Three-Dimensional Volume Imaging to Increase the Accuracy of Surgical Management in a Case of Recurrent Chordoma of the Clivus.

BACKGROUND The clivus is a depression in the anterior occipital bone of the skull base, posterior to the dorsum sellae, at the junction with the sphenoid bone. Chordoma is a rare tumor arising from embryonic remnants of the notochord and can be locally aggressive with a tendency to recur. The optimal management of this rare tumor remains controversial. A report of a case of recurrent chordoma of the clivus is presented to illustrate the value of volumetric three-dimensional (3-D) reconstruction with computed tomography (CT) and magnetic resonance imaging (MRI) to determine optimal surgical management. CASE REPORT A 53-year-old man presented with pain in the right orbital cavity, right proptosis, swelling of the right cheek, and bilateral loss of vision. He also had adrenal insufficiency. CT and contrast-enhanced (gadolinium) T1-weighted MRI with multiplanar acquisition were performed with volumetric 3-D reconstruction of the tumor, to increase the chances of treatment success. Surgical resection was performed to remove the tumor and reduce the risk of recurrence. Histology of the tumor was consistent with chordoma, supported by positive immunohistochemical staining for S-100 and epithelial membrane antigen (EMA). CONCLUSIONS This report highlighted the value of 3-D volume imaging in the diagnosis and treatment planning in a rare case of recurrent chordoma of the clivus. Analysis of tumor volume may be an indicator of the efficacy of surgery, complementing the Response Evaluation Criteria In Solid Tumors (RECIST) system and as a valuable tool to predict treatment outcome.

Rinosporidiose nasal na infância / Nasal rinosporidiosis in children

A rinosporidiose é uma doença fúngica rara, causada pelo Rhinosporidium seeberi, de contágio por inalaçäo de poeira (esterco de gado infectado) ou inoculaçäo de orifícios corporais pelo contato com água contaminada. Acomete cavidade nasal (mais comum), olhos, nasofaringe, uretra, conduto auditivo externo. Tem curso clínico lento e, como manifestaçöes nasais, obstruçäo, epistaxe, rinorréia, presença de massa tumoral polipóide friável, lobulada, indolor, geralmente de implantaçäo septal. Caracteriza-se histologicamente por cistos globulares contendo endosporos ("sporangia"), recoberto por agrupamentos de eosinófilos, em meio a reaçäo granulomatosa. O tratamento é cirúrgico (com recorrência em 10 por cento dos casos) e medicamentoso, utilizando diamino-difenil-sulfona ou anfotericina para evitar-se recidivas. Apresentamos um caso de rinosporidiose em criança de 10 anos, sexo feminino, com quadro de obstruçäo nasal e epistaxe à esquerda há 3 meses com tumoraçäo em fossa nasal esquerda, submetida à terapêutica cirúrgica