Excision of an asymptomatic cervical intradural neurenteric cyst through the anterior approach: a study of two cases and a review of the literature.

BACKGROUND: Spinal neurenteric cysts are very rare lesions, especially after the second decade of life. They account for 0.3% to 0.5% of all spinal tumors and occur most commonly in ventral locations. The cysts are usually removed via a posterior approach. PURPOSE: To present the clinical and radiologic results of patients with spinal neurenteric cysts who were treated via anterior approach procedures. STUDY DESIGN: This report is composed of two cervical neurenteric cyst cases that are compared with published studies. METHODS: We present two patients, 41- and 39-year-old women, each with a cervical intradural neurenteric cyst. Both of these patients had apparent neck pain without neurological deficit. MRI revealed neurenteric cysts located at C7 and C7-T1 levels. After anterior corpectomy, the intradural cysts were removed, and then fusion was performed. RESULTS: The postoperative period went well. The follow-up cervical MRI studies were performed at 3, 6, and 18 months postoperatively, and there were no abnormalities found. CONCLUSIONS: This study has led to the conclusion that although neurenteric cysts are rare in adults, they can still be present with only persistent neck pain and without neurological deficits. This may lead to misdiagnosis. The importance of MRI is not controversial in the early diagnosis. An anterior approach may be considered the first preference for surgical technique in patients with ventrally located neurenteric cysts.

Two cases of nasal natural killer T-cell lymphoma.

Nasal natural killer T-cell lymphoma is a very aggressive and destructive disease with a poor prognosis. We hereby present two male patients in whom diagnostic problems and a mortal course were encountered. One patient (age 31 years) had progressive ulceration in the nasal area. Two biopsies that had been taken elsewhere were inconclusive. The other patient (age 40 years) was referred with a previous histopathologic diagnosis of squamous cell carcinoma. He complained of an unhealing wound in the hard palate. Biopsies were repeated in each case. Diagnosis was made by immunohistochemical examination. Both patients died shortly after the diagnosis. The importance of obtaining an adequate and deep biopsy sample and employing sophisticated immunohistochemical examination is emphasized for an accurate diagnosis.

Malignant mesothelioma of the tunica vaginalis: presenting with intermittent scrotal pain and hydrocele.

Paratesticular mesotheliomas are very rare tumors. In this paper, we present the management of a 38-year-old male patient with paratesticular malignant mesothelioma who was initially misdiagnosed and treated as recurrent epididymitis. After the final pathology report defining paratesticular mesothelioma during scrotal exploration, he underwent radical orchiectomy and hemiscrotal excision as a complementary, secondary procedure. His metastatic workup did not show any dissemination. Therefore, he did not receive any adjuvant treatment and remained disease-free for more than 2 years.

Staged, open, no-ischemia nephron-sparing surgery for bilateral-multiple kidney tumors in a patient with birt-hogg-dubé syndrome.

Hereditary kidney cancer patients with bilateral multiple kidney tumors represent challenges in the era of rapidly growing minimal invasive treatment techniques. Birt-Hogg-Dubé Syndrome (BHDS) is an autosomal dominant genodermatosis characterized by a triad of benign skin tumors (fibrofolliculomas, trichodiscomas, acrochordons) together with an increased risk of developing malignant renal tumors and pulmonary disease such as pneumothoraces and multiple lung cysts. The morbidity and mortality of the affected patients is determined by the presence of the kidney tumors, which tend to be multifocal and bilateral, as observed in other hereditary kidney cancer syndromes like von Hippel-Lindau disease, familial leiomyomatosis, and hereditary papillary renal cell carcinoma. Herein, a patient with BHDS, presenting with synchronous bilateral multiple kidney tumors, is reported. The report describes the management of kidney tumors with two-stage open nephron-sparing surgery in which the nonvascular clamping technique was utilized.

Vitrified human ovaries have fewer primordial follicles and produce less antimüllerian hormone than slow-frozen ovaries.

Slow-freezing and vitrification methods of human ovarian tissue cryopreservation were compared in terms of primordial follicle count and in vitro antimüllerian hormone (AMH) and estradiol production. Compared with fresh and slow-frozen ovaries, vitrified ovaries contained statistically significantly fewer primordial follicles and produced statistically significantly less AMH in vitro. Estradiol production from slow-frozen and vitrified ovaries was similar but statistically significantly lower than from fresh cultured strips.

Comparison of palpation-versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules.

BACKGROUND: The aim of this study was to compare the results of palpation-versus ultrasound-guided thyroid fine-needle aspiration (FNA) biopsies. FINDINGS: Clinical data, cytology and histopathology results were retrospectively analyzed on all patients who underwent thyroid FNA biopsy in our outpatient endocrinology clinic between January 1998 and April 2003. The same investigators performed all thyroid FNAs (ASC) and cytological evaluations (KP). Subjects in the ultrasound-guided group were older, otherwise there were no differences in baseline characteristics (gender, thyroid function, the frequency of multinodular goiter, nodule diameter and nodule location) between groups. Cytology results in nodules aspirated by palpation (n = 202) versus ultrasound guidance (n = 184) were as follows: malignant 2.0% versus 2.7% (p = 0.74), benign 69.8% versus 79.9% (p = 0.02), indeterminate 1.0% versus 4.9% (p = 0.02), inadequate 27.2% versus 12.5% (p < 0.01). Malignant results were compared with Fisher's exact test. Other cytology categories were compared with chi-square test. Eighteen patients from the palpation- and 23 from ultrasound-guided group underwent surgery. In the palpation-guided group, the sensitivity of FNA was 100%, specificity 94%, positive predictive value 67% and negative predictive value 100%. In the ultrasound-guided group, the sensitivity of FNA was 100%, specificity 80%, positive predictive value 73% and negative predictive value 100%. CONCLUSION: We demonstrate that ultrasound guidance for thyroid FNA significantly decreases inadequate for evaluation category. We also confirm the high sensitivity and specificity of thyroid FNA biopsy in the diagnosis of thyroid cancer. Where available, we recommend universal application of ultrasound guidance for thyroid FNA biopsy as a standard component of this diagnostic technique.

Chondromyxoid fibroma involving the entire metacarpal: a case report.

The occurrence of chondromyxoid fibroma in the hand is rare. We report a case of chondromyxoid fibroma involving the whole fourth metacarpal that was treated by curettage and cancellous bone allograft.