Ectopic recurrent craniopharyngioma of the frontal bone

Ectopic recurrence of craniopharyngioma is a rare phenomenon after transcranial resection of the primary tumor. The authors present a case of ectopic recurrent adamantinomatous craniopharyngioma of the frontal bone resected 16 years after initial transcranial resection of the primary tumor. The lesion was first radiographically described 12 years after surgery and was adjacent to the osteosynthesis plate that had been implanted at the craniotomy site. The recurrent craniopharyngioma was totally resected via a lateral eyebrow approach. No infiltration of the meninges or the brain was detected. Only 50 cases of ectopic recurrent craniopharyngioma have been described to date, with the present case being the first one with recurrence located at the skull bone. So far 2 mechanisms have been described: contamination with tumor cells alongside the surgical tract and spreading via CSF and the subarachnoid space. The authors reviewed the literature, provided the largest collection of cases so far, and performed basic statistical analysis regarding ectopic recurrence. Pediatric and adult patients as well as male and female ones are affected equally by this phenomenon. The mean time of ectopic recurrence after initial surgery was 7.1 years. Ectopic recurrence, although rare, should always be considered in a patient with a newly diagnosed intracranial lesion who has undergone transcranial craniopharyngioma resection before.     

An elderly case of recurrent craniopharyngioma suffering from hemorrhage

A case of a 63-year-old female with craniopharyngioma is reported. She first suffered from occult pituitary apoplexy and had recurrent enlargement and characteristic changes of a tumor during short periods. This patient was hospitalized after suddenly developing bitemporal hemianopsia. An intra-and suprasellar hematoma was revealed on computed tomography (CT) and magnetic resonance imaging (MRI). At the first operation, the hematoma was removed totally by the transsphenoidal approach, but tumor tissues were not identified. During the following 12 months, operations were repeated three times due to the recurrence and/or enlargement of a tumor associated with visual symptoms. Pathological diagnosis was squamous-type craniopharyngioma without any malignancy. Microscopic appearance of the tumor apparently changed during the clinical course. The characteristic findings were revealed respectively on MRI and CT. On the first preoperative MRI, a lesion of diffuse high signal intensity was observed on both T1 and T2 weighted images. At the second operation, the lesion was also revealed as having high signal intensity on T1 and T2 weighted images but the tumor had a large cyst with serous-yellowish fluid contents. A differential diagnosis was made on CT. At the third and fourth operations, the tumor was solid and had atheromatous contents. The lesion was revealed as having low signal intensity on T1 image and high on T2 respectively. Occult pituitary apoplexy with intra and suprasellar hemorrhage is very rare in cases of craniopharyngioma and only nine cases have been reported until now. It is also interesting with this high-aged patient that repeated recurrence and/or enlargement of a tumor with different microscopic appearances occurred during such short periods.(ABSTRACT TRUNCATED AT 250 WORDS)     

Stereotactic intracavitary therapy of recurrent cystic craniopharyngioma by instillation of 90yttrium

Six consecutively presenting patients with craniopharyngiomas, (F:M = 4.2; mean age: 35.2 years, range 17-58) histologically proven by one or more previous operations, and with recurrence of a wholly or predominantly cystic nature, were treated by 90yttrium (90Y) radioisotope instillation into the cyst. Five patients had undergone external beam radiotherapy and the remaining patient had concomitant stereotactic radiosurgery to a co-existing solid component. Seven cysts in six patients have been treated. Five cysts, previously requiring repeated aspiration at intervals of 2-20 weeks have required no further surgical intervention following 90Y treatment (FU mean 3.5 years, range 1.2-7), although two of these required a second 90Y treatment. No patient developed a visual field defect or evidence of hypothalamic dysfunction. One patient died within a month of treatment from complications related to a solid recurrence. One patient developed a large solid/cystic recurrence at 4 months and died shortly thereafter from an unrelated cause. We summarize results from other series that have demonstrated the efficacy of this technique, usually as primary therapy, but this is the first series to demonstrate its usefulness as salvage therapy. The prospect of survival with good quality of life can be offered to patients with multiply recurrent disease who have exhausted all conventional means of treatment. In our experience intracavitary 90Y is a safe and highly effective means of controlling cystic recurrence in refractory craniopharyngioma. Some patients require more than one treatment.     

Treatment of recurrent gliomas

In operation for gliomas, it is our principle to remove extensively by sucker dissection technique. But, in many cases, we cannot achieve total removal because of invasion of tumor cells into the deep or vital structure. Postoperatively we apply irradiation, chemotherapy and immunotherapy in every cases. Even after multimodality treatment, recurrence may be inevitable. In order to check the recurrence as early as possible, we took follow-up CT scan regularly. When the recurrence appeared on CT scan, we actively performed reoperation. In this paper, we present characteristics of follow-up CT scan and result of the reoperation. Since introduction of CT scan in 1977, we have followed 30 supratentorial malignant gliomas and 16 supratentorial low grade gliomas postoperatively. CT scan was taken in every three months to check the course of contrast enhancement. After removal of the tumor, round low density area appeared on CT scan showing residual cavity. By contrast enhancement, various shape of high density area were seen. We divide the postoperative CT scan in 4 types by mode of contrast enhancement. In the type 1, enhanced area was persistent around the low density area. In the type 2, enhanced area was present around the low density area just after operation, but gradually disappeared. In the type 3, no enhanced area was present. In the type 4, dissemination occurring late after operation. Among the malignant gliomas, 12 cases belonged to the type 1, 6 cases to the type 2, 10 cases to the type 3, and 2 cases to the type 4. Among the low grade gliomas, 3 cases belonged to the type 1, 2 cases to the type 2, and 9 cases to the type 3.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ciliated craniopharyngioma

A tumor of Rathke's cleft origin was studied, which showed some histologic features consistent with craniopharyngioma, but also had ciliated and mucin-containing cells more commonly observed in Rathke's cleft cysts. The combination of features provides further evidence that craniopharyngiomas and Rathke's cleft cysts have a common embryonic origin.     

Infrasellar craniopharyngioma

A case of infrasellar craniopharyngioma is reported. This must be the first report that presents computed tomographic findings of an infrasellar craniopharyngioma. A computed tomography scan demonstrated the characteristic features of a tumor at the base of the skull extending massively into the nasopharynx, prepontine cistern, and suprasellar region. Further, air-contrast computed tomographic cisternography suggested the extradural growth of the tumor. We confirmed these neuroradiologic findings at a transsphenoidal operation.     

Treatment of recurrent thymic tumors

Surgery is the cornerstone of therapy for recurrent thymic tumors. The pattern of recurrence is, however, less defined. Between 1966 and 1988, we operated on 83 patients with thymoma, 11 of whom underwent surgery for recurrence (group I). In 1989, we initiated a prospective multimodality protocol and have enrolled 128 patients with 9 (7%) recurrences since (group II). In group I, 1 patient was originally at stage I, 2 were at stage II, 5 at stage III, and 3 at stage IV. The patients underwent 1 (#10) or 2 (#1) reoperations and 5 showed histological progression of malignancy. One patient died postoperatively, 6 died of disease, and 3 are alive and disease free 18 to 22 years after the first operation. In group 2, no patient was originally at stage I, 1 was at stage II, 4 were at stage III, and 4 at stage IV. Reoperation (5 patients) was followed by chemotherapy and 2 showed histological progression of disease. One patient died after 2 years, and 4 patients are alive after 6 to 11 years. All recurrent tumors were thymomas with cortical differentiation. Early onset of recurrence was a negative prognostic factor. Thymomas can recur also at early stages. A multimodality approach is indicated also for early stage lesions based on histology.     

复发性腹股沟疝的手术治疗

腹股沟疝术后复发依然是腹股沟疝手术的最常见并发症,也是疝外科医师必须面对并作出正确处理的议题。本文通过检索分析近10年复发性腹股沟疝治疗的相关文献,对其手术治疗的结果进行归纳总结,探讨复发性腹股沟疝的合理手术方案,并对治疗提出的问题给出答案与相应推荐级别。     

Treatment of recurrent subareolar abscess

Recurrent subareolar abscess is an infrequent but troublesome disease of the breast among young women. Recent experience with 5 patients indicated that successful treatment of recurrent subareolar abscess requires excision of the diseased ducts and necrotic cavity, including the inverted section of the nipple. The operative procedure described herein allows us to radically manage recurrent subareolar abscess and at the same time leave a nipple with a good cosmetic appearance.     

大肠癌复发的处理--附30例报告

目的 了解大肠癌复发的病因,明确大肠癌复发再手术治疗的价值。方法 回顾性分析复发性大肠癌30例临床资料。结果 剖腹探查证实局部复发16例,肝转移6例,腹腔广泛转移8例。局部复发肿瘤根治性或姑息性切除16例。短路吻合术8例,近端肠造疹术3例,均选择辅以腹腔化疗、放疗、免疫治疗及DSA下灌注化疗。再手术后生存1年者4例,生存3年者4例,生存4年者2例。至今健在的6例,其中再手术后1年者2例,2年者2例,3年者2例。结论 复发性大肠癌再手术并辅以综合治疗能明显延长生存期。     

Recurrent ectopic craniopharyngioma

A 66-year-old woman developed an asymptomatic mass in the right frontal lobe 5 years after undergoing a right frontal craniotomy and removal of a craniopharyngioma. The mass progressively enlarged over the next 3 years, during which time it became multiloculated and partially cystic. Repeat craniotomy was performed 8 years after the original operation, at which time the mass was found to be an ectopic craniopharyngioma. The lesion probably resulted from seeding of tumour cells along the surgical tract at the time of the initial surgery.     

Amenorrhea-galactorrhea and craniopharyngioma

A 40-year-old woman had a 1-year history of amenorrhea-galactorrhea. She was found to have an intrasellar tumor with suprasellar extension and a prolactin level of 98.1 ng/mL. Subtotal resection of the tumor resulted in a return of the prolactin level to normal within 4 days of the operation and of the prolactin response to thyrotropin releasing hormone, accompanied by the disappearance of the galactorrhea. Histologic examination revealed a typical craniopharyngioma. These observations indicate that one important mechanism of hyperprolactinemia in patients with craniopharyngioma is direct encroachment on the hypothalamus and/or pituitary stalk by the tumor and interruption of prolactin inhibiting factor.     

Ectopic clival craniopharyngioma

Summary.  Ectopic craniopharyngioma is a rare entity. The authors present a very rare case of an ectopic clival craniopharyngioma completely separate from the sella turcica.  A 44-year old woman presented with abducens palsy. A MR imaging study and a CT scan revealed a cystic clival lesion separate from the sella turcica. Surgical resection was performed successfully with flexible endoscope-assisted procedure using an endonasal transsphenoidal approach. No evidence of involvement of the sellar region was found according to radiological, intra-operative, and clinical findings.  A review of the literature revealed no other such cases. The discussion includes the formation of craniopharyngioma from the ectopic Rathke's pouch remnants and the surgical approach for clival lesions. We believe that our approach provides good results with minimal invasiveness for some clival lesions. Published online October 31, 2002 Correspondence: Takakazu Kawamata, M.D., Ph.D., Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo 162-8666, Japan.     

Treatment for recurrent hepatitis C

Hepatitis C virus (HCV) has become the leading cause for orthotopic liver transplantation (OLT) worldwide. OLT for HCV has been associated with good survival outcomes. HCV recurrence has been universally documented in allograft recipients within the 1st year post-transplantation. Slow but steady progression of recurrent disease has resulted in allograft failure in a small number of patients in the short-term and may cause allograft destruction in a larger number of patients in the long-term. A pressing need has therefore developed to identify antiviral regimens to treat or prevent recurrent disease. Unfortunately, current antiviral therapy has limited efficacy and is associated with multiple adverse events. Therefore, a concerted effort has been directed toward identification of the patient populations who are most susceptible to the deleterious effects of recurrent disease or those who are most likely to benefit from antiviral treatment. These patient populations may therefore be selected for antiviral therapeutic intervention. Unsuccessful antiviral therapy or the development of allograft may be an indication for retransplantation (re-OLT), a procedure that is not widely accepted since it is associated with high morbidity and mortality. Nevertheless, the appropriate and timely utilization of re-OLT may achieve good results in selected patients. This chapter will outline the current understanding and the results of medical and surgical therapeutic options for recurrent HCV following OLT.     

Ectopic recurrence of craniopharyngioma

A 27-year-old woman presented with ectopic recurrence manifesting as an asymptomatic mass in the left frontal convexity 5 years after subtotal removal of suprasellar craniopharyngioma through a right orbitozygomatic craniotomy. The mass had enlarged gradually over the next 5 years, so a second operation was performed for total removal. The histological diagnoses of both lesions were adamantinomatous type craniopharyngioma with MIB-1 indexes of 4.2% and 7.4%. The second lesion probably resulted from dissemination. Craniopharyngioma is a benign tumor, and ectopic recurrence is rare. Long-term clinical and neuroimaging follow up is recommended.