Coexistence of plasma cell granulomas of lung and central nervous system.

A rare case of concurrent plasma cell granulomas (PCG) of the lung and the central nervous system (CNS) is reported. A 30-year-old man was presented with recurrent left headaches lasting for two years. Computerized tomographic (CT) scan and magnetic resonance imaging (MRI) of the head disclosed a process extending from the lateral aspect of the left cavernous sinus to the tentorium cerebelli and the infratemporal fossa through the foramen ovale. At the same time, chest-X ray and CT scan showed three symptomless masses of the pulmonary right lower lobe. Histological examination of cerebral samples and of one of the pulmonary nodules revealed the presence of a fibrous tissue containing numerous lymphocytes and plasma cells as well as remnants of vascular and respiratory structures. Immunohistochemical study proved these cells to be polyclonal. Ultrastructural analysis confirmed the presence of lymphoid cells and failed to disclose any argument for meningioma or histiocytosis X. The differential diagnostic problems of PCG are discussed as well as considerations about clinicopathological features, histogenesis and pathogenesis of inflammatory pseudotumours (IPT).

Extracorporeal circulation with deep hypothermia and circulatory arrest in the treatment of intracranial arterial aneurysms.

Extracorporeal circulation with circulatory arrest and deep hypothermia in surgery on certain giant intracranial arterial aneurysms or on aneurysms difficult to access is described. The series includes a giant left carotid aneurysm, an aneurysm of the basilar artery bifurcation, a patient with two aneurysms, one on the right middle cerebral artery and the other at the end of the basilar artery, and a fourth patient with two aneurysms, one on the right middle cerebral and the other on the right carotid. Closed-thorax extracorporeal circulation with femoral cannulation was performed on all the patients. Surgical procedure is described and the advantages and disadvantages discussed. Results are encouraging. The authors suggest that the technique be used during surgical treatment of certain intracranial aneurysms that are in awkward positions or are very large in size. They emphasize that the procedure should be confined to exceptional cases.