Giant plexiform neurofibroma and suboccipital meningocele manifesting as segmental neurofibromatosis

A 34-year-old woman presented with segmental neurofibromatosis manifesting as a soft lump with a large café-au-lait macule on her occipital region and neck. Magnetic resonance imaging showed a thick skin tumor in the occipital region and posterior neck, and a suboccipital meningocele which seemed to have no association with her symptoms. Biopsy lead to a histological diagnosis of giant plexiform neurofibroma. During biopsy, massive local bleeding occurred and hemostasis was achieved by electrocautery and meticulous suture ligation. The postoperative course was uneventful and observation was continued for both the giant plexiform neurofibroma and the meningocele.     

Videoscopic resection of a giant symptomatic pericardial cyst: case report

A 47-year-old woman presented with shortness of breath, chest discomfort, and hoarseness. She was found to have an enlarged cardiac silhouette on plain chest radiography. Computed tomographic scan and magnetic resonance imaging were diagnostic of a giant pericardial cyst. The patient underwent successful videoscopic removal of the cyst with complete resolution of her symptoms.     

Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow

A 43-year-old woman presented with symptomatic mesenteric ischemia caused by median arcuate ligament compression of her celiac artery. Magnetic resonance angiography clearly demonstrated stenosis of the proximal celiac artery. She underwent laparoscopic decompression by division of the ligament and excision of the celiac plexus. Laparoscopic Doppler ultrasound scanning demonstrated markedly improved flow in the artery. She was discharged in 15 hours and reported complete resolution of her symptoms at the 3-month postoperative visit. Laparoscopy provides a less invasive but equally effective method for decompressing the celiac artery as well as assessing adequacy of flow after its release.     

Rectal erosion of synthetic mesh used in posterior colporrhaphy requiring surgical removal

Treatment of pelvic organ prolapse with transvaginally placed synthetic mesh has recently increased. Several reports of complications have surfaced raising the overall question of safety regarding its use for vaginal prolapse repair. This case report describes a rectal erosion and dyspareunia that resulted from mesh placed into the posterior vaginal wall. A 47-year-old woman underwent a laparoscopic supracervical hysterectomy and a posterior repair with polypropylene mesh resulting in a rectal erosion. Despite removal of all of the mesh that could be excised rectally resulting in a healed rectal mucosa, the patient had persistent dyspareunia and pain requiring complete removal of the mesh using a vaginal approach. After surgery, the patient had resolution of all her symptoms. Further studies of transvaginally placed synthetic mesh need to be performed to determine its safety and efficacy.     

Presacral tumor associated with the Currarino triad in an adolescent

A 17-year-old woman presented with pain over the sacral region. Plain radiographs of the sacrum demonstrated a bony deformity of the sacrococcygeal region in the shape of a scimitar. Magnetic resonance imaging showed a cystic mass of the presacral region which appeared to be continuous with the dural sac. An anteroposterior view myelogram revealed caudal elongation of the dural sac, and on the lateral view it was recognized as an anterior meningocele. At surgery, we confirmed a connection between the presacral mass and the rectum. In light of the combination of a sacral bony deformity, presacral mass including meningocele, and mass-rectum connection, we made the diagnosis of the Currarino triad, which is a rare complex of congenital caudal anomalies. The patient underwent excision of the presacral mass. Histologic examination of the resected specimen revealed features of an epidermoid cyst. Received: 4 August 1999     

Urethral prolapse in premenopausal, healthy adult woman

Urethral prolapse is an uncommon clinical condition that is reported predominantly in children and postmenopausal women. We describe a case of a 39-year-old woman who presented at the emergency room with vaginal bleeding and pain related to Valsalva maneuver (lifting weight). She described several similar previous episodes, which started during her second pregnancy at 32 years of age. The episodes initially occurred every 6 months, but she did not seek medical assistance for 7 years, during which time symptoms became more frequent. She had no previous history of irradiation, pelvic infection, or urogenital surgery. During physical examination, a urethral prolapse was identified. Pelvic and urinary ultrasound (US) showed no other abnormality. The patient underwent cystourethroscopy and surgical excision of the urethral prolapse, with complete resolution of symptoms. Histopathology confirmed benign inflammatory urethral mucosa tissue with edema and vascular congestion.     

Surgical resection of melorheostosis in the ribs

Melorheostosis is a rare nongenetic developmental anomaly of the cortical bone. We present a 40-year-old woman who was diagnosed with melorheostosis affecting the ribs only. Chronic pain and cosmetic deformity were her presenting symptoms. She underwent posterolateral thoracotomy and excision of the affected ribs, with a satisfactory outcome of this uncommon presentation.     

Gamma knife radiosurgery for temporal bone chondroblastoma: case report

A case with chondroblastoma arising from the right temporal bone was reported. A 52-year-old woman demonstrated residual tumor growth after surgical excision. The patient presented continuous right temporalgia and right facial twitch while opening her mouth. The tumor was an expansile mass (tumor volume: 12.8 cm3) and showed homogeneous hypo-intensity on T1 and T2-weighted images, but little contrast enhancement. The patient underwent gamma knife radiosurgery (GKR: marginal dose: 12 Gy, maximum dose: 24 Gy). One month later, her symptoms improved completely. The size of the tumor was reduced to 6.4 cm3 twenty months after GKR. The patient has been free of recurrence and side effects for four years since GKR. GKR may be useful to control residual chondroblastoma of the skull after surgery.     

Recurrent Hypertrophic Peroneal Tubercle Associated With Peroneus Brevis Tendon Tear

Stenosing peroneal tenosynovitis resulting from hypertrophy of the peroneal tubercle has been well described. Successful surgical treatment addresses the hypertrophied peroneal tubercle as well as any intrinsic tendon pathology. We report a case of recurrent foot pain caused by stenosing peroneal tenosynovitis in a 16-year-old woman. Four months after excision of a hypertrophic peroneal tubercle, the patient developed a recurrence of symptoms. Imaging studies, repeat operative exploration, and pathologic specimen demonstrated a recurrence of the peroneal tubercle hypertrophy associated with a longitudinal tear of the peroneus brevis tendon. Re-resection of the hypertrophied tubercle and peroneal tendon repair resulted in a resolution of symptoms.     

Platelet-rich plasma for calcific tendinitis of the shoulder: a case report

We report a 44-year-old woman with calcific tendinitis of the shoulder treated with platelet-rich plasma injection. Prior to this, she had no improvement of the symptoms after 6 weeks of ultrasound treatment, Codman exercises, and anti-inflammatory treatment. Platelet-rich plasma was injected into the subacromial area 3 times at 2-week intervals. She had progressive improvement of pain after 2 weeks, and was asymptomatic at week 6. The patient then underwent the previous protocol of rehabilitation. At the one-year follow-up, the patient was pain-free and had complete resolution of calcific tendinitis. The patient had regained full range of movement and had resumed all her activities.     

Suboccipital meningocele presenting as a huge retropharyngeal mass in a patient with neurofibromatosis Type 1. Case report.

The authors report an extremely rare case of neurofibromatosis Type 1 (NF1) with a suboccipital meningocele presenting as a huge retropharyngeal mass. A 73-year-old woman with typical cutaneous manifestations of NF1 presented with nasal obstruction and dysphagia due to a retropharyngeal mass. Magnetic resonance imaging revealed a huge mass lesion extending from the right occipital bone defect to the retropharynx through the right paravertebral region. Computerized tomography scanning after intrathecal administration of contrast material confirmed that the mass was a meningocele protruding through a right occipital bone defect. The authors attempted to ligate this meningocele, most of which was excised via a suboccipital approach, but a second transcervical operation was required. Finally, the meningocele resolved and the patient was discharged without symptoms.     

Surgery for multiple lung metastases from alveolar soft-part sarcoma

Between 1985 and 1993, six patients were surgically treated for alveolar soft-part sarcoma (ASPS) arising from the thighs or buttocks, four of whom underwent aggressive excision of multiple metastases using a neodymium: yttriumaluminum garnet (Nd: YAG) laser. In total, 33 tumors were removed from these four patients during eight pulmonary operations. In patients, 1, 3, and 4, uncontrollable extrapulmonary involvement and/or local recurrence at the primary site were noted during their treatment course, and they died of tumor progression 40, 68, and 46 months after excision of the primary lesion, respectively. In patient 1, a 37-year-old woman, prolonged survival with adequate lung function was achieved after the excision of metastases, including one bulky metastatic tumor located adjacent to the mediastinum, which might have led to a lethal complication. Patient 3, a 25-year-old woman who underwent aggressive metastasectomies for both pulmonary and extrapulmonary metastases combined with intermittent chemotherapy, died of widespread metastases to multiple organs. On the other hand, patient 2, a 23-year-old woman who underwent excision of 130 pulmonary and three brain metastases during four thoracotomies and two craniotomies, is still alive without any symptoms 98 months after excision of the primary lesion. These data suggest that repeated excisions of lung metastases from ASPS may influence long-term survival or maintenance of good performance status in patients in whom extrapulmonary metastasis and recurrence are either absent or controlled.     

Posterior fossa surgery complicated by a pseudomeningocele, bilateral subdural hygromata and cerebellar cognitive affective syndrome

We report the case of a 51-year-old woman who underwent excision of a left postero-inferior, para-vermian cerebellar hemangioblastoma and foramen magnum decompression for an associated acquired Chiari I malformation. Two weeks postoperatively she developed a pseudomeningocele, bilateral supra- and infratentorial subdural hygromata, and a clinical disorder compatible with the cerebellar cognitive affective syndrome. There was no response to drainage of the left supratentorial collection. CSF aspiration from a pseudomeningocele lead to resolution of her syndrome and the subdural effusions. The relationships between the subdural hygromas, pseudomeningocele, location of the lesion within the cerebellum, cerebellar oedema, and the cause of her cognitive-affective syndrome are discussed.     

Remarkable epidural scar formation compressing the cervical cord after osteoplastic laminoplasty with hydroxyapatite spacer

The authors report on an 81-year-old woman whose condition deteriorated 2 months after undergoing osteoplastic laminoplasty with placement of hydroxyapatite spacers. Magnetic resonance imaging showed postlaminectomy scar formation compressing the cervical spinal cord. The patient underwent laminectomy and removal of remarkably thick epidural scar tissue, which resulted in resolution of her symptoms. Histological diagnosis of the scar was fibrous granulation tissue with foreign body granuloma, characterized by multinucleated giant cells and marked increases of capillary vessels, fibroblasts, and collagen fibers. This case of symptomatic postlaminectomy scar formation after osteoplastic laminoplasty suggests that osteoplastic laminoplasty cannot always prevent laminectomy membrane formation.     

Surgical management of a dermal lymphatic malformation of the lower extremity

Dermal lymphatic malformations are rare congenital hamartomas of superficial lymphatics characterized by high recurrence rates after excision. The standard therapy for a single lesion is surgical excision with wide margins, which reduces recurrence but can have a potentially unacceptable aesthetic outcome. A case of a 24-year-old woman with a 6 cm × 5 cm dermal lymphatic malformation on her right thigh, diagnosed by clinical history, physical examination, magnetic resonance imaging and pathological findings, is reported. The patient underwent wide local excision with split-thickness skin grafting. After pathological examination revealed negative margins, the patient underwent tissue expander placement and excision of the skin graft with primary closure. The lesion did not recur, and the patient achieved a satisfactory aesthetic result. The present case represents the first report of the use of tissue expanders to treat dermal lymphatic malformations in the lower extremity and demonstrates a safe, staged approach to successful treatment.     

Osteochondroma of distal femur as an unusual cause of locked knee

We present a case of an unusual cause of locked knee. A 45-year-old woman was admitted via the accident and emergency department with her right knee locked in 30° of flexion. There was no history of trauma. X-rays revealed an osteochondroma of her distal femur. She underwent surgical excision of the lesion. The quadriceps muscle was found to be hooked around it. The patient recovered full range of knee movements after the surgery. This complication of osteochondroma of distal femur has not been mentioned in the literature.     

Rodent under the hat

This report describes a case of neglected scalp basal cell carcinoma (BCC) resulting in total destruction of soft tissue and underlying cranium, with remarkably preserved dura and no parenchymal involvement. A 57-year-old woman presented with a 2-week history of lethargy. On removal of her hat, a large round ulcer was revealed. It transpired that the patient noticed a pruritic scalp lesion 9 months ago. As the lesion and wound enlarged, she was too embarrassed to inform her family and hid it under a hat at all time. She never experienced meningitic symptoms. Biopsy confirmed BCC. Subsequently, she underwent two free latissimus dorsi flap reconstructions to cover the wound and palliative radiotherapy. She responded well to treatment. This case provides a rare opportunity to observe the natural history of scalp BCC. The reasons for the rarity of this mode of presentation and the low incidence of intracranial infection are discussed.     

Madura foot: treatment of Nocardia nova infection with antibiotics alone.

This case report documents the presentation of a 29-year-old woman with a deep Nocardia nova infection of the foot involving the bones. The patient responded well to prolonged antibiotic therapy, with essentially complete resolution of her symptoms. The results suggest that surgical intervention in these unusual cases may be unnecessary and that good clinical results can be obtained pharmacologically.     

Esophageal stent erosion into the common carotid artery

A pseudoaneurysm of the common carotid artery was found with computed tomography in a 62-year-old woman with an esophageal stent that had eroded through her skin. The pseudoaneurysm was treated with a self-expanding nitinol stent; after massive hemoptysis, an endograft was placed on the pseudoaneurysm. The patient then underwent ligation of the left common carotid artery, proximal to the carotid bulb, and excision of the endograft and previously placed coils. The esophageal stent wires were so that they could no longer impinge the common carotid artery.