RESUMO
Granulocytic sarcomas are solid, extramedullary-located neoplasms composed of immature myeloid cells, associated with myeloproliferative syndromes. Central nervous system involvement is very rare and may develop either after complete remission, coexist with or precede the systemic disease, being the last one that guides the radiological diagnosis and marks the prognosis. In this work, we report 2 pathologically-verified cases of intracranial granulocytic sarcoma treated by surgical means. Their clinical, diagnostic, therapeutic and prognostic features are discussed in the light of the most relevant scientific literature published to date.
Assuntos
Neoplasias Encefálicas , Sarcoma Mieloide , Neoplasias Encefálicas/diagnóstico por imagem , Sistema Nervoso Central/fisiologia , Humanos , Prognóstico , Indução de Remissão , Sarcoma Mieloide/diagnósticoRESUMO
The authors present a patient with subcutaneous tumors associated with a desmoplastic medulloblastoma. This 6-year-old male who had previously undergone total removal of a cerebellar medulloblastoma was admitted because of new tumoral masses in the abdominal wall and the nuchal area. Ultrasound imaging demonstrated that both lesions were in the subcutaneous tissue. Both tumors were in the vicinity of the surgical incisions, which implies that they were implanted during previous procedures. Pathologic examination of the tumors obtained from gross surgical resection revealed medulloblastoma but with less advanced differentiation compared with the primary neoplasm. This report discusses unusual pure limited subcutaneous metastases of medulloblastoma. The objective of this report is to bring into consideration this presentation of medulloblastoma to the neurologic differential diagnosis.
Assuntos
Meduloblastoma/patologia , Meduloblastoma/secundário , Inoculação de Neoplasia , Tela Subcutânea/patologia , Criança , Evolução Fatal , Humanos , MasculinoRESUMO
We present four cases of cerebral amebae infection treated at our neurosurgical department. Patient 1 was a 12-year-old male with skin lesions of 2 years' progression involving the midface. He received a corticosteroid course, and, after that, he presented a right body hemiparesis. Patient 2 was a 5-year-old male, with a past surgical history of fibula fracture and osteomyelitis of 1-year evolution, associated with lesions of the surrounding skin that presented with partial seizures. Patient 3 was a 3-year-old female who presented with a stroke-like episode and with partial seizures. Patient 4 was a 6-year-old male who had ulcerative lesions in the face of 1-year evolution. After a corticosteroid course, he presented with right-body hemiparesis. All patients were human immunodeficiency virus-negative and died 1 month or less after surgery because of progressive evolution of the disease. Histopathology revealed granulomatous amebic encephalitis. All patients revealed infection from Balamuthia mandrillaris (Leptomyxiidae). Treatment consisting of pentamidine, clarithromycin, fluconazole, and 5-fluorocytosine was ineffective. Although extremely uncommon, granulomatous amebic encephalitis should be considered in the differential diagnosis of cerebral lesions while nonspecific, associated granulomatous skin lesions support the diagnosis of amebiasis.