Cystic meningioma. Case report and literature review

BACKGROUND: Cystic meningioma is a rare variety of meningioma. It represents 1,6 to 10% of intracranial meningiomas, the authors report a case of intracranial cystic meningioma with a review of literature. CASE REPORT: A 46-year-old female presented with left parietooccipital headache followed by right side hemiparesis. CT scan brain showed a left parietal tumor with double solid and cystic components thought to be glioma or metastasis preoperatively. At surgery the extraaxial solid and cystic lesion had a well defined capsule that could be easily separated from the perilesional cortical surface. The tumor was totally removed. The histological study showed a cystic meningioma. CONCLUSION: Cystic meningioma is an uncommon tumor that should be considered in the differential diagnosis of brain tumors with a cystic component.     

Diffuse calvarial meningioma. Case report and review of the literature

An extremely unusual calvarial meningioma in a 77-year-old woman is reported. The meningioma spread widely and symmetrically within the calvaria and grew extracranially within the scalp as well as intracranially. Reactive dural hyperplasia induced narrowing of the intracranial space and occlusion of the superior sagittal sinus, resulting in intracranial hypertension. After external decompression, the patient's symptoms markedly resolved. The authors review the literature on calvarial meningioma, discuss its pathogenesis, and propose mechanisms responsible for the patient's intracranial hypertension.     

Intradiploic meningioma of the skull. Case report and review of literature

A case of a patient with an accidentally discovered scalp mass is presented. Radiological investigation documented an osteolytic intradiploic lesion of the cranial vault. The lesion was surgically removed and histological examination revealed a meningioma. The literature concerning these uncommon tumours of the skull is reviewed, and the differential diagnosis is discussed.     

Chronic subdural hematoma associated with an intracapsular meningioma. Case report and short review of the literature

We describe a patient with a chronic subdural hematoma, associated with a intracapsular meningioma, who was successfully treated by operation. The development of chronic subdural hematoma and the possible relationship between the two lesions are discussed. A short review of the literature concerning this subject is included.     

Pancreatoblastoma in an adult: Case report and review of the literature

A 50-year-old man presented with progressive gastrointestinal symptoms. An abdominal computed tomography scan demonstrated a 12 × 12-cm pancreatic mass involving the greater curvature of the stomach and multiple hypervascular hepatic metastases. An initial fine needle aspiration of the pancreatic mass was nondiagnostic, and a subsequent fine needle aspiration of a liver mass was read as metastatic acinar cell carcinoma. The patient underwent a palliative resection for tumor-associated pain and gastrointestinal hemorrhage that revealed a large pancreatic tumor invading through the full thickness of the colon at the splenic flexure and adherent to the posterior gastric wall. The pathology from the distal pancreatectomy, splenectomy, partial gastrectomy, partial colectomy, and cholecystectomy unexpectedly supported a diagnosis of pancreatoblastoma with evidence for squamoid corpuscles as well as areas of acinar formation. Despite multiple chemotherapy regimens, the patient’s disease continued to progress in the liver and the lungs. During the course of his therapy, the patient’s serum α-fetoprotein levels and serum lipase levels rose concurrently, suggesting tumor-associated production of both of these factors. Seventeen months after the diagnosis of metastatic pancreatoblastoma, the patient died from his disease. Our case illustrates the fact that pancreatoblastomas are extremely difficult to diagnosis preoperatively. In addition, our case demonstrates that pancreatoblastomas can be α-fetoprotein producing, hormone producing, and enzyme producing when it occurs in adults. The University of California, San Francisco Committee on Human Research approved this project (approval No. H9672-26472-01).     

Bilateral chronic subdural hematoma associated with meningioma. Case report and review of the literature

Gross intracranial hemorrhage associated with brain tumor has been reported to range from 3.6-10%. Brain metastases and malignant glioma are the most frequent underlying pathologies. Intracranial hemorrhage related to meningioma is a rare condition. Subarachnoid hemorrhage, acute subdural hematoma, intratumoral and intraparenchymal hematomas are the most common forms of bleeding associated with meningioma. By contrast, chronic subdural hematoma (cSDH) and intraventricular hemorrhage are seen less frequently. The authors report a very rare case of left fronto-parietal convexity meningioma associated with bilateral cSDH in a patient with history of recent minor head trauma and review the literature on hemorrhage associated with meningiomas.     

High-dose radiation-induced meningioma in children. Case report and critical review of the literature

Object

High-dose radiation-induced meningiomas in children are a rare occurrence. We discuss the clinical data and the differences of these rare tumors from those of spontaneous counterpart and radiation-induced meningiomas of the adult population.

Case report

We report a case of meningothelial meningioma, which occurred in a 9-year-old boy who underwent radiotherapy for a parieto-occipital cutaneous angioma. In addition, we collected 18 cases of high-dose radiation-induced meningiomas in children from a literature review with Medline.

Results

Radiation-induced meningiomas in children show a female predominance, a short latency period that seems to be related to the age at irradiation, and an aggressive behaviour.

Conclusion

Exposure to the potentially carcinogenic effects of radiotherapy should be reserved only for tumors that demonstrate subsequent progression. A meticulous follow-up of patients treated with radiation therapy is mandatory.     

Clear cell meningioma of the cauda equina in an adult: case report and literature review

In the pediatric population, clear cell meningiomas are more frequently intracranial than intraspinal in location. Tumors recur in up to 40% of cases within 15 postoperative months and are often managed with repeated resection with or without radiation therapy. The management strategy for adults with clear cell meningiomas involving the lumbar spinal canal (cauda equina) is less clearly defined. A 41-year-old woman presented with mild, right greater than left, lower extremity paresis. An enhanced magnetic resonance (MR) scan revealed a homogeneously enhancing intradural lesion filling the spinal canal at the L3-L4 level. Preoperative noncontrast MR studies of the brain and cervical and thoracic spine were negative. An L2-L5 laminectomy was performed for gross total excision of the intradural lesion, which was adherent to one nerve root of the cauda equina. Frozen-section diagnosis confirmed clear cell tumor. Differential diagnoses included meningioma versus renal cell carcinoma. Negative postoperative chest, abdominal, and pelvic computed tomography studies ruled out tumor of renal cell origin. Enhanced MR studies of the neuraxis proved negative. Consultations with multiple oncologists and radiation therapists recommended neither radiation nor chemotherapy following this initial surgery. She remains disease-free 1 year postoperatively. The high recurrence rate for clear cell meningiomas in children requires repeated tumor resection with or without secondary radiation therapy. Following gross total resection of lumbar tumors in adults, reserving radiation therapy for secondary recurrences provides optimal management.     

Associated cervical schwannoma and dorsal meningioma. Case report and review of the literature.

The association between spinal meningiomas and neurinomas without clinical signs of neurofibromatosis is very rare with only four cases reported in literature. A case of 70-year-old woman with a history of progressive paraparesis is presented. A cervico-dorsal magnetic resonance with contrast showed two tumors with different enhancement. The patient had examination negative for neurofibromatosis. At histological examination cervical schwannoma and a dorsal meningioma were found. The Authors debate the rarity of this association, the possible pathogenesis and the MR findings.     

Intraparenchymal meningioma originating from underlying meningioangiomatosis. Case report and review of the literature

The authors present the case of a 20-year-old woman with right-sided temporal intraparenchymal meningioma originating from underlying meningioangiomatosis. The patient manifested temporal-type seizures as the initial symptom. She had no stigmata of neurofibromatosis Type 2. Neuroradiological studies revealed an intraaxial, contrast-enhancing lesion in the right temporal lobe. After gross-total removal of the tumor, histological examination revealed a transitional meningioma with surrounding neural parenchyma and features of meningioangiomatosis. Although there were no signs of anaplasia, necrosis, or increased mitosis, tumor islands were observed in the adjacent neuropil. The rare association of meningioangiomatosis and meningioma is discussed, along with radiological and surgical findings.     

Metastasis of breast carcinoma to intracranial meningioma. Case report and review of the literature.

A case of metastasizing breast carcinoma to an intracranial meningioma is presented. The pathogenesis and principles of diagnosis of this rare occurrence are discussed in light of the data reported from the literature.     

Subcutaneous metastasis at the operative route of an atypical meningioma of the tentorium. Case report and literature review

Metastatic spreading is a rare complication of meningioma. We report a subcutaneous metastasis from an atypical meningioma of the tentorium. A 69-year-old man presented with a meningioma of the tentorium. The tumor was totally resected. The histological diagnosis was atypical meningioma. The tumor recurred two years later and was irradiated. Despite irradiation, the tumor progressed and was resected three years later. Five months following the second surgery, an isolated subcutaneous mass developed at the skin incision and was resected. The histological examination of the subcutaneous tumor showed histological features of atypical meningioma. Surgery of atypical meningioma carries the risk of iatrogenic metastasis, despite previous irradiation.     

梨状腹综合征1例报告并文献复习

目的探讨梨状腹综合征的临床特征及诊治方法,提高对梨状腹综合征的认识。方法回顾性分析1例梨状腹综合征的临床资料并复习有关文献。结果经导尿及抗感染治疗,患者症状缓解。随访6月,无复发。结论影像学检查可诊断此病。梨状腹综合征的发生可能与遗传因素有关。     

Third ventricular chordoid glioma: case report and review of the literature

BACKGROUND: Chordoid glioma of the third ventricle is a rare type of brain tumor that was recently characterized as a novel tumor entity. We present a case and review of the literature. CASE REPORT: A 49-year-old woman presented with progressive headache, memory impairment and urinary incontinence. MRI showed a large well-circumscribed tumor in the third ventricle. The tumor was partially removed via a trans-lamina terminalis approach. The histologic findings indicated chordoid glioma. Residual tumor was treated by stereotactic radiosurgery and showed no regrowth at 2-year follow-up. CONCLUSIONS: The ideal therapy is total removal of the tumor. However, according to the literature, total removal of the tumor carries a high risk because of its location, and conventional radiation therapy has little effect on the residual tumor. On the other hand, stereotactic radiosurgery appears more promising, and to date, no regrowth has been reported after gamma-knife therapy.     

Volvolus in an adult patient due to intestinal malrotation. Case report and review of literature

Intestinal malrotation is a rare cause of bowel obstruction in adults and it could create a perplexing situation for surgeons not familiar with this pediatric pathology. Symptomatic patients present either acutely with bowel obstruction and intestinal ischemia with a midgut or cecal volvolus, or chronically with vague abdominal pain. Several modalities can be used to describe the intestinal abnormality such as barium X-ray, computer tomography scans, angiography and sometimes also the explorative laparotomy. The authors report on a case 62 years-old women presented to Emergency Center for plurime episodies of biliar emesis and diffuse abdominal pain in the last 5 days and treated for bowel obstruction secondary to a midgut volvolus in anomaly of fetal intestinal rotation.