with a mass in the pineal region and obstructive hydrocephalus. A neuroendoscopic biopsy for the lesion, ventriculoperitoneal (VP) shunting, and focal irradiation were conducted as initial treatment. Histological diagnosis of the biopsy specimen was germinoma. He underwent further irradiation and two tumor resections. Histological diagnosis was mature teratoma without a germinomatous component. After serial treatments, the intracranial lesion was controlled. However, 14?months after presentation, extraneural lesions were confirmed in the posterior mediastinum and retroperitoneal space. The biopsy specimen of the retroperitoneal space lesion was histologically diagnosed as germinoma. Although chemotherapy with cisplatin and etoposide was undertaken, extraneural lesions ware uncontrollable and he died. At autopsy, extraneural lesions were confirmed in the posterior mediastinum, retroperitoneal space, and right lung. Histological diagnosis of extraneural lesions was germinoma. This case was considered to be a pineal mixed germ cell tumor mainly consisting of germinoma and mature teratoma, which caused hematogenous metastasis of the germinoma component. Systemic chemotherapy and irradiation for primary lesions as an initial treatment is important to cure the primary lesion and prevent extraneural metastasis.     

Malignant Intracranial Epithelioid Hemangioendothelioma Presumably Originating from the Lung: Case Report

OBJECTIVE AND IMPORTANCE: Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that presents histological features and biological behavior of low-grade malignancy. The authors report a case of malignant intracranial EHE, in which surgical excisions and additional immuno-chemotherapy were ineffective. Emphasis is placed on the histological features of this rare tumor and its potential for malignancy. CLINICAL PRESENTATION: A 69-year old male presented with paresis of the right arm. Magnetic resonance imaging revealed intracranial multiple lesions in the right temporal and parietal and left frontal lobes. Chest radiography revealed a mass lesion occupying the lower lobe of the left lung that had been followed as old tuberculosis since it had not changed in size for as long as 5 years. INTERVENTION: We performed craniotomy and excised tumors. Histological examination demonstrated that the excised tumors had the features of EHE. Further intracranial recurrence after the excision of the tumors necessitated adjuvant treatment with interferon alpha-2b. However, the patient continued to deteriorate and died 3 months later. Postmortem study disclosed the tumor cells existing in the left lung, pleura, ribs, intercostal tissues and diaphragm. Other organs including liver, bone, and skin were free from tumor invasion, which indicated that the malignant EHE originated from the left lung and metastasized to the brain. CONCLUSION: To the authors knowledge, no case of malignant EHE that simultaneously involves the central nervous system and the lung has been previously reported. An extensive inspection for involvement of other organs is recommended after recognizing an intracranial EHE.     

Imaging analysis of primary malignant intracranial lymphoma

OBJECTIVE To investigate the images characteristics of primary malignant intracranial lymphoma. METHODS Retrospective study was conducted on CT/MRI imaging characteristics of 9 cases with primary malignant intracranial lymphoma. RESULTS The patients had lesions mostly in the supratentorial region, including the parts of deep white matter, para-ependymal regions, and corpus callosum. The shapes of the lesions were round or irregular. CT scan showed equal or slightly high density of the tumor images, compared with the normal tissue in the brain. The TIWI of MRI scan on the tumor showed low signal and the T2WI showed equal or slightly high signal. The MRI signals were homogenous. Cystic lesion, calcification, and hemorrhage were rarely seen in MRI. Edema around tumor and its occupational effect was lessened. Edema around tumor shown in MRI was not in accordance with the true volume of the tumor mass. Enhanced scan on the lesions showed homogenous enhancement, and the pia mater invaded and/or the spread along ependyma. CONCLUSION Images of primary malignant intracranial lymphoma have specific characteristics that are useful in its diagnosis and differential diagnosis.     

A Case Report of Cervical Thymic Cyst and Review of Literature

We are reporting a case of 10-year-old female child with an asymptomatic left sided cystic neck mass who underwent surgical excision. She was diagnosed as having a cervical thymic cyst based on histopathologic findings. The review of available literature on thymic cyst has shown that cervical thymic cyst is a rare occurrence, but should always be thought of in the differential diagnosis of cystic masses in the neck especially presenting in children.     

颅内病灶特征与初诊脑转移癌患者认知功能水平的相关性研究

目的 探讨初诊脑转移癌患者颅内病灶特征与认知功能水平的相关性。 方法 以2015—2016年间收治的 51例初诊脑转移癌患者为研究对象,利用CT和(或) MRI确定患者颅内病灶特征,用蒙特利尔认知评估量表评估患者认知功能水平。组间比较采用Mann-Whitney U检验,等级资料相关性采用Spearman法分析。 结果 51例初诊脑转移癌患者中 47例(92%)存在认知功能障碍,其中轻度认知功能障碍 31例(61%),痴呆 16例(31%)。单独左、右半球受累的患者认知功能水平无统计学差异(P=0.425),双侧半球受累较单独左侧半球受累的患者认知功能水平下降(P=0.042)。病灶累及≥3个脑叶较单个或2个脑叶受累的患者认知功能水平下降(P=0.015、0.024)。颅内病灶体积及水肿带体积对患者总体认知功能无影响(P=0.077、0.178)。颅内病灶个数>3个的患者较病灶个数为 1~3个的患者认知功能水平下降(P=0.010)。 结论 90%以上的初诊脑转移癌患者存在认知功能障碍,认知功能障碍主要与病灶部位、累及脑叶、病灶个数相关,而与病灶及水肿带体积无相关性。     

Cystic metastasis versus brain abscess: role of MR imaging in accurate diagnosis and implications on treatment

Intracranial cystic metastases are difficult to differentiate from non neoplastic lesions like a cystic abscess on routine magnetic resonance imaging (MRI) sequences in patients with a known primary cancer. Diffusion weighted MRI sequences can help in differentiating between the two. This carries significant implications on the intent and nature of treatment. We present a case of a forty five-year- old patient of squamous cell carcinoma of larynx who developed an intracranial cystic ring enhancing lesion following chemotherapy. Though routine MRI was equivocal, MR diffusion was highly suggestive of an abscess and this led to surgical excision which confirmed the diagnosis. We discuss this case and review the literature regarding the role of newer MRI sequences and the ramifications on patient treatment.     

Diffusion-weighted MR imaging abnormalities in pediatric patients with surgically-treated intracranial mass lesions

SummaryIntroduction Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that measures the degree of water diffusion in vivo. DWI abnormalities are frequently observed on immediate postoperative imaging following surgical resection of gliomas in adults. These abnormalities subsequently demonstrate contrast enhancement, which may be confused with lesion recurrence. The purpose of this study was to investigate the occurrence of these postoperative abnormalities in pediatric patients with intracranial mass lesions.Methods Thirty-three consecutive patients ≤18 years old with a newly diagnosed intracranial mass lesion underwent MRI, including DWI, before and immediately after surgical treatment.Results The median patient age was 9.9 years (range 0.2–18 years). Supratentorial and infratentorial lesions were identified in 22 and 11 patients, respectively. Infiltrative and noninfiltrative, as well as benign and malignant lesions, were included. Postoperative imaging demonstrated areas of reduced diffusion adjacent to the resection cavity in 20 (61%) cases. The median volume of these areas was 1.7 cm³ (range 0.3 cm³–12.0 cm³). Subsequent imaging studies in 9 of the 18 cases showed contrast enhancement in the area corresponding to the DWI abnormality. There were no clinical deficits attributable to any of the diffusion abnormalities. There was no association between the occurrence of these abnormalities and whether the lesion was infiltrative, non-infiltrative, benign, or malignant.Conclusions DWI abnormality on immediate postoperative MRI is common following surgery for newly diagnosed intracranial mass lesions in pediatric patients. Focal contrast enhancement in the postoperative period may be confused with recurrence for some lesions. Our study suggests that immediate postoperative DWI is useful in interpreting new areas of focal contrast enhancement on subsequent imaging in children who have had surgery for brain tumors.     

Oral malignant melanoma: a review of the literature

Primary oral malignant melanoma (OMM) is a rare neoplasm, accounting for 0.5% of all oral malignancies. The etiology is unknown; tobacco use and chronic irritation may play some role. Clinically, OMM may mimick other pigmented lesions. A biopsy is required in order to establish the diagnosis. The reported risk of malignant cells spreading during invasive procedures and factors such as size of the lesion or anatomical limitations, may influence the diagnostic surgical procedure. Therapy of OMM is commonly based on surgical excision of the primary tumour, supplemented by radiotherapy, with chemotherapy and immunotherapy serving as adjuncts. Prognosis is poor, with a 5-year survival rate of approximately 15%.     

Undifferentiated Pleomorphic Sarcoma of the Male Breast Causing Diagnostic Challenges

Undifferentiated pleomorphic sarcoma of the breast are uncommon and often present diagnostic challenges. Herein, we report a case of the undifferentiated pleomorphic sarcoma occurring in the male breast. A 76-year-old man presented with a palpable bean-sized mass in his left breast for two months. Core needle biopsy revealed the presence of atypical cells in a fibrous proliferative lesion, which was removed by wide excision. Based on examination of the excised tumor, the initial pathologic diagnosis was atypical spindle cell lesion with uncertain malignant potential. One year later, the patient returned with a recurrent mass atthe previous surgical site. The mass was again surgically removed using wide excision. Based on histological findings with immunomarkers, the final diagnosis was undifferentiated pleomorphic sarcoma. Undifferentiated pleomorphic sarcoma of the breast can cause genuine diagnostic difficulty and appropriate immunohistochemistry is mandatory for differential diagnosis.     

Lingual metastasis as an initial presentation of renal cell carcinoma

Distant metastasis of malignant neoplasm to the oral soft tissue is extremely rare. We report a case of renal cell carcinoma (RCC) metastasizing to the tongue. A 47-year-old man visited our hospital with chief complaint of a lump on the middle third of the dorsum of his tongue and the lesion fell off from the tongue. Although histopathological diagnosis of the mass was granuloma teleangiectaticum, similar nodule reappeared in the same area 2 weeks later. The second lesion was composed of granuloma teleangiectaticum and aggregation of neoplastic clear cells in ductal arrangement. The clear cells were immunohistochemically positive for EMA and CD10. The abdominal CT scan revealed a 5.5 cm mass in the left kidney, suggesting RCC. Thus, the lingual lesion was consistent with metastatic RCC. There has been no recurrence for 2 years after the radical nephrectomy and local excision of the tongue.     

Differential Diagnosis between Primary Intracranial Melanoma and Cerebral Cavernoma in Crohn’s Disease: A Case Report and Literature Review

Primary intracranial melanomas are rare, with a challenging diagnosis based only on clinical and imaging features. The authors described the case of an intracerebral right parieto-temporal melanoma mimicking a cavernoma in a patient affected by Crohn’s disease. A 67-year-old female patient with Crohn’s disease and small bowel stenosis was hospitalized for surgical removal of the terminal ileum and latero-lateral ileo-colic anastomosis. During postoperative week 1, the patient developed psychomotor agitation followed by altered consciousness. An urgent brain CT showed a right intracerebral parieto-temporal hemorrhage with intralesional calcifications. The patient underwent a decompressive craniectomy with hematoma drainage and a complete resection of the lesion. Histologic examination showed characteristics consistent with malignant melanoma. In patients with inflammatory bowel disease (IBD), the differential diagnosis between intracerebral melanoma and cavernoma may be challenging, considering the similar clinical and radiological findings. Thus, a comprehensive multidisciplinary approach is required to exclude the possible coexistence of such intracranial lesions.     

Primary anaplastic pleomorphic xanthoastrocytoma with widespread neuroaxis dissemination at diagnosis––a pediatric case report and review of the literature

We report a 5 year-old boy with primary anaplastic pleomorphic xanthoastrocytoma (PXA) with whole neuroaxis dissemination at diagnosis who experienced the sudden onset of generalized convulsion. Head- and spinal magnetic resonance imaging (MRI) showed widespread gadolinium (Gd)-enhanced lesions extending to the bilateral frontal- and medial temporal lobes and the spinal cord. Subsequent MRI study demonstrated that the lesion size increased without any neurological deterioration. Under a histopathologic diagnosis of anaplastic PXA he underwent adjuvant chemotherapy consisting of 12 cycles of carboplatin and vincristine. The patient is alive without any neurological deficits; follow-up MRI showed that the lesions remained stable during 18 months of chemotherapy. We report a very rare pediatric case of primary anaplastic PXA with dissemination involving the entire neuroaxis at the time of diagnosis.     

Gastric carcinosarcoma presenting as a huge epigastric mass

Gastric carcinosarcoma often presents with an elevated lesion or increased thickness of the stomach wall. Histological diagnosis is achieved using conventional hematoxylin and eosin staining to confirm the coexistence of both epithelial and mesenchymal elements. We report a case of gastric carcinosarcoma presenting as a large mass in the epigastric region. Specimens obtained by endoscopic biopsy and surgical excision showed diffuse proliferation of atypical cells in sheet formation. No mucus production or glandular structures were apparent, but immunoreactivity for both epithelial and mesenchymal markers was noted. These findings led to a definitive diagnosis of gastric carcinosarcoma. Immunohistochemical analysis is useful for the early diagnosis and treatment of gastric carcinosarcoma.     

Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

Background The aim of this study was to determine factors that predict under-evaluation of malignancy in patients diagnosed with atypical ductal hyperplasia (ADH) at ultrasound-guided core needle biopsy (CNB), and to develop a prediction algorithm for scoring the possibility of a diagnosis upgrade to malignancy based on clinical, radiological and pathological factors. Methods The study enrolled patients diagnosed with ADH at ultrasound-guided CNB who subsequently underwent surgical excision of the lesion. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. Results A total of 102 patients with ADH at CNB were identified. Of the 74 patients who underwent subsequent surgical excision, 34 (45.8%) were diagnosed with invasive or in situ malignant foci. Multivariate analysis revealed that age >50 years, microcalcification on mammography, size on imaging >15 mm and a palpable lesion were independent predictors of malignancy. Focal ADH was a negative predictor. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.903 (95% CI: 0.82–0.94), and the negative predictive value was 100% for a score ≤3.5. Similar findings were observed for a validation dataset of 54 patients at other institutions. Conclusions A scoring system to predict malignancy in patients diagnosed with ADH at CNB was developed based on five factors: age, palpable lesion, microcalcification on mammography, size on imaging and focal ADH. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

多发性皮下Rosai-Dorfman病1例报告并文献复习

目的:探讨多发性皮下Rosai-Dorfman病的临床病理特征、诊断、鉴别诊断。方法:对1例多发性皮下Rosai-Dorfman病进行组织形态学、免疫组化及特殊染色检查,并随访及复习相关文献。结果:肿块分别位于左侧胸壁及右腹股沟区,两处病变组织学上表现相似,呈细胞疏松区和密集区交替分布的结节状结构,细胞疏松区可见淋巴窦样结构,其间有一些体积较大、胞浆丰富淡染的组织细胞,可见胞质内吞噬物和淋巴细胞"伸入运动";细胞密集区散在淋巴滤泡伴较多浆细胞、中性粒细胞等浸润。免疫表型:组织细胞呈S-100、CD163及CD68阳性。结论:多发性皮下Rosai-Dorfman病罕见,确诊主要依靠形态学及免疫组化标记,无论临床及病理均需与纤维组织细胞瘤、Langerhans细胞组织细胞增生症、非特异性肉芽肿、炎性肌纤维母细胞性肿瘤等相鉴别,治疗以手术切除为主,预后较好。