Occipital aneurysmal bone cysts in an adult patient: a rare case and review of literature

This study aimed to report a rare case of occipital aneurysmal bone cysts [ABCs] in an adult patient. ABCs account for 1% of primary bone tumors. They are usually seen in pediatric age and rare in adults. They are benign fibro-osseous lesions, but they also tend to double in size rapidly and destruct the morphology of the bone. They have a tendency to extend to the long bones and vertebral column. The calvarial ABCs are 3%-6% of ABC. They usually affect the frontal and temporal bones of the skull, and cranial nerve findings are frequently seen. In the adulthood, occipital ABCs are extremely rare. Sixteen cases of occipital ABC, average age 15 years, have been reported in the literature. A 50-year-old female patient was admitted to the clinic with the history of an occipital mass lesion, which had been growing for 6 months. Magnetic resonance imaging and computed tomography of the cranium revealed an irregular-shaped destructive lesion of 55 × 18 × 28 mm3 in the diploe part of the occipital bone. The mass with an approximately 6 cm radius, and 1 cm normal bone edge was completely excised. Because of total resection, no adjuvant therapy was performed. Neither recurrence nor residual lesion was observed in the postoperative 24 months

Phenytoin Induced Erythema Multiforme after Cranial Radiation Therapy

The prophylactic use of phenytoin during and after brain surgery and cranial irradiation is a common measure in brain tumor therapy. Phenytoin has been associated with variety of adverse skin reactions including urticaria, erythroderma, erythema multiforme (EM), Stevens-Johnson syndrome, and toxic epidermal necrolysis. EM associated with phenytoin and cranial radiation therapy (EMPACT) is a rare specific entity among patients with brain tumors receiving radiation therapy while on prophylactic anti-convulsive therapy. Herein we report a 41-year-old female patient with left temporal glial tumor who underwent surgery and then received whole brain radiation therapy and chemotherapy. After 24 days of continous prophylactic phenytoin therapy the patient developed minor skin reactions and 2 days later the patient returned with generalized erythamatous and itchy maculopapuler rash involving neck, chest, face, trunk, extremities. There was significant periorbital and perioral edema. Painful mucosal lesions consisting of oral and platal erosions also occurred and prevented oral intake significantly. Phenytoin was discontinued gradually. Systemic admistration of corticosteroids combined with topical usage of steroids for oral lesions resulted in complete resolution of eruptions in 3 weeks. All cutaneous lesions in patients with phenytoin usage with the radiotherapy must be evoluated with suspicion for EM.