Intramedullary spinal tuberculoma presenting as a conus tumor: a case report and review of the literature

Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. Although tuberculosis is unusual in the west, it is still prevalent in Asia and Africa. We report a case in which the diagnosis was made histologically without evidence of symptoms of systemic tuberculosis. The lesion, located in the conus medullaris, mimicked a conus tumor. The patient was a 20-year-old man who presented with a history of progressive leg weakness, urinary urgency, and impotence. There was no history of, or recent contact with, tuberculosis. A diagnosis of an intramedullary tumor in the conus medullaris was made by MRI. The patient underwent a T11-L1 laminectomy and total resection of the lesion with microsurgical technique. Histologic examination revealed a granulomatous lesion containing Langhans’ giant cells, inflammatory cells, and caseating necrosis. Antituberculous medication was instituted as soon as the diagnosis was made. Neurologic symptoms and signs slowly improved postoperatively. A combination of microsurgical resection and antituberculous chemotherapy should be the choice of treatment for intramedullary tuberculomas. Received: 11 January 1997 Revised: 1 April 1997 Accepted: 17 April 1997     

Brain stem tuberculoma in adult patients: Diagnosis and treatment

A consecutive series of six adult patients ranging in age from 29 to 53 years is presented. The clinical and radiological features in each patient are described. Attention is drawn to the features demonstrated on computed axial tomography. In only one patient, the first encountered, was surgical excision undertaken and histological verification obtained. One patient died before any form of treatment could be instituted. The remaining four patients were treated with antituberculous chemotherapy alone and their progress monitored by sequential computed tomography. The excellent response and good outcome in this conservatively treated group are documented.     

Giant pilomatricoma mimicking a malignant parotid mass

Pilomatricomas are benign neoplasms of the hair follicle occurring relatively often in the pediatric population. However, lesions attaining massive proportions are very rarely encountered. We describe such a case presenting in the parotid region and initially misdiagnosed as malignancy. Preoperative biopsy provided accurate diagnosis and allowed definitive surgical excision using a parotid-sparing approach. In children, giant pilomatricoma should be included into the differential diagnosis of noninflammatory masses of the salivary gland region.     

Intramedullary tuberculoma of the conus: a case report

Tuberculomas of the spinal cord are rare. The objective of this study was to illustrate the diagnosis and treatment of tuberculomas of the conus medullaris. They must be suspected in patients with a clinical context and a typical spinal cord mass lesion. Treatment is primarily medical. Surgery is reserved for cases of rapid neurological deterioration or doubts concerning the diagnosis. We report a case of intramedullary tuberculoma of the conus in a 27-year-old woman with paresthesias and weakness of the lower limbs who had been treated for pulmonary tuberculosis. The spinal MR showed a characteristic intramedullary ring-enhancing lesion. She improved neurologically one month after the beginning of the antituberculous drugs and a laminectomy. Seven months later, the patient is asymptomatic and the lesion has nearly completely disappeared completely.     

颈椎髓外硬膜下结核瘤1例

患者,男,38岁,以颈项部疼痛1个月,突发左上肢麻木无力3d入院。1个月前,无明显诱因,出现颈部疼痛,无双上肢感觉障碍,无活动受限,无头晕头痛,就诊于当地医院(具体治疗不详),症状无改善。3d前突然出现左上肢麻木无力,右上肢麻木感,排尿无力。既往:3年前无明显诱因出现颈部皮肤溃烂     

Giant carcinoid tumor mimicking pulmonary sequestration

A 42-year-old woman who previously underwent two consecutive thoracotomies for a lower lobe mass in her right lung was referred to our clinic for further management. Both procedures were abandoned due to excessive bleeding. Computed tomographic angiography demonstrated an infra-diaphragmatic systemic arterial supply of the mass similar to pulmonary sequestration. However the lobe had a normal venous drainage to the left atrium. Then a right lower lobectomy was undertaken through a hemi-clamshell incision, and histopathology revealed an atypical carcinoid tumor. The patient was discharged home after a satisfactory postoperative period. She still remains disease free at 14 months follow-up.     

Congenital disseminated malignant rhabdoid tumor and cerebellar tumor mimicking medulloblastoma in monozygotic twins: pathologic and molecular diagnosis.

Malignant rhabdoid tumors are highly aggressive childhood tumors. Recently, all of the malignant rhabdoid tumors, whatever their location, have been related to the inactivation of the hSNF5/INI1 gene. A subset of cerebral tumors, associated with malignant rhabdoid tumors or isolated ones arising in siblings, showed similar molecular alterations. We report for the first time in monozygotic twins a congenital disseminated malignant rhabdoid tumor in one twin and a cerebellar tumor mimicking a medulloblastoma in the other. Molecular analysis revealed similar alterations for both tumors: a deletion of exon 7 of the hSNF5/INI1 gene in one allele, and a point mutation in the same exon in the other, suggesting a common genetic pathway. Analysis of constitutional DNA revealed a germline mutation. These findings are in favor of a common etiology for rhabdoid tumor and a subset of brain tumors developing in infancy.     

Giant malignant triton tumor of the scalp

Malignant triton tumor is a malignant schwannoma with rhabdomyoblastic differentiation. This tumor is very rare. Case reports and small series have been reported in medical literature. Malignant triton tumor occurs predominantly in the trunk, head, neck, and lower extremities. There is an important relationship with Von Recklinghausen disease. Patients with this tumor have a very poor prognosis, with a rapid and fatal course. We present a clinical case with a giant malignant triton tumor of the scalp.Level of Evidence: Level V, diagnostic study.     

Giant malignant phylloides tumor: case report

The incidence of phylloides breast tumors is less than 1% in the population affected by breast cancers. The age at higher risk is between 35 and 45 years. These neoplasms are characterized by a proliferation of mesenchimal and epithelial cells. We present a rare case of giant malignant phylloides tumor (28 x 21 x 15 cm) with a complet substitution of the gland. The clinical presentation of phylloides tumors is heterogenous; the surgical treatment is a conservative one of the gland if the neoplastic lesion size is less than 5 cm with a free margin of 1 cm and a mastectomy if the diameter of lesion is more than 5 cm. Complementary therapies still remain controversial.     

脑结核球继发急性粟粒性肺结核和结核性脑膜脑炎一例

患者女,26岁,既往无肺结核病史.患者入院前3 d流产后出现反复发热,体温最高达39.7℃,伴头痛、恶心、呕吐,并感右下肢乏力、麻木,经＂头孢哌酮/舒巴坦＂抗感染治疗后症状无明显缓解,遂转入我科进一步诊治.     

合并其他消化道恶性肿瘤的胃肠间质瘤临床病理特征及其诊治

目的探讨合并其他消化道恶性肿瘤的胃肠间质瘤（GIST）患者的临床病理特征及诊治方法。方法回顾性分析2004年9月至2012年11月间在上海仁济医院接受手术治疗的525例原发性GIST的临床资料,其中合并其他消化道恶性肿瘤者46例．未合并其他消化道恶性肿瘤者479例。结果合并其他消化道恶性肿瘤的46例GIST患者术前诊断率仅为2．2％（1／46）,按NIH术后危险度分级,极低危患者36例（78-3％）,低危患者9例（19．6％）,高危患者1例（2．2％）。与未合并其他消化道肿瘤的GIST患者相比,合并者多见于老年患者（P=0．001）,多发生于胃（P=0．000）,肿瘤直径更小（P=0．000）,核分裂像更少（P=0．000）,危险度更低（P=0．000）。46例患者5年生存率为36．1％,显著低于未合并者的82．2％（P=0．000）。结论合并其他消化道恶性肿瘤的GIST大多为低危或极低危险度,对预后影响较小,其预后主要取决于合并的消化道恶性肿瘤,故对其治疗主要针对合并的恶性肿瘤,同时在不明显增加手术风险和术后并发症的情况下可考虑一并切除GIST。     

Abdominal tuberculoma mimicking a pancreatic neoplasm: Report of a case

We report herein a case of clinically solitary abdominal tuberculoma. A 28-year-old woman was admitted to hospital for treatment of an abdominal tumor shown to be located in the head of the pancreas and compressing the superior mesenteric vein by echosonography and computed tomography (CT). There were no clinical signs or symptoms of tuberculosis in the lungs or abdomen. Thus, under the diagnosis of a neoplasm of the pancreas, an exploratory laparotomy was performed which revealed tuberculosis. The patient made an excellent recovery on anti-tuberculous treatment, and no evidence of a tumor was seen on a CT scan performed 6 months after the initiation of treatment. Abdominal tuberculoma is often mistaken for a malignant neoplasm and the nonsurgical diagnosis of this entity continues to be a challange.     

Giant aneurysm of the anterior inferior cerebellar artery simulating a cerebellopontine angle tumor

An aneurysm of the anterior inferior cerebellar artery simulating a cerebellopontine angle tumor is reported. Only 13 such cases have been published so far. The relevant literature is reviewed.     

Giant pilomatrixoma looks like a malignant soft tissue tumor: a case report

Pilomatrixoma is a skin appendage tumor, which is manifested as a firm, solitary lesion. It usually measures 0.5–3.0 cm in diameter and is typically found in young people. A 31-year-old woman presented with a giant tumor of the upper dorsal region. On preoperative examination, the tumor seemed to be a malignant soft tissue tumor. It was totally excised, and the resultant defect was repaired with a latissimus dorsi musculocutaneous flap. On pathological examination, the tumor was confined to the subcutaneous layer and was composed of basophilic and shadow cells. Signs of atypia in basophilic cells present in the tumor were minimal. The tumor was consequently diagnosed as benign pilomatrixoma. The number of reported cases of pilomatrixoma larger than 10 cm in diameter is very small. This case is therefore presented as a rare case of pilomatrixoma.This article was presented at the 47th Scientific Meeting of the Japan Society of Plastic and Reconstructive Surgery, April 2004, Tokyo, Japan.     

Vestibular schwannoma and tuberculoma occurring In collision in the posterior fossa: A case report

IntroductionThough acoustic schwannoma is the most common primary tumour in the cerebello-pontine angle, its occurrence with tuberculoma has never been reported.Presentation of caseA case of a vestibular schwannoma and tuberculoma occurring as collision tumors in the posterior fossa in a 46 years old female is reported. She presented with chronic raised intracranial pressure manifesting as headache, occasional diplopia, speech disturbance, and unsteady gait. Magnetic resonance imaging of the brain demonstrated a vestibular schwannoma and tuberculoma in the right cerebello-pontine angle. The lesions were resected through retro sigmoid route. The caudal mass was vestibular schwannoma while the rostral and medial portion was tuberculoma.DiscussionThe occurrence of a vestibular schwannoma and tuberculoma in collision has hitherto never been reported. The pathogenesis, surgical challenges and management of such a rare entity is discussed and the relevant literature is briefly reviewed.ConclusionThe association of vestibular schwannoma and tuberculoma is rare. Surgical excision of lesions occurring in collision can be formidable. They require careful planning and strategy.