Case of renal myxoma

Renal myxomas are rare neoplasms. Only three cases have been convincingly diagnosed as renal myxoma. Here we report an additional case. The case was a 36-year-old man and he was discovered incidentally at the regular health-check for chronic hepatitis B. Computed tomography showed 8 cm low-density tumor in the lower pole of the left kidney. The tumor was slightly enhanced by contrast agents. Magnetic resonance imaging revealed the tumor as low intensity on T(1)-weighted imaging and high intensity on T(2)-weighted images. The tumor was enhanced by gadrinium enhancement homogeneously. The resected kidney contained semitranslucent, gelatinous, tan mass within the lower pole of the kidney. The microscopic examination showed the typical appearance of a myxoma, which consisted of large amounts of myxoid material containing a few uniformly scattered spindle cells The tumor cells showed immunoreactivity for vimentin but not for S-100 protein, epithelial membrane antigen, cytokeratin, alpha smooth muscle actin.     

Myxoma of the kidney

A 62-year-old man had a right renal mass incidentally diagnosed by ultrasonography. Magnetic resonance imaging revealed a well-defined right renal mass with homogenous low-signal intensity on the T(1)-weighted pulse sequence and heterogeneous high-signal intensity on the T(2)-weighted pulse sequence. A right nephrectomy was performed. The histological examination showed a myxoma, which is a very uncommon neoplasm in the kidney. Eight cases have been reported previously.     

Renal hemangiopericytoma discovered at a health screening: a case report

We report a case of renal hemangiopericytoma which was incidentally discovered by ultrasonography at a health screening. A 58-year-old man was admitted to our hospital for close examination of the renal tumor. Computed tomography revealed the left renal tumor, 60 x 50 mm in size, which was well enhanced with contrast medium. Magnetic resonance imaging revealed an isointensity mass (T1-weighted) and high-intensity mass (T2-weighted) at the left kidney. Radical nephrectomy was performed on suspicion of left renal cell carcinoma. Histopathological examination revealed renal hemangiopericytoma. The present case is the 7th in the Japanese literature.     

Cranial fasciitis of childhood: a case report.

Cranial fasciitis of childhood is very rare, only 17 cases having been reported in the literature. We report an additional case of this rare disease. The patient was a 5-year-old boy who complained of left exophthalmos and double vision. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large epidural mass in the left frontal region that had invaded into the underlying anterior skull base. The tumor showed homogeneous, low density with nonhomogeneous contrast enhancement on the CT scans, and low intensity on the T1-weighted and high intensity on the T2-weighted MRI images. A whitish-pink, elastic, hard tumor was revealed in the epidural space in the left anterior cranial fossa, which was totally excised with curettage of the affected anterior skull base. The origin of the tumor was suspected to be the fibrous connective tissue of the sphenofrontal suture. The histological diagnosis was that of cranial fasciitis. There was no evidence of recurrence 1 year postoperatively.     

Large, benign osteoblastoma of the temporal bone--case report

Benign osteoblastoma is a rare tumor of bone, usually confined to the long bones and vertebrae. Its occurrence in the calvaria is extremely rare. The authors report a case of a temporoparietal lesion in a 29-year-old male. Computed tomography revealed a low-density mass, which was irregularly enhanced by contrast medium. Magnetic resonance imaging demonstrated a mass of low intensity on T1- and high intensity on T2-weighted images. Angiography confirmed the presence of a large epidural mass in the left temporal region. The tumor was excised and the pathological diagnosis was benign osteoblastoma.     

Giant cell reparative granuloma of the temporal bone: neuroradiological and immunohistochemical findings

A 38-year-old man presented with a giant cell reparative granuloma (GCRG) of the left temporal bone. Computed tomography showed a osteolytic middle cranial mass lesion. Magnetic resonance (MR) imaging showed the lesion as low intensity with heterogeneous enhancement by gadolinium on the T1-weighted images, and extremely low intensity on the T2-weighted images. Angiography showed the lesion as highly vascular and fed by branches of the left external carotid artery. After preoperative embolization, gross total removal of the tumor was performed. The postoperative course was uneventful and no evidence of recurrence has been found for more than 4 years. Histological examination revealed GCRG with multinucleated giant cells in the fibrous background, abundant collagen bundles, hemosiderin deposits, and trabeculae of reactive bone. Some of the mononuclear stromal cells and almost all of the giant cells were positive for CD68, suggesting histiocytic differentiation. These histological features reflect the marked decrease in signal intensity on T2-weighted MR images.     

Unilateral renal cystic disease in an adult

We report a case of unilateral renal cystic disease in a 68-year-old man. He had no family history of renal cystic disease, and his serum creatinine level was 1.2 mg/dL. The computed tomographic scan revealed near-complete replacement of the right kidney by numerous cysts and almost no residual parenchyma. The left kidney was normal, and there were no hepatic or pancreatic cysts. Magnetic resonance imaging showed numerous cysts in the right kidney and a normal left kidney. The cysts showed homogeneously low intensity on T1-weighted images and homogeneously high intensity on T2-weighted images. The disease in our patient was compatible with unilateral renal cystic disease as defined by Levine and Huntrakoon, and was distinct from autosomal dominant polycystic disease and other unilateral cystic diseases of the kidney. Our literature survey revealed no report of unilateral renal cystic disease in Japan.     

Retroperitoneal ganglioneuroma: a case report

A primary retroperitoneal ganglioneuroma was found incidentally in a 44-year-old man. Computed tomography revealed a homogeneous mass just above the right kidney. T1-weighted magnetic resonance imaging demonstrated the homogeneous mass, but T2-weighted imaging revealed a heterogeneous mass with a markedly high intensity area. The tumor was resected through a transabdominal approach. The resected specimen measured 11 x 9 x 4.5 cm and weighted 270 g. Histological examination showed that the lesion was a ganglioneuroma composed of mature ganglion cells and nerve fibers.     

A case of foreign-body granuloma

A 24-year-old male patient was admitted to our Ryukyu University Hospital, complaining of visual disturbance. He had had partial removal of a suprasellar region tumor in another hospital one year before the admission. Microscopical findings had shown two cell patterns of germinoma in the first operation. Following it, the patient received irradiation with a total dose of 54Gy. The tumor completely disappeared after these procedures. On this admission, plain CT scan revealed an isodensity mass in the suprasellar cistern extending to the right side of the third ventricle, which was enhanced homogeneously. In MRI, the mass showed low intensity in the T1-weighted inversion recovery sequence, and heterogeneously, high intensity in the T2-weighted spin echo sequence. By bifrontal craniotomy, the tumor was removed. Histologically, it consisted of granuloma containing fine cotton fibers. MRI findings of intracranial foreign-body granuloma were discussed.     

Neurosyphilis manifesting as a focal mass lesion: computed tomographic and magnetic resonance imaging features--case report.

The computed tomographic (CT) and magnetic resonance (MR) imaging findings in a middle-aged male with cerebral syphilis are described. He presented with convulsive seizures and focal neurological deficits. A CT scan revealed a slightly enhanced, low-density mass in the left parieto-occipital region. MR imaging showed low intensity on T1-weighted images and high intensity on T2-weighted images. He was initially diagnosed as having a low-grade glioma. However, intraoperative histological examination of a small surgical specimen revealed no tumor cells but heavy infiltration of inflammatory cells in the meninges and cerebral parenchyma. Immunostaining for Treponema organisms by the peroxidase-antiperoxidase method was positive. Although the clinical and radiological findings are nonspecific, neurosyphilis should be considered in any patient in whom a nonspecific mass lesion is demonstrated by CT and MR imaging.     

Metastatic carcinoma of the adrenal gland from large cell neuroendocrine carcinoma; report of a case

A 69-year-old man had undertaken left upper lobectomy (ND 2 a) with partial resection of the left lower lobe under the diagnosis of a primary lung cancer, T2N0M0, stage IB in June, 2002. The histopathological diagnosis was large cell neuroendocrine carcinoma (LCNEC), T3N0M0, stage IIB. The patient was discharged on postoperative day 25. Abdominal computed tomography (CT) revealed an enhanced tumor in the left adrenal lesion, 3 cm in diameter, in October, 2003. Magnetic resonance imaging (MRI) showed a slightly low intensity mass on T1-weighted imaging and slightly high intensity on T2-weighted imaging without invasion to other organs. Tumor marker, NSE was slightly elevated on blood examination. Left adrenalectomy was performed with a surgical margin. Histopathologically, the tumor was diagnosed as metastasis of LCNEC. There is no evidence of recurrence for a year after surgery. Although a prognosis of LCNEC is poor in general, we should consider the resection of metastatic carcinoma of the adrenal gland from LCNEC for long-term survival expectantly.     

A multicentric glioma presenting different pathological appearances: a case report

We report a multicentric glioma case which revealed different pathological appearances. A 45-year-old male had been admitted to our hospital complaining of an attack of transient sudden aphasia. On magnetic resonance imaging (MRI), T1-weighted images revealed a low intensity and T2-weighted images demonstrated a homogeneous high intensity abnormal mass in the frontal lobe, which was not enhanced with gadolinium. Removal of the tumor was performed through a right frontal transcortical approach in March, 2002. Histological diagnosis was gemistocytic astrocytoma. The patient's condition was uneventful and postoperative MRI revealed a marked decrease in the volume of the tumor. A total of 54 Gy radiation to the brain in the locality was performed. Four months after the initial surgery, the patient suffered from incomplete right hemiparesis. MRI showed a left parietal abnormal mass which had a ring formation enhancement after gadolinium administration. This Neuro-radiological examination demonstrated complete independence from the initial right frontal tumor. A second surgery which was concerned with cyst aspiration was carried out on August 10, 2002. During the next month, a third operation for partial removal of a left parietal abnormal mass was performed. Histological diagnosis was anaplastic astrocytoma. The right frontal and left parietal tumors revealed neither continuous relation suggesting intracerebral invasion, nor dissemination through the subarachnoid space nor intracerebral metastasis. Our case was diagnosed as multicentric glioma with different pathological appearances, of which only 9 cases have been reported previously.     

A case of schwannoma in the renal hilum

A 58-year-old female presented with a well-encapsulated tumor in the left renal hilum on computed tomography (CT). On magnetic resonance imaging (MRI), the tumor showed low intensity on the T1-weighted image, high intensity on the T2-weighted image. Laparoscopic radical nephrectomy was performed because we could not exclude the possibility of malignancy such as renal cell carcinoma. Histopathological examination revealed that the tumor was a benign Schwannoma. Although renal hilum is a common site of renal schwannoma, it is difficult to differentiate benign tumors from malignant ones, and then nephrectomy is usually performed.     

A case of retroperitoneal schwannoma: diagnostic usefulness of magnetic resonance imaging

A 36-year-old man visited our hospital with a chief complaint of difficult urination. He was admitted for further examination because ultrasonography showed a heterogeneous solid mass in the lower abdomen. Intravenous urography showed the right ureter and bladder to be pushed leftward without hydronephrosis. Computerized tomography showed a giant solid mass in the retrovesical space. Magnetic resonance imaging revealed a round, well-encapsulated tumor, showing low intensity on the T1-weighted image, heterogeneously high intensity on the T2-weighted image and irregular enhancement with Gd-DTPA. Histopathology of the extirpated tumor was benign schwannoma.     

Solitary fibrous tumor of the meninges in the posterior cranial fossa: magnetic resonance imaging and histological correlation--case report

A 58-year-old female presented with a rare case of intracranial solitary fibrous tumor (SFT) manifesting as progressive ataxic gait and hearing loss on the left persisting for 6 months with recent symptoms of increased intracranial pressure. Computed tomography demonstrated a large isodense irregular-shaped mass in the left posterior cranial fossa. T2-weighted magnetic resonance imaging showed two components appearing as very low intensity and high intensity. Extreme-lateral suboccipital craniotomy was performed. Gross total resection was achieved except for some dural attachment in the jugular foramen. All symptoms and signs subsided after surgery. Histological, immunohistochemical, and electron microscopic examinations led to a diagnosis of SFT. The strongly hypointense areas on the T2-weighted images were hypocellular region characterized by disorganized spindle cells and thick bands of collagen. The hyperintense areas on the T2-weighted images were hypercellular region mimicking hemangiopericytoma. Strong immunoreactivity for CD34 was also helpful in the diagnosis. Electron microscopy revealed absence of pinocytic vesicles and dense laminae which are characteristic of hemangiopericytoma. The magnetic resonance imaging appearance of SFT seems to be pathognomonic.     

Intrahepatic cholangiocarcinoma with extensive sarcomatous change: Report of a case

A 77-year-old woman was admitted to our hospital with severe upper abdominal pain. Ultrasonography showed a well-defined hypoechoic mass with heterogeneity in the left lobe of the liver, and computed tomography demonstrated a low-density mass with enhanced peripheral areas. Magnetic resonance imaging revealed a mass with iso- to low signal intensity on T1-weighted images (WI) and heterogeneous high and low signal intensity on T2 WI. The tumor was found to be hypovascular by angiography. During 5 months of observation, the tumor increased in size, which strongly suggested malignancy. A laparotomy was performed under the provisional diagnosis of a neoplasm other than hepatocellular carcinoma, revealing that the hepatic mass had invaded the gastric wall. Therefore, a left hepatic lobectomy with dissection of the lymph nodes and hemigastrectomy was carried out. Histologically, the tumor was found to be composed of a large amount of sarcomatous elements and a small amount of adenocarcinomatous elements, both of which were partly intermingled. Immunohistochemically, the sarcomatous element demonstrated the features of malignant fibrous histiocytoma (MFH). Thus, a diagnosis of intrahepatic cholangiocarcinoma with MFH-like sarcomatous change was confirmed.     

Experience of thoracoscopic extirpation of intrapulmonary lymphangioma

We report a 59-year-old woman who underwent thoracoscopic extirpation of the intrapulmonary cystic lymphangioma which was located in the subpleural space of the left upper lobe. A chest X-ray showed a solitary round nodule in the left pulmonary hilum. A computed tomography scan revealed a mass shadow at the interlobar region surrounding the interlobar pulmonary artery. A round nodule was recognized as low signal intensity on T1-weighted images by magnetic resonance imaging. There was biphasic signal intensity on T2-weighted images as well. Radiologically, we diagnosed this lesion as a benign cystic tumor in the lung. Thoracoscopic observation revealed a cystic lesion just beneath the visceral pleura of the upper lobe adjacent to the interlobular pulmonary artery. As this suggested a benign bronchogenic cyst, we performed extirpation of the cyst under thoracoscopy. After this operation, the cyst was diagnosed as an intrapulmonary cystic lymphangioma pathologically.     

Central neurocytoma: report of a case

Central neurocytoma is a rare intraventricular tumor recently accepted as a clinicopathological entity. A 21-year-old female was admitted with three-year history of episodic headaches and vomiting, and with rapid deterioration of her left vision over two weeks prior to admission. Computed tomography (CT) scan revealed a marked hydrocephalus and an isodense, mildly enhancing mass in the left lateral ventricle. On magnetic resonance imaging (MRI) scan, T1-weighted images revealed an intraventricular mass of slightly high intensity signal, which contained areas of low intensity signal representing multiple intratumoral cysts. The tumor showed a minimal enhancement with Gd-DTPA. A diagnosis of central neurocytoma was confirmed by an electron-microscopic study of a surgical specimen; there were numerous neuronal cell processes containing microtubules and dense-core vesicles, and a few small intercellular junctions were also identified.     

Primary rhabdomyosarcoma associated with tumoral hemorrhage--case report

A 42-year-old female presented with right hemiparesis. Computed tomography (CT) demonstrated a slightly heterogeneous high density mass over the left frontal convexity with peritumoral edema, with homogeneous enhancement by contrast material. Magnetic resonance imaging showed the left frontal convexity tumor as a heterogeneous low intensity area on the T1-weighted image and a heterogeneous high intensity area on the T2-weighted image, with homogeneous enhancement and dural tail sign after intravenous administration of gadolinium-diethylenetriaminepenta-acetic acid. After admission, the patient suddenly lost consciousness. CT demonstrated aggressive increase in the bulk of the tumor and large peritumoral hemorrhage. The tumor was totally removed. The histological diagnosis was rhabdomyosarcoma. Combined immunohistochemistry and electron microscopy techniques should be used to differentiate rhabdomyosarcoma from malignant meningioma.     

A case of retroperitoneal ancient schwannoma in the pelvis

We treated a case of retroperitoneal ancient schwannoma in the pelvis detected incidentally at a health examination without clinical manifestation in a 59-year-old Japanese man found to have hypertension. Computed tomography showed a heterogeneously enhanced 8 x 7 cm solid mass in the pelvic retroperitoneal space. Magnetic resonance imaging revealed an encapsulated tumor, showing a low intensity on the T1-weighted image, heterogeneously high intensity on the T2-weighted image and the tumor homogeneously enhanced with Gd-DTPA. It was suspected to be a mesenchymal tumor. The tumor was resected en bloc. The histologic examination of the extirpated tumor was an ancient schwannoma. A total of 11 retroperitoneal ancient schwannoma cases were reviewed.