Asymptomatic eyebrow mass. A rare presenting sign of malignant non-Hodgkin's lymphoma.

A 60-year-old woman had a solitary mass in her left eyebrow that was first thought to be a dermoid cyst and following excision and histological examination was found to be a localized, malignant, non-Hodgkin's lymphoma of the mixed lymphocytic and histiocytic type. Subsequent lymphangiography after excisional biopsy of the left eyebrow mass demonstrated extensive para-aortic and inguinal lymph node involvement.     

Multiple brain tumors of different cell types with an unruptured cerebral aneurysm--case report.

A rare case of coexistent Burkitt-type lymphoma and meningioma associated with an unruptured cerebral aneurysm is presented. A 49-year-old male complaining of headache and right hemiparesis was admitted to our hospital. Neuroradiological examination revealed a multinodular mass in the left frontal convexity and an unruptured cerebral aneurysm at the M1 portion of the left middle cerebral artery. He underwent an operation for tumor removal and aneurysm clipping. Histological examination revealed the tumor to be a typical meningotheliomatous meningioma without malignancy. However, a second operation was necessary for another tumor invading into the left frontal lobe, which proved to be a Burkitt-type lymphoma. The second tumor may have been resulted from irritative effect of the first tumor, but the aneurysm was considered purely coincidental.     

Xanthogranulomatous pyelonephritis in childhood. A case report

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 year old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood.     

Calcifying aponeurotic fibroma. A case of multiple primary tumours. Case report.

A 20 year old man had had three subcutaneous tumours on his left forefinger for 15 years. After operation they were found to be infiltrating into the surrounding tissue, and histological examination showed them to be calcifying aponeurotic fibromas. To the knowledge of the author this is the first reported case of multiple primary tumours of this kind.     

Congenital lobar emphysema of left upper lobe. A case report

In a 2 1/2-year-old boy chest X-ray examination because of dyspnoea revealed hyperlucency of the left upper lobe with herniation of the hyperinflated lobe into the right hemithorax. Surgical exploration showed the upper lobe of the trilobed lung to be the site of congenital lobar emphysema, while the lingula and left lower lobe were collapsed. Left upper lobectomy was successfully performed.     

Traumatic dislocation of the testis.

We report on a patient having testis dislocated into the superficial crus caused by an accident on a fishing boat. On physical examination, the left hemiscrotum was empty, and a painful mass was palpable inside the left thigh. On sonography, the testis appeared to be normal. Magnetic resonance imaging showed that the mass was located between subcutaneous tissue and muscle layer of the thigh. Surgical intervention was performed, and the left testis was found within the subcutaneous tissue inside the thigh, with slight torsion of the spermatic cord. The testis was fixed in the left hemiscrotum. To our knowledge, traumatic dislocation of the testis into the superficial crus is rare, and only 2 cases have been reported.     

Intragluteal spindle cell hemangioendothelioma. An unusual presentation of a recently described vascular neoplasm.

A 40-year-old woman noted a large tumor mass in the left buttock that, on microscopic examination, proved to be a recently described, relatively uncommon spindle cell hemangioendothelioma. This particular neoplasm, which has some features of Kaposi's sarcoma, seems not to have been reported previously in a deep, intramuscular location.     

Surgical treatment of recurrent primary malignant tumor of the left atrium.

A young woman presented with a tumor in the left atrium resembling a left atrial myxoma. After simple excision of the tumor the diagnosis of primary malignant fibrous histiocytoma of the heart was made. A course of radiation therapy was given. Four subsequent recurrences were treated by cardiotomy and resection of the left atrial wall. At the third, fourth, and fifth operations fulguration of the left atrial wall was performed. Subsequent chemotherapy failed to control the tumor. The patient was admitted 6 weeks after the last resection and died. Postmortem examination revealed a large recurrent tumor obstructing the left atrium with no metastases. The clinical course, cardiac catherization data, and postmortem examination are presented. Palliation was achieved by repeated resection of a radiation-resistent primary sarcoma of the heart.     

Single stage multiple stenting in Takayasu's arteritis. Case report

A 32-year-old Filipino female presented with Takayasu's arteritis manifesting as an abrupt onset of syncope. Physical examination revealed diminished consciousness, right hemiparesis, and a large discrepancy in blood pressure between the upper and lower extremities. Magnetic resonance imaging revealed cerebral infarcts in the left basal ganglia and the left temporal lobe. Angiography revealed complete occlusion of the left common carotid artery and severe stenosis of the brachiocephalic artery, the right common carotid artery, and the left subclavian artery. Based on the clinical examination and studies, the diagnosis was Takayasu's arteritis, type I. The patient's condition stabilized after 2 months of prednisone and anti-platelet therapy. Single stage multiple stenting in the brachiocephalic artery, the right common carotid artery, and the left subclavian artery was then performed using high pressure inflation to dilate the arteries due to the remarkably rigid lesions that resulted from extensive and diffuse fibrosis throughout the vessel walls. Although a small intimal flap occurred during inflation of the left subclavian artery, re-dilation was possible with the stent. Even with evidence of notable recovery in blood pressure and cerebral blood flow, no further neurological improvement was observed. In view of the favorable short- and intermediate-term results, single stage multiple stenting may be the optimum treatment option for first-line stent-supported angioplasty in patients with Takayasu's arteritis.     

Cardiac leiomyosarcoma. Case report

A case of primary cardiac leiomyosarcoma diagnosed at Ia?i Cardiology Center is presented. The study was made on the surgical biopsy specimen, and the diagnosis by routine morphological techniques. The gross examination revealed a large intracavitary left atrial tumor attached by a small sessile base to the left posterior atrial wall, having a smooth, white-gray surface, and a dense consistency. On the cut surface, the tumor had a whirled white appearance, with focal brown areas. The microscopic examination revealed the presence of a spindle cell tumor, forming fascicles orientated at right angles. The study revealed the morphological aspect characteristic to leiomyosarcoma.     

Asymptomatic congenital oesophageal cyst infiltrating the lung: an unusual complication.

An asymptomatic 14-year-old boy presented with minor chest trauma. Chest X-ray showed opacity in the upper zone of the left lung. Further investigations with magnetic resonance imaging showed it to be a posterior mediastinal mass with a fistula to the lung, along with cystic changes in the left upper lobe of lung. Left upper lobectomy with excision of the mass was performed. Histological examination later showed an oesophageal duplication cyst with a fistula to the left upper lobe of the lung. We present this unusual complication of an oesophageal cyst infiltrating the lung in an asymptomatic child.     

Adrenal incidentaloma.

Adrenal incidentalomas are tumors that are serendipitously found by radiological examination. The incidence of adrenal incidentalomas in patients undergoing abdominal CT approaches 1 %. The evaluation of a patient with an adrenal incidentaloma requires, in addition to a clinical history and physical examination, a focused biochemical evaluation to investigate if there is excess secretion of catecholamines, glucocorticoids, or aldosterone. Some tumors have specific features on imaging that identify them as benign or malignant. The recommendations for management of adrenal incidentalomas include resection of all functioning tumors regardless of size, preferably by the laparoscopic approach. Large, non-functional tumors should also be removed. Biochemical and radiological surveillance is recommended for at least one year, if a tumor is left in place.     

Stereotactic radiosurgery for cavernous sinus cavernous hemangioma--case report.

A 40-year-old female presented with cavernous sinus cavernous hemangioma manifesting as left abducens and trigeminal nerve pareses. Magnetic resonance imaging revealed a left cavernous sinus tumor. The tumor was partially removed. Histological examination of the specimen confirmed cavernous hemangioma. Radiosurgery was performed using the gamma knife. The tumor markedly decreased in size after radiosurgery and morbidity was avoided. Cavernous sinus cavernous hemangiomas may be difficult to treat surgically due to intraoperative bleeding and cranial nerve injury. Stereotactic radiosurgery can be used either as an adjunct treatment to craniotomy, or as the primary treatment for small cavernous sinus cavernous hemangioma.     

Metastatic brainstem tumor manifesting as hearing disturbance--case report.

A 53-year-old male, who had undergone a left upper lung lobectomy for cancer 2 years previously, presented with metastatic brainstem tumor manifesting as hearing disturbance. At first an otorhinolaryngologist treated him for senile sensorineural hearing disturbance. However, he suffered gait ataxia and was referred to our department. On admission, neurological examination found mild cerebellar ataxia on the left and gait unsteadiness. Neurootological analysis revealed central-type sensorineural hearing disturbance on the left both in the pure tone audiogram and speech discrimination test. Neuroimaging studies revealed a ring-like enhanced mass centered in the ventral left middle cerebellar peduncle, partly extending to the inferior cerebellar peduncle. Peritumoral edema extending to the ipsilateral cochlear nucleus was recognized. He underwent surgery via a left lateral suboccipital transcondylar approach. The histological diagnosis was adenocarcinoma identical with the primary lung cancer. Intra-axial brainstem metastatic lesion can be a cause of hearing disturbance, so should be included in the differential diagnosis for a patient complaining of hearing disturbance, especially with a past history of cancer.     

Cardiac myxoma metastasizing to the brain. Case report

A 55-year-old man, who had previously had a left atrial myxoma excised, developed recurrent hematomas of the left occipital lobe. Microscopic examination revealed the presence of metastatic myxoma.     

Congenital aneurysm of the sinus of Valsalva protruding into the left ventricle. Review of diagnosis and treatment of the unruptured aneurysm.

During a routine physical examination, a 34-year-old man, in apparent good health, had an electrocardiogram which revealed left axis deviation. Cardiac evaluation disclosed mild aortic regurgitation and left anterior fascicular block. Nine months later, the patient was admitted to the critical care unit after he had experienced cardiac arrest while jogging. Angiograms demonstrated a large unruptured aneurysm in the right coronary sinus of Valsalva protuding into the left ventricle. Echocardiographic manifestations also suggested also suggested a sinus of Valsalva aneurysm. The defect was repaired through an aortic approach. The aneurysmal sac was emptied and the neck sutured securely. Twenty-two months postoperatively, the patient continues to be asymptomatic. We anticipate that this will decrease the threat of recurrent arrhythmias..     

Concurrent cysts of the mediastinum, pleura and neck.

A 14-year-old male was found to have a mediastinal mass on chest radiograph. Chest computed tomography scans showed a cystic lesion behind the left main bronchus. Magnetic resonance imaging revealed additional cystic lesions in the left chest and root of the neck. He underwent excision of mediastinal mass and a pleural cyst. The neck lesion was presumed to be a cystic hygroma. Histological examination of the two lesions resected showed them to be a foregut cyst and a benign mesothelial cyst. We know of no other report of concurrent multicystic lesions in the chest and neck and hypothesize that these cysts may have a common embryonic origin.     

Subependymal giant-cell astrocytoma. Case report with ultrastructural study.

A 13-year-old boy presented with an obstructive left lateral intraventricular mass. Pathological examination revealed a subependymal giant-cell astrocytoma. Further clinical investigation confirmed the diagnosis of tuberous sclerosis. Ultrastructural examination confirmed previously reported features of this tumor. Tumor cells containing large dense granulated bodies and dense-core vesicles, not previously described in this tumor, were identified.     

Paraganglioma of the latero-sellar area. Case report

Paraganglioma of the sellar and latero-sellar area is extremely rare. We report a case of latero-sellar and suprasellar paraganglioma of a 58-year-old women which caused deterioration of visual acuity and left exophthalmia without endocrine dysfunction. Magnetic resonance imaging showed a large tumor in the sellar and parasellar area, which extended to the left cavernous sinus and infiltrated the left orbit, the ethmoid, the sphenoidal sinus and the left pterygomaxillary fossa. Surgery by transcranial, left frontotemporal approach, enabled subtotal removal. Definitive histologic examination revealed a paraganglioma with signs of anaplasis. We report our clinical findings and present a review of literature.     

Involvement of the inferior caval vein in adrenal metastasis.

A patient was referred to our hospital for resection of a large renal cell carcinoma with invasion of the inferior caval vein, diagnosed as such with CT, angiography and cavography. The history mentioned partial resection of the left lung for lung carcinoma 16 months before. At operation the tumor could not be removed, the patient died because of postoperative pulmonary complications. Autopsy and histopathological examination revealed a large metastatic tumor of the previous lung carcinoma in the left adrenal gland. The clinical implications and some diagnostic methods are discussed.