Adult granulosa cell tumour of the testis and bony metastasis. A report of the first case of granulosa cell tumour of the testicle metastasising to bone.

Granulosa cell tumour is among the rarest forms of testicular cancer. Only 21 cases have been reported to date and only 4 have metastasised. All documented metastases are intra-abdominal. We present the first case of granulosa cell tumour of the testis metastasising to bone (tibia), presenting 6 years after orchidectomy. This highlights the need to maintain a high index of suspicion for extra-abdominal metastases during long-term follow-up in patients with previous testicular granulosa cell tumour.

Choroid plexus papilloma of the posterior third ventricle during infancy & childhood: report of two cases with management morbidities.

We report two cases of posterior third ventricular choroid plexus papilloma, one in an 8-month-old infant and another in a two-year-old child. These cases presented with features of obstructive hydrocephalus. Both these patients underwent a ventriculo-peritoneal (VP) shunt surgery prior to the tumor excision. Following the VP shunt surgery both patients developed ascitis requiring exteriorization of the abdominal end of the shunt. There was a clear proof of CSF overproduction: 1400-1500 ml/day in the eight-month-old infant and 900-1200 ml/day in the two-year-old child. In the former it was transient and could be treated with revision of the VP shunt whereas in the second case a ventriculo-arterial shunt had to be done. In the second case a staged reduction cranioplasty was also performed for an enormously enlarged head (head circumference--74 cm). Interesting clinical and radiological findings and useful management strategies are described.

Aspergillus spinal epidural abscess.

Spinal abscess due to Aspergillus is rare. A young boy with chronic granulomatous disease and aspergillosis of the rib had been treated with antifungal treatment 3 months earlier. The patient presented with a brief history of progressive paraparesis. Imaging showed D9--11 vertebral involvement and destruction of the D10 vertebral body with angulation and a large dorsally placed, multiloculated epidural abscess extending from D6 to L2. There was also extensive granulation anterior to and on either side of the vertebrae. The patient underwent extensive laminectomy and decompression of all the loculi and partial removal of the granulation tissue. Aggressive medical treatment was started. The authors recommend an aggressive surgical and medical approach in such cases of disseminated invasive aspergillosis, even though the result may not be very satisfactory. This report discusses the full clinical profile and management of Aspergillus spinal epidural abscess and emphasizes the need to follow up these cases to detect recurrence and new lesions, even if the patients are on adequate medical treatment. In spite of all efforts, high morbidity and mortality is common in such patients.

Sciatica due to malignant nerve sheath tumour of sciatic nerve in the thigh.

Malignant peripheral nerve sheath tumour (MPNST) is a rare malignant neoplasm arising from the supportive non-neural component of the peripheral nerves. An unusual case of pain and weakness of the foot and calf muscles due to a giant MPNST of the sciatic nerve in the posterior compartment of the thigh is presented. The patient was already investigated as a case of sciatica due to a lumbar disc disease with a negative magnetic resonance imaging and then unsuccessfully operated elsewhere twice, with a misdiagnosis of tarsal tunnel syndrome. Neurosurgical referral prompted a diagnostic magnetic resonance study of the thigh, revealing the lesion, which was completely excised microsurgically with total relief in the pain and partial improvement in the weakness and sensations in the sole of the foot.

Congenital and late-onset primary haemangiomas of the temporalis muscle: case report.

We report on two patients with haemangiomas of the temporalis muscle, one congenital and one of late onset, which were diagnosed on computed tomography. Both were resected successfully and both patients are well with no signs of recurrence 3(1/2) years and 18 months later, respectively.

An unusual presentation of an intra-parenchymatous frontal yolk sac tumour : case report.

Yolk sac tumours are rare conditions among the germ cell tumours. Intracerebral germ cell tumours are exceedingly rare. A 15 year old girl presenting with a one week history of raised intracranial pressure is described. She had bilateral papilloedema and a right 6th nerve palsy. CT scan showed an intra-parenchymatous right frontal ring enhancing lesion of 2 cms diameter. The patient underwent microsurgical total excision of the tumour, followed by chemotherapy. She was asymptomatic at three years following surgery.

Endodermal cyst of septum pellucidum and pregnancy: a case report.

BACKGROUND: Endodermal or Neurenteric cysts are commonly found in spine. Their intracranial occurrence is rare and such a cyst in the septum pellucidum is exceptional. METHOD: We report a woman, with 33 week pregnancy, presenting in a semiconscious state due to raised intracranial pressure (ICP) due to hydrocephalus caused by a large lesion in the septum pellucidum. Computed tomography (CT) revealed the lesion which was better characterised by the Magnetic Resonance Imaging (MRI). First baby was delivered by LSCS and bilateral ventriculo-peritoneal shunts were inserted; and later on the cyst was excised. RESULT: There was full neurological recovery following the insertion of VP shunt. After excision of cyst cerebrospinal fluid (CSF) pathway was established and shunts could be removed. Post-operative period was complicated by septic ventriculitis. Eventually patient was discharged home in excellent condition. CONCLUSION: Endodermal cyst of septum pellucidum is an uncommon condition. Such lesions may be large when revealed, good outcome is expected after surgical excision.

Pathological prognostic factors in breast carcinoma.

OBJECTIVE: Pathological prognostic factors in breast cancer are now widely used to predict biological behavior of cancer and to plan its effective management. In this paper, we attempt to evaluate the reports from our histopathology laboratory spanning over a period of 4 years, to assess completeness in recording these factors. It will enable us to improve and standardize reporting on breast cancer. METHODS: The pathology reports of primary carcinoma of the breast diagnosed in our laboratory from 1st January 1994 to 31st December 1997 (4 year period) were reviewed for details on tumor size, histological type and grade, presence or absence of tumor emboli in vascular channels, proximity of the tumor to resection margins and lymph node status. RESULTS: Tumor size was not recorded in 1 case each in 1994, 1995 and 1996 and 2 cases in 1997. Histological type was mentioned in all cases in 1995 and 1997. It was not mentioned in 1 case in 1994 and 3 cases in 1996. Out of 77 cases with axillary clearance, the total number of lymph nodes was recorded in 83% of cases. The number of lymph nodes with metastasis was recorded in 71% of cases. CONCLUSION: Our histopathology laboratory receives the majority of surgical biopsies carried out in the Sultanate of Oman. During our study period we received a total of 45354 biopsies. From 1993 onwards, pathological prognostic factors of breast carcinoma were incorporated in our pathology reports following the publication of major and leading articles regarding the same. This study shows an improvement in the quality of reports after introducing this concept in 1994. This study clearly reveals the necessity for written protocols to be established, to standardize and improve the quality of reporting.

Frontal intraosseous cryptic hemangioma presenting with supraorbital neuralgia.

Primary intraosseous cranial hemangiomas are rare benign tumors comprising 0.2% of all osseous neoplasms. Symptomatic cranial cryptic hemangiomas are extremely rare. We report the case of a 43-year-old man with a cryptic hemangioma of the superior orbital rim. Radiological investigations revealed it to be an intraosseous cryptic mass which was totally excised and the supraorbital nerve was decompressed, relieving the patient of his symptoms. Histopathology showed features of an intraosseous hemangioma.

Pattern of breast neoplasms in Oman.

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Gastric carcinoma in the Sultanate of Oman: Incidence and distribution.

Gastric carcinoma has always been considered a major problem in the Sultanate of Oman. This study was conducted to document the cases in Oman over a two-year period, in order to determine incidence, age, sex and geographical distribution of the condition. All cases of gastric carcinoma in Omani nationals presenting to the medical facilities throughout Oman from November 1987 to November 1989 were reviewed from pathology records, surgical database records and by personal communication with surgeons at regional hospitals. Specimens taken at surgery or endoscopic biopsy were examined and classified according to Lauren's criteria. Over the two-year period, 104 cases of gastric carcinoma were observed. This represented an annual incidence of 4.2/100,000 population, but when adjusted to the standard European population age distribution (in the Oman population, 51% are under 15 years of age), the incidence was 8.6/100,000. The male:female ratio was 1.6:1 and the peak age group was 60-69. All tumors were advanced and most were located in the antral part of the stomach. There were more intestinal types of tumors than diffuse and a preponderance of intestinal metaplasia. This first survey of stomach carcinoma in Oman will provide a reference for future studies and indicates the need for earlier detection.

Efficacy of Cymelarsan in the treatment of natural chronic Trypanosoma evansi infection in camels in the Sudan.

The efficacy of Cymelarsan, administered by intramuscular (i/m) injection in the treatment of chronic cases of camel trypanosomosis due to Trypanosoma evansi, was tested under controlled laboratory conditions. It was confirmed that Cymelarsan is a safe drug for use in dromedary camels when administered i/m at dose rates of 0.25 or 0.50 mg/kg body weight. During the 90 days post-treatment no relapses occurred at either dose rate. Hence, the drug was found to be fully effective against the chronic form of the natural disease. A dose of 0.25 mg/kg body weight of Cymelarsan given i/m is recommended.