Pediatric giant cell glioblastoma: a case report and review of the literature

Introduction Giant cell glioblastoma is a subtype of glioblastoma multiforme (GM) whose most characteristic histology is the presence of plentiful multinucleated giant cells. These tumours are very rare and account for only 5% of GM. They do not have specific localization, although normally they are supratentorial and affect mostly the temporal lobe. They may occur at any age, but mostly they occur in younger people than GM. They are infrequent in childhood, but they have longer survival in paediatric age.Case report We present an 11-year-old girl that was operated but whose tumour recurred in a month after apparent total removal.Discussion We review in the literature the clinical, histological, immuno-histochemical and genetic characteristics, as well the prognosis of this tumour.     

Large cystic fibrous dysplasia of the temporal bone: case report and review of literature.

Fibrous dysplasia is an uncommon benign disorder of unknown aetiology. It most likely represents a disorder of normal bone development. As it may occasionally involve the temporal bone, and encroach on the middle cranial fossa, it is of interest to the neurosurgeon. Fibrous dysplasia of the cystic variety is very uncommon. We report a case of a large cystic fibrous dysplasia involving predominantly the squamous temporal bone. The radiology and histology are discussed, and its differentiation from other lesions.     

Pediatric quetiapine overdose: a case report and literature review

Quetiapine is a medication approved for the treatment of psychotic disorders in adults. At this time it is not approved for the treatment of children or adolescents. It is an atypical antipsychotic agent that is efficacious in treating both the positive and negative symptoms of schizophrenia. There is currently little information available concerning the safety of quetiapine in overdose, and there are no previous case reports of quetiapine overdose in the pediatric population. We present the case of a 15-year-old girl who ingested 1250 mg of quetiapine (21.6 mg/kg) in a suicide attempt. She developed multiple symptoms including tachycardia, agitation, hypotension, and unconsciousness. We compare her symptoms to previous adult cases of quetiapine overdose and review overdose treatment recommendations. We also examine clinical situations that may lead to a more severe clinical course.     

A thoracic spinal bone giant cell tumor in a skeletally immature girl. A case report and literature review

Purpose

Giant cell tumors (GCT) are benign primary bone tumors, locally aggressive, affecting in long bones in young adults during the third decade. It is rare to experience this lesion in skeletally immature patients. GCT are related to a risk of local recurrence and malignant transformation.

Method

We report a rare case of a giant cell tumor of the thoracic spine in a skeletally immature girl presenting with a painful right scoliosis.

Results

MRI, CT scan, and bone scintigraphy were discordant and the percutaneous biopsy non-contributive.

Conclusion

A marginal “en bloc” resection was performed and revealed the GCT. Based on a literature review, the diagnosis and the surgical management of this case are discussed.

     

Giant cell reparative granuloma of the pediatric cranium: case report and review of the literature

Purpose

Giant cell reparative granulomas are rare bone tumors. Although benign, these tumors are locally destructive and can be highly vascular. They seldom occur in the cranial vault. We describe a multidisciplinary approach to a case of giant cell reparative granuloma of the cranium in a 3-year-old patient.

Case report

A 3-year-old girl female referred to the pediatric neurosurgery department for evaluation of a retro-auricular mass. She had a history of recurrent otitis media with two subsequent courses of antibiotics without resolution. CT imaging revealed an expansive lesion located in the right mastoid region. Open surgical biopsy revealed a hemorrhagic tumor consistent with a giant cell reparative granuloma. Angiography identified a hypervascular tumor blush that was supplied by the occipital artery. Preoperative transcatheter embolization was performed followed by a multidisciplinary surgical resection and reconstruction. Blood loss was minimal, and the patient recovered well after surgery.

Conclusion

Preoperative endovascular embolization and a multidisciplinary intraoperative approach with primary resection and cranial vault reconstruction is an effective approach to hypervascular giant cell reparative granulomas.     

大脑半球切开术一例报道并文献复习

目的通过我们的1例患者探讨大脑半球切开术的操作技术并附有简单的文献复习。方法 1例12岁女孩,诊断为药物难治性癫痫。临床表现为简单部分性发作,发作频繁。影像学显示左侧大脑半球弥漫性软化灶。经过充分的术前准备,在导航系统引导下行改良的经岛周大脑半球切开术,手术过程顺利。结果术后患者恢复良好,右侧肢体运动功能无明显下降,言语功能正常。术后随访6个月未再有癫痫发作。结论结合文献复习,大脑半球切开术是功能性大脑半球切除术的彻底改良,手术操作可行,具有和大脑半球切除术相同的疗效,远期并发症明显减少。     

颅内植物性异物肉芽肿:一例报告并文献复习

目的 颅内植物性异物肉芽肿临床十分罕见,对其临床表现和组织病理学特征进行探讨,避免误诊.方法与结果 报告l例颅内植物性异物肉芽肿患者的临床表现、组织病理学特征和免疫表型,并复习相关文献.男性患者,23岁.主要表现为发作性四肢强直性抽搐,病程7年.头部MRI检查显示,左侧侧脑室前角前下方额叶皮质内长约1.60 cm的小结节状混杂信号影,邻近额叶组织有胶质化表现.术中可见左侧额底病灶与硬脑膜粘连,大小约为3cm×2cm,呈灰褐色,质地较韧,边界不清,部分钙化,血供丰富.光学显微镜观察显示,肉芽肿伴纤维组织增生、透明变性、钙化及淋巴细胞、浆细胞浸润,未见肿瘤细胞及寄生虫病变;病变组织表达波形蛋白和CD68,不表达胶质纤维酸性蛋白、S-100蛋白和上皮膜抗原.结论 颅内植物性异物肉芽肿根据其部位不同临床表现多样,根据异物种类及存留时间的长短,其影像学也存在多样性,但是可以通过组织病理学和免疫组织化学检测明确诊断,与肿瘤、寄生虫病变相鉴别,并初步明确其植被类型.     

Totally thrombosed giant P2 aneurysm: a case report and review of literature.

The diagnosis and treatment of intracranial saccular giant aneurysms is still difficult despite developments in neuroradiology, neuroanesthesiology and micro-neurosurgery. These aneurysms are usually located on major intracranial arteries and are rarely on distal branches of these arteries. An extra-axial 4 x 5 cm mass lesion in the left mediobasal temporal region was detected on the CT and MRI examinations of a 37 year old male patient who was admitted to our institution with headache and slight right-sided hemiparesis lasting for 2 months. The lesion was avascular on angiography. Surgery proved that the lesion was a totally thrombosed giant aneurysm of the P2 segment of posterior cerebral artery (PCA). The P2 segment was clipped proximal to the aneurysm with pterional-transsylvian approach and the aneurysm was totally excised. Giant aneurysms of the P2 segment are rare and 15 cases have been reported in the literature. This report presents a rarely seen totally thrombosed giant P2 aneurysms and discusses the difficulties in diagnosis and treatment.     

Clear cell meningioma: case report and literature review.

The clear cell meningioma is rare and a recently described histologic variant of meningioma. The most interesting aspect of clear cell meningioma is the high recurrence rate and agressiveness. Until now 17 intracranial clear cell meningioma cases had been reported in the English language literature. We present 2 new cases of clear cell meningioma which is discussed with the relevant literature.     

Subcutaneous granuloma annulare of the scalp in childhood: a case report and review of the literature

Granuloma annulare is a benign inflammatory skin lesion of unknown etiology that is usually seen in adults and children and subtypes of it includes localized granuloma annulare, generalized granuloma annulare, subcutaneous granuloma annulare and arcuate dermal erythema. Etiology and pathogenesis of granuloma annulare are obscure, although there is much evidence for an immunologic mechanism. Precipitating factors are insect bites, sunburn, photochemotherapy, drugs, physical trauma, acute phlebitis and sepsis after surgery. Some investigators were suggested a relationship of granuloma annulare to a latent or clinically manifest diabetes or rheumatoid arthritis. In contrast, an association of subcutaneous granuloma annulare with these diseases in childhood has not been reported in the literature. Subcutaneous granuloma annulare of the scalp is rare lesion in childhood and nodules on the scalp are usually non-, or slightly mobile, whereas lesions on the extremities are freely mobile. For definitive diagnosis, a biopsy should be performed but wide surgical intervention or medical treatment is not indicated. In case of recurrence, no additional diagnostic studies are necessary.     

Chondromyxoid fibroma of frontal bone: a case report and review of the literature

Chondromyxoid fibroma is an unusual benign tumor of cartilaginous tissues that may be confused with other some malign tumors. It is rarely seen in the skull. A 45-year-old female was admitted with painless bony swelling in the forehead. Computerized tomography demonstrated a well-defined expansive lesion with a sclerotic margin measuring approximately 3 cm in diameter in the right frontal bone. On MRI, T1-weighted images revealed a well circumscribed, lobulated and strongly enhancing lesion. On the T2-weighted images, the lesion showed high heterogeneous signal intensity. The patient underwent tumor excision with craniectomy, then acrylic cranioplasty. The histopathological diagnosis was chondromyxoid fibroma. There was no recurrence in a period of 22-months. In conclusion, chondromyxoid fibroma is a benign primary bone tumor that is located extremely rarely in the frontal bone. Accurate initial diagnosis of such tumors are important for appropriate treatment. En block surgical resection of the tumor is the cornerstone of treatment.     

Aneurysmal bone cyst of the orbit : a case report with literature review

Aneurysmal bone cyst (ABC) is benign vascular lesion destructing the cortical bone by the expansion of the vascular channel in the diploic space that usually involve long bone and spine. Orbital ABC is rare and the clinical symptoms deteriorate rapidly after initial slow-progression period for a few months. A 12-year-old female patient visited ophthalmologist due to proptosis and upward gaze limitation of the right eye, and orbital mass was noted in the upper part of right eye on orbital MRI. Five months later, exophthalmos was worsened rapidly with other features of ophthalmoplegia. Orbital mass was enlarged on MRI with intracranial extension. Surgery was done through frontal craniotomy and intracranial portion of the tumor was removed. Destructed orbital roof and mass in the orbit was also removed, and surrounding bone which was suspected to have lesion was resected as much as possible. Histopathological diagnosis was aneurysmal bone cyst. Postoperative course was satisfactory and the patient's eye symptoms improved. Authors report a rare case of orbital ABC with review of the literature. Exact diagnosis by imaging studies is important and it is recommended to perform surgical resection before rapid-progressing period and to resect the mass completely to prevent recurrence.     

Aneurysmal bone cyst of the temporal bone: a case report

Aneurysmal bone cyst in temporal region is rare. It is a benign condition and may extend intracranially. Total surgical removal is recommended, whenever possible in one stage or in multiple stages. Prognosis is excellent and total removal will effect a cure. An unusual case of aneurysmal bone cyst of temporal region is reported.     

Recurrent orbitofrontal cholesterol granuloma in pediatric patient: case report and review of the literature

Orbitofrontal cholesterol granuloma is a rare entity which typically involves the lateral part of the supraorbital ridge. It causes progressive expansion and erosion of the inner and outer tables of the frontal bone. We describe a case of recurrent orbitofrontal cholesterol granuloma in a 17-year-old girl. In June 2002 this patient had originally presented to an eye clinic with a small palpable mass in the right superolateral orbit, limitation on upgaze, and progressive proptosis. MRI of the orbit revealed an intraorbital extraconal mass with smooth border, high signal on both T1- and T2-weighted magnetic resonance images. She underwent an anterior orbitotomy via a subbrow incision. The lesion was removed completely, and histopathological examination confirmed a cholesterol granuloma. She remained asymptomatic until her presentation in August 2005. On second admission (3 years later), she complained of a tender palpable mass in the superolateral aspect of the right orbit. Her right eye was 4 mm proptosed and 4 mm inferomedially displaced with limited elevation. The rest of the examination was normal. MRI of the orbit showed a large intraorbital but extraconal mass with smooth border, high signal on both T1- and T2-weighted images without enhancement after gadolinium injection. She underwent complete surgical excision by means of a bicoronal approach. Histopathological diagnosis revealed cholesterol granuloma. No recurrence of the lesion has been observed during the last 6 years following the second operation.     

Eosinophilic granuloma of the skull associated with epidural haematoma: a case report and review of the literature

Introduction Eosinophilic granuloma (EG), a benign bone lesion, represents a focal form of histiocytosis X. Here, the authors report a case of an extremely rare presentation of a solitary EG of the skull.Case report A 9-year-old boy presented with headache and vomiting for 3 days. His examination was unremarkable except for a tender mass in his left occipital region. Radiological studies revealed a huge bilateral epidural haematoma under the occipital bone, extending supratentorially and infratentorially, and a nonenhanced, epidural, soft tissue mass overlying the left transverse sinus. Evacuation of the epidural haematoma was performed and it was noted that the left transverse sinus wall was eroded by the EG at one point with venous oozing. Review of the literature The acute presentation of a solitary EG of the skull with an epidural haematoma was described in only four cases in the literature. This is the first documented case in terms of the origin of an epidural haematoma.