A 64-Year-Old Woman with Imaging Features Consistent with a Posterior Intrapericardial Lipoma and 5-Year Imaging Follow-Up.

BACKGROUND Primary cardiac and pericardial neoplasms are rare and may be found incidentally on echocardiography. We present a case of a 5-year imaging follow-up in a patient with a large posterior pericardial lipoma diagnosed by magnetic resonance imaging of the mediastinum. CASE REPORT A 64-year-old woman was admitted to the Department of Cardiology for detailed assessment due to an intrapericardial mass revealed on transthoracic echocardiography in an outpatient setting. Computed tomography revealed a capsulated posterior intrapericardial homogenous mass of fat density. There was no enhancement of the lesion with contrast agent administration. Ultimately, magnetic resonance imaging confirmed the benign nature of the tumor, leading to the intrapericardial mass being classified as a lipoma. Due to the clinical features of the lesion - the preserved intracardiac flow and the asymptomatic course of the disease - conservative treatment was appropriate for this patient. A 5-year imaging follow-up was uneventful, the patient remained asymptomatic, a mild tumor growth was identified by computed tomography, and there was still no recommendation for surgery. CONCLUSIONS This case has shown that although echocardiography and computed tomography imaging can identify posterior intrapericardial tumors, magnetic resonance imaging can identify diagnostic features and support the benign nature of a tumor that may not be amenable to surgical removal.

Neuroregenerative effects of polyethylene glycol and FK-506 in a rat model of sciatic nerve injury.

The recently introduced polyethylene glycol (PEG) treatment restores axonal continuity after nerve injury, leading to rapid recovery of nerve function. The impact of PEG therapy on neuroregeneration has not yet been compared with any intervention with an established proneuroregenerative potential. FK-506 is an immunosuppressive agent with documented proneuroregenerative potential in nerve injury models. The aim of this study was to compare the effects of PEG therapy and preinjury FK-506 administration in rats with sciatic nerve transection injury. Four groups of male Sprague Dawley rats (seven per group) underwent sciatic nerve transection with primary repair. Group A received placebo injections, group B placebo injections and PEG treatment, group C FK-506 injections, and group D both FK-506 injections and PEG treatment. Clinical outcomes were assessed by the skin prick test and Sciatic Functional Index (SFI). Regenerated nerves underwent histomorphometric analysis. The histomorphometric analysis demonstrated that compared with the controls, nerve specimens from all treated groups showed signs of enhanced neuroregeneration (higher mean axonal area) (p < 0.001). The histomorphometric parameters for group D (PEG + FK-506), mean axonal area (p < 0.001) and axonal count (p > 0.05), were significantly better than those in the other study groups. The Form factor was closest to its optimal values in group B (p < 0.0001). At the end of the study, mean skin prick test scores in all treated groups were significantly higher than those in controls (p > 0.05). During the first postoperative week, PEG-treated rats (groups B and D) presented with higher values of the SFI than animals from groups A and C, but the difference was not statistically significant. Combined therapy with PEG and FK-506 seems to produce better neuroregeneration outcomes than a simple suture-based repair complemented with either PEG or FK-506 treatment.

Morphological evidence of the beneficial role of immune system cells in a rat model of surgical brain injury.

The blood-brain barrier prevents infiltration of peripheral immunocompetent cells into the CNS under physiological conditions. Following brain trauma there is reported a rapid and massive immunological response. Our earlier data indicated that surgical brain injury causes breaking of brain parenchyma integrity and results in cell changes and death, astrogliosis and disruption of blood vessels. The aim of the present studies was to investigate and characterize immunocompetent cells entering brain damaged parenchyma in the early period following the injury in a rat model of surgical damage. In the investigations we used light and electron microscopy techniques. Four days following the lesion many monocytes and macrophages were detected in the injured parenchyma. We also found many activated microglial cells with phagosomes within the cytoplasm. The phagocytes digest the cellular debris and clean up the parenchyma. The data suggest the beneficial role of immunocompetent cells following surgical injury.

[Schwannoma of the common peroneal nerve. A differential diagnosis versus rare popliteal cyst]. / Nerwiak oslonkowy nerwu strzalkowego wspólnego w obrebie dolu podkolanowego. Róznicowanie z torbielami zwyrodnieniowymi.

The presented case concerns a patient with neuralgia of the common peroneal nerve and progressive neurological deficit caused by interfascicular growth of schwannoma. The ultrasound diagnostics identified the lesion as a popliteal cyst. Magnetic resonance imaging revealed features of atypical cyst location. Due to the clinical course, it was decided to decompress the nerve trunk. An interfascicular tumor was identified intraoperatively. Particular nerve bundles were separated microsurgically and the tumor of schwannoma morphology was removed. The postoperative course brought resolution of neuralgia and improvement of peroneal nerve function. In the case in question attention was focused on the differential diagnostics of processes located in the popliteal fossa. Imaging examination indicated an atypical cyst location rather than a morphologically solid tumor. The clinical course is essential for determining the nature of the lesion. Decompressing the common peroneal nerve in microsurgical technique allows the prevention of further neurological symptoms in the postoperative course.

[Occipito-cervical fixation in plasmocytoma. Method modification. Technical report]. / Stabilizacja potyliczno-szyjna u chorego w przebiegu szpiczaka. Modyfikacja metody operacyjnej. Nota techniczna.

Intraoperative modification of use and stabilization of the Axon system (Synthes) for occipito-cervical fusion in a patient treated oncologically due to plasmocytoma is presented. Pathological fracture, range of the process and damage of anterior cervical fusion necessitated the use of occipito-cervical stabilization. Different anatomical conditions within the occipital bone in the form of its thinning was observed. Fixing with screws was impossible due to the bone structure. In consequence, modification of stabilization with an ad hoc elaborated technique (burr holes in the occipital bone and stabilization with titanium wire) was implemented. Modifications and specific indications related to the clinical course of plasmocytoma are discussed.

Granulomatous inflammation of dura mater--a rare side effect after application of hemostatic and insulation materials in case of two-stage operation of huge meningioma.

Haemostatic and isolating materials may cause local reactions as a foreign body. The case presented here of intracranial granulomatous lesion pertains to a patient operated in two stages due to a huge meningioma. During the first operation the tumour was partially removed. Because of persistent intraoperative haemorrhage haemostatic flakes of Oxycel and Spongostan were applied locally. In order to cover the lack of the dura, an insulation material--Tachosil was used. Histological examination of the tumour specimens confirmed the preoperative diagnosis of benign meningioma, mainly of the angiomatous subtype. The second stage of operation was performed after 3 months and the meningioma was completely removed, as well as dura mater and meningioma attachment with its oncological margin. The resected dura mater was thickened and histologically showed intensive granulomatous infiltrations and foreign body reactions most likely to Oxycel. Clinically no local and general infection and improper healing was observed after the first and the second treatment stage, but an allergic skin lesions and increased eosinophils in peripheral blood smear were noted. It was stated that systemic allergic reaction and granulomatous inflammation of dura mater were an uncommon response to the applied haemostatics and/or insulation material used during the first operation. This report show that haemostatic and isolating agents, generally used in neurosurgical procedure, may rarely cause local granulomatous processes considered as delayed hypersensitivity and the foreign body reactions. Therefore, they may hinder morphological assessment of the tissues during re-exploration and must be differentiate with the other infectious and non-infectious granulomatous processes.

Ten years observation and treatment of multifocal pilocytic astrocytoma.

Pilocytic astrocytoma (PA) usually occurs in younger patients. It is a benign, generally well-delineated, WHO grade I tumour with favorable prognosis, which makes it different from diffuse astrocytomas, classified as higher grades of malignancy. A case study of PA was presented in a young female patient, observed and treated at the Neurosurgical Department for the period of 10 years, during which time she had frequent surgical procedures due to recurrence and dissemination of the tumour. The initial symptom of the disease was epileptic seizure at the age of 16. Neuroradiological study revealed cerebral tumour in the right temporal lobe, then the first temporal lobe surgery followed by re-operation and radiotherapy was performed. The patient developed hydrocephalus, treated with the ventriculo-peritoneal shunt. After 5 years local recurrence of the tumour appeared in the right temporal region. The patient was operated and the tumour was totally removed. Initially, the histopathological diagnosis of ganglioglioma was suggested for primary tumour, finally the diagnosis of pilocytic astrocytoma for both recurrent and primary tumour was established. During the next years of observation increasing neurological symptoms in lower limbs developed. Subsequently, the patient reported pain syndrome in lumbosacral and perineal area. Consecutive MRI studies revealed a spinal canal tumours localized at the thoracic level and next at sacral level. The spinal tumour was surgically treated in both locations; the last operation was done 10 years after surgery of the primary temporal lobe tumour. Histopathological examinations of the excised foci from spinal canal revealed neoplasm consistent with WHO grade I pilocytic astrocytoma. The presented case indicates that despite the spread of the neoplastic process, a histopathologically benign tumour (WHO I grade) allows for long-term survival and observation period. Unfortunately, multifocal tumour involving midline structures causes major neurological symptoms and deficits. In the presented case we dealt now with the ascending spread process and the occurrence of the new foci in both subtentorial and parameningeal spaces inside the cranial cavity. It is a rare clinical manifestation of a disease ever described in the literature.

The immature endothelial cell in human glioma. Ultrastructural features of blood capillary vessels.

New vessel formation is a prerequisite for the growth of a tumour mass. Growing evidence suggests that endothelial progenitor cells circulate in the blood and participate in that process. The purpose of the present study was ultrastructural and electron microscopic immunocytochemical examination of capillary blood vessels in human glioma. The results showed striking morphological changes in these vessels. Our observations indicate that tumours build vessels by cooption of pre-existing vasculature and de novo recruitment of endothelial progenitor cells. Immature endothelial cells characterized by fibrils in the cytoplasm and Flk-1 positive immunoreactivity were observed as small clusters or luminally localized individual endothelial progenitor cells that participate in intussusceptive vessel growth. This observation indicates that the tumour microenvironment determines biological and functional attributes of endothelial progenitor cells.

Hemosiderin pigmentation of tumour cells in cerebellar pilocytic astrocytoma associated with post-traumatic hemorrhage in adults.

The pilocytic astrocytoma is only rarely associated with gross intratumoral hemorrhage despite rich vasculature and blood vessel changes, accompanied often by perivascular depots of hemosiderin. We report an unusual case of pigmented cerebellar pilocytic astrocytoma presenting with posttraumatic hemorrhage in a 38-year-old man with no history related to the tumor. CT and MRI examination after head injury demonstrated unexpectedly the cystic lesion of 2 cm in diameter in the region of the right cerebellar hemisphere and vermis. The lesion was associated with hematoma and it was surgically removed 3 weeks after trauma. Histopathological examination revealed pilocytic astrocytoma tissue with broad hemorrhagic changes and with an unusual pattern of massive pigmentation of the cytoplasm of pilocytic astrocytes, consistent with hemosiderosis. Positive stains for iron and ferritin and ultrastructural study confirmed deposition of hemosiderin granules in the tumour cells. There was no evidence of melanin or melanosomes. This finding of hemosiderin accumulation in the cytoplasm of neoplastic astroglia seems to be analogous to post-hemorrhagic pigmentation of the normal Bergmann glia and subpial astrocytes. In the literature, the examples of neuroepithelial tumors with hemosiderin pigmentation of tumor cells have been rarely documented. To our knowledge, this is the first reported case of pigmented pilocytic astrocytoma exhibiting extensive intracellular hemosiderin deposition.

Clinicopathological and ultrastructural study in two cases of chordoid glioma.

Chordoid glioma is a rare benign neoplasm of uncertain histogenesis occurring in the third ventricle/ /suprasellar region. Recently, data have emerged suggesting that chordoid glioma is a variant of ependymoma related to a specialised ependyma of the subcommisural organ or the lamina terminalis area. In this study, we report clinicopathological and ultrastructural findings in two chordoid glioma cases. In case 1, a tumour (1.5 cm in diameter) in a 62-year-old man invaded the anterior-basal part of the third ventricle in the lamina terminalis region. In case 2, a large tumour in a 51-year-old woman occupied the whole third ventricle. The tumour attached to the medio-basal hypothalamic region. Histologically, both cases revealed a distinct chordoma-like pattern and glial immunophenotype of tumour cells. Under the electron microscope the tumour cells exhibited microvilli, intercellular lumina, intermediate type junctions and focal basal lamina formations. These findings were similar to those previously reported in the chordoid glioma cases. Moreover, the intracytoplasmic cilia and subplasmalemmal pinocytic vesicles or caveoles were observed. The study supports the view of ependymal derivation of chordoid glioma. Its relation to lamina terminalis or infundibular/median eminence area presumably reflecting tumour origin from the modified ependyma of circumventricular organs of the third ventricle is discussed.

Can genetic material retrotransposition be a cause of pathology accompanying cerebral aneurysm rupture?

Our considerations were prompted by observation of patients who underwent surgery due to cerebral aneurysm rupture. Elevated anti-HIV antibody titers were detected in such patients. The above condition was not observed either in subjects with intracranial hemorrhages from cerebral angiomas. The observed titers remained certainly below the cut off level indicating contact with HIV. We analyzed the subpopulations of peripheral blood lymphocytes both in the surgery patients and in the control group represented by blood collected from blood donors. On the other hand, the proliferation potential of circulating lymphocytes in the blood of patients with subarachnoid hemorrhages due to cranial aneurysm ruptures was found to be decreased. Dislocation of transposons, so-called 'unauthorized recombination' is known to occur within the framework of genetic code pathology. Endogenous human viruses have been described, and they may be involved in the development of autoimmune disorders. Additionally, viruses involved in autoimmune processes, which may be 'identical' with retrotransposons, have been described. Moreover, there are studies demonstrating that AIDS is caused by retrotransposition of genetic code material fragments. Our considerations are substantiated by ultrastructural analyses of material coming from the gyrus rectus cortex fragments, resected in patients who underwent clipping of a ruptured aneurysm of the anterior communicating artery. We demonstrated in neuronal chromatin the presence of a molecule ca. 80 nm in diameter, corresponding with its size to retroviruses or genetic material molecules with altered substructure. The authors suggest a new mechanism of development of neurological deficits in patients with ruptured cerebral aneurysms.