Clival chordoma presenting with isolated unilateral cranial nerve XII palsy: A case report.

INTRODUCTION: Chordomas are rare malignant neoplasms that can originate anywhere along the cerebrospinal axis. However, they are most commonly found in the spine, cranium, and sacrococcygeal region. Chordomas can manifest differently depending on their location and most symptoms are a result of local invasion. We present a rare case of intracranial clival chordoma that manifested as isolated unilateral cranial nerve XII (CN XII) palsy. PRESENTATION: A 53-year-old male presented to the neurosurgical clinic with headaches, dysarthria, and pharyngeal pain. Neurological examination showed left-sided atrophy of the tongue. MRI scan showed an infiltrative lesion in the clivus which was hypointense on T1 and hyperintense on T2. The lesion was treated surgically however full resection was not achieved. Pathological examination and subsequent immunohistochemical staining confirmed the diagnosis of chordoma. DISCUSSION: To our knowledge, there have been only two reported cases of clival chordoma that presented with isolated CN XII palsy which manifested clinically as dysarthria and unilateral atrophy of the tongue. This makes our case the third reported case of clival chordoma that presented with isolated CN XII palsy. CONCLUSION: We report a rare case of clival chordoma that presented with isolated left CN XII palsy. Physicians should consider clival chordomas in their differential diagnoses when faced with isolated unilateral CN XII palsy. Surgical resection combined with adjuvant radiotherapy remains the preferred treatment protocol.

Spinal intradural extramedullary cavernoma: A case report.

INTRODUCTION: Cavernomas are rare vascular lesions that can occur anywhere along the neuraxis. However, they are most commonly found in the cerebral hemispheres. Spinal cavernomas are more uncommon and intradural extramedullary cavernomas are the most uncommon as they constitute only 3 % of spinal cavernomas. PRESENTATION: A 36-year-old female presented to our neurosurgical clinic with a history of back pain radiating to the left side of the chest with left lower extremity paresthesia and ataxia without urinary disturbance. Neurological exam showed left-sided hypoesthesia below the T9 dermatome in addition to increased patellar and Achilles reflexes on the left side. MRI showed a homogeneous intradural extramedullary mass which was hyperintense on T1 and hypointense on T2 and it was surgically resected. Pathological examination confirmed the diagnosis of intradural extramedullary cavernoma. DISCUSSION: Intradural extramedullary cavernomas are extremely rare lesions that arise within the area located between the inner surface of the dura and the pial surface of the spinal cord. Up until 2022 only 40 cases of intradural extramedullary cavernomas were reported in the literature. MRI is the preferred imaging modality and pathology is the golden standard for diagnosis. Surgical resection showed very promising results and it is considered the golden standard for treating this condition. However, surgery should be performed urgently to give an optimal outcome. CONCLUSION: Clinicians should consider this condition in their differential diagnoses when faced with progressive spinal root compression symptoms, sudden onset myelopathy, or progressive subarachnoid hemorrhage.

Primary spinal oligodendroglioma with intracranial extension: a case report.

Introduction: Primary spinal cord oligodendrogliomas (PSO) are sporadic tumors that arise from oligodendrocytes in the central nervous system (CNS). They can affect adults and children and make up about 2% of all intramedullary (IM) spinal tumors. Here, the authors present the second case in the literature of a primary spinal oligodendroglioma with intracranial extension. Presentation: A 28-year-old right-handed female presented to our emergency room severely malaised with left-sided hemiparesis, numbness, tingling, and urinary retention with positive Babinski and negative Hoffmann. MRI showed a widespread heterogeneous mass extending from the medulla to C7 with syringomyelia inferior to the mass. The mass was removed surgically, and her neurological condition improved rapidly. The gross, pathological exams, and immunohistochemistry confirmed the diagnosis of oligodendroglioma. Discussion: Up until 2017, there have been 60 documented cases of PSO in the literature and we have found two more cases in our search between 2017 and 2023. Also, there has been only one case recorded with an intracranial extension, making our case the 63rd PSO case and the second one with cranial extension. Conclusion: The golden standard for imaging is MRI. Surgical excision is the main treatment in the literature. Single-stage laminectomy showed promising results and surgical resection was the critical intervention to which the patient responded. This matches what was stated in the literature that surgery is the primary mode of treatment in PSO patients.

Xanthogranulomatous pyelonephritis mimicking renal cell carcinoma: a case report.

Xanthogranulomatous pyelonephritis (XGPN) is a rare, serious, and chronic inflammatory disorder of the kidney characterized by a destructive process that invades the renal parenchyma, which is most commonly associated with urinary tract obstruction and infection. It affects women more often than men. Case presentation: Herein, the authors report a case of a 48-year-old male presented to their hospital with complaints of malaise, fever, chills, left flank pain, and a history of a staghorn calculus in the renal pelvis, which was removed by surgery 7 years ago. Ultrasonography and computed tomography scans showed an enlarged left kidney with cystic formation and pelvicalyceal system dilation with the presence of multiple large stones. The renogram showed a dysfunctioning left kidney. An open radical left nephrectomy was performed. Renal cell carcinoma (RCC) was suspected in both the gross and microscopic examinations. The immunohistochemistry was the decisive factor in confirming the diagnosis of XGPN. Clinical discussion: Preoperative and postoperative diagnosis of XGPN can sometimes be difficult due to diverse differential diagnoses. The misinterpretation of 'foam cells' as 'clear cells' consistent with RCC is the most important diagnostic challenge for pathologists. Conclusion: The unusual findings of this case report suggest a careful evaluation of patients with a renal cystic mass, that can be misdiagnosed as a RCC. A combined computed tomography scan evaluation together with histopathology and immunohistochemistry are essential for a correct diagnosis of this rare renal entity.