Spontaneous carotid dissection.

Spontaneous internal carotid dissection typically occurs in young or middle-aged patients. It is associated with a high rate of recovery and low mortality. Anticoagulant and antiplatelet drugs fail to demonstrate a significant improvement when compared with placebo. A 38 year-old woman with spontaneous dissection of the internal carotid artery diagnosed by MRI is reported. She had an excellent recovery without treatment and no recurrent attack occurred after one year of follow-up. The clinical manifestations, diagnostic tests and treatment of spontaneous internal carotid disection are briefly reviewed in this communication.

Concurrent occurrence of solitary spinal epidural osteochondroma and angiolipoma.

A unique concurrent occurrence of spinal epidural osteochondroma and angiolipoma was found in the first thoracic level of a 21-year-old man. The combined lesions produced longstanding motor and sensory disturbances because of compression of the corresponding segment of the spinal cord, and abrupt paraparesis presumably due to spontaneous hemorrhage from the angiomatous component of the angiolipoma. The neurological deficits were satisfactorily improved after surgical removal of the hematoma as well as of both lesions which were regarded as mesenchymal hamartomas.

Calcified cystic pituitary prolactinoma.

An unusual cystic pituitary prolactinoma in a 20-year-old man is described. The tumor was roentgenographically calcified. Ultrastructurally, the calcium deposits were found within the cytoplasm of tumor cells, extracellular spaces and blood vessels. The mechanism of intratumoral calcification is discussed in relation to degeneration of neoplastic cells and reparative process.

Lipoblastic meningioma: a light and electron microscopic study.

A patient with intracranial lipoblastic meningioma in the right frontal lobe is reported. The tumor was entirely made up of vacuolated cells. The nature of this rare neoplasm has been verified by light and electron microscopic studies.

Adenosquamous carcinoma of the thyroid: a case report and review of the literature.

A case of mixed squamous cell carcinoma and papillary adenocarcinoma of the thyroid in a 75-year-old woman is described. Review of 19 reported adenosquamous carcinoma including the present case revealed that they tended to occur in the sixth and seventh decades of life with an average age of 63.84 years and without sexual predilection. Local invasion and metastases of this highly fatal neoplasm are common.

POEMS syndrome: a case with proliferative vasculopathy and a review of cases Thailand.

A Thai male, aged 36 yrs, presented with chronic progressive sensorimotor polyneuropathy and mixed osteosclerotic and lytic lesions at the lumbar vertebrae (L). Generalized hyperpigmentation, bilateral gynecomastia, small testes, hepatomegaly, lymphadenopathy and ascites were observed. Computerized tomography of the lumbosacral spines revealed osteosclerotic changes at L3,4,5 with spiculated bony proliferation at the transverse processes and posterior components of the spines. Histopathological examination of the lesion was compatible with plasmacytoma. Proliferative vasculopathy was demonstrated in plasmacytoma. Serum immunofixation showed an IgM monoclonal gammopathy. Further investigation demonstrated secondary adrenal insufficiency with low level of plasma testosterone. The patient responded well to local radiotherapy and intermittent chemotherapy with melphalan and prednisolone. The histopathological findings of proliferative vasculopathy suggested the important role of capillary leakage as a factor responsible for systemic manifestations in the POEMS syndrome. The reported cases of this syndrome among Thais are summarized.

Cerebral abscesses due to Pseudomonas pseudomallei.

Two cases of cerebral abscesses caused by Pseudomonas pseudomallei are reported. The first case, a 51-year-old women had a sudden onset of progressive right hemiparesis and right facial palsy and died within 7 days. Postmortem examination disclosed brain abscess in association with disseminated infection outside the central nervous system. The second case, a 9-year-old boy displayed cerebral abscesses as an isolated manifestation. Recovery occurred after treatment with ceftazidime. Review of the ten case reports of cerebral melioidosis revealed that the lesion occurred in patients of all ages and was more common in men than in women. The frontoparietal lobe was the most common location. Fever, headache, and hemiparesis were frequent clinical manifestations while seizures, ataxia were uncommon. CT scanning, serum antibody titer along with hemoculture were useful investigate tools. The importance of early diagnosis and prompt treatment is emphasized for this fatal but treatable disease.

Esophageal tuberculosis presenting as intramural esophagogastric hematoma in a hemophiliac patient.

A spontaneous intramural esophagogastric hematoma developed in a patient with hemophilia A. The hematoma did not resolve after antihemophiliac factor replacement but ruptured into the stomach causing massive gastrointestinal bleeding. The associated enlarged right tracheobronchial gland and the histopathological finding of fibrocaseating granuloma at the esophagogastric junction indicated that the primary disorder was esophageal tuberculosis. The whole process responded rapidly to antituberculous treatment.