The Human Tail: A Simple Skin Appendage or Cutaneous Stigma of an Anomaly?

AIM: The human tail is a term to describe skin-covered protrusions in the lumbosacral and coccygeal region, ascribing to the resemblance to the tails in the animals. The first reports dates back to second half of the 19th century, the etiological bases could not been ascertained yet. They are mainly classified as true or pseudo-tails. MATERIAL AND METHODS: Five cases with human tails were diagnosed and managed in our hospital between 2010 and 2014. Their demographic and lesion characteristics are presented. RESULTS: Three of the 5 cases were male patients. The ages ranged between 1 day and 50 years at the time of diagnosis. The patients were diagnosed basically by the external appearance of the lesions without neurological deficits. Detailed examination revealed several associated lesions: two dermal sinus tracts, one tethered spinal cord and one club-foot in one-day preemie. Two patients had true and 3 had pseudo-tails. Four of them underwent surgery but the last one did not accept surgery. Surgery consisted of simple excision of the lesion in 2 patients with true tails and excision and removal of dermal sinus tract and untethering when necessary in the other 2 pseudo-tails. CONCLUSION: The presented study indicated that true human tails are simple skin appendages without any associated spinal anomalies. However, pseudo-tails are potentially complex lesions with a high risk of spinal dysraphisms; warranting further diagnostic work-up and more extensive surgical technique if necessary. The key to managing human tails is making a clear distinction between true tails and pseudo-tails.

Distinctive Characteristic Features of Intramedullary Hemangiopericytomas.

STUDY DESIGN: The retrospective analysis of intramedullary hemangiopericytomas (HPCs) was performed, and the entity was discussed in accordance with the literature findings. PURPOSE: This study aimed at defining distinctive characteristic features of intramedullary HPC with respect to surgical approach and prognosis. OVERVIEW OF LITERATURE: Intramedullary HPCs are extremely rare tumors. They originate from capillary pericytes, supposedly follow the vessels over the spinal cord, and infiltrate deep into the spinal cord without a distinct plane. Their treatments and prognosis are not well-defined in the literature. METHODS: Our database was retrospectively reviewed for the cases of HPCs. Later on, a literature search was performed to reveal all reported cases of intramedullary HPCs. The following key words were searched in PubMed databases: "hemangiopericytoma and intramedullary," "hemangiopericytoma and spine (spinal) and intradural," and "hemangiopericytoma and spinal cord." The articles were reviewed for patients' demographics features, imaging characteristics, tumor-specific factors (surgical technique, pathological descriptions, and world health organization grades), and postoperative course and prognosis (adjuvant therapies, recurrences, complications, and mortalities). RESULTS: A total of seven patients (three male and four female) was reached, with their ages ranging from 15 to 80 years (mean, 32.5 years). The tumors were located majorly in thoracic region (5/7, 71.4%), and only two cases were in the cervical region (2/7, 28.6%). All tumors were completely removed, and only two cases received radiotherapy. No recurrence was reported. CONCLUSIONS: Complete resection of the intramedullary HPCs seems to be the best management strategy for long-term and recurrence-free survival and in alleviating further need for radiotherapy.

Clinical outcomes and efficacy of transforaminal lumbar endoscopic discectomy.

BACKGROUND: Transforaminal lumbar endoscopic discectomy (TLED) is a minimally invasive procedure for removing lumbar disc herniations. This technique was initially reserved for herniations in the foraminal or extraforaminal region. This study concentrated on our experience regarding the outcomes and efficacy of TLED. MATERIALS AND METHODS: A total of 105 patients were included in the study. The patients were retrospectively evaluated for demographic features, lesion levels, numbers of affected levels, visual analog scores (VASs), Oswestry disability questionnaire scale scores and MacNab pain relief scores. RESULTS: A total of 48 female and 57 male patients aged between 25 and 64 years (mean: 41.8 years) underwent TLED procedures. The majority (83%) of the cases were operated on at the levels of L4-5 and L5-S1. Five patients had herniations at two levels. There were significant decreases between the preoperative VAS scores collected postoperatively at 6 months (2.3) and those collected after 1-year (2.5). Two patients were referred for microdiscectomy after TLED due to unsatisfactory pain relief on the 1(st) postoperative day. The overall success rate with respect to pain relief was 90.4% (95/105). Seven patients with previous histories of open discectomy at the same level reported fair pain relief after TLED. CONCLUSIONS: Transforaminal lumbar endoscopic discectomy is a safe and effective alternative to microdiscectomy that is associated with minor tissue trauma. Herniations that involved single levels and foraminal/extraforaminal localizations were associated with better responses to TLED.

Incidence and clinical significance of lesions presenting as a scalp mass in adult patients.

BACKGROUND: Lesions initially presenting as a scalp mass are quite common entities with a wide spectrum of causes. They may be directly related to the scalp itself or may be secondary stigmata of an underlying process in the skull. The rate and clinical significance of the differential diagnosis of these lesions are not well studied in the adult population. METHODS: Three hundred sixty patients were operated on for scalp masses at our hospital between January 2011 and February 2014. The patients were defined retrospectively by using the hospital coding system for scalp lesions. Among these patients, 15 were excluded for being younger than 16 years old. RESULTS: A total of 345 patients, consisting of 172 females (49.9 %) and 173 males (50.1 %), were included in the study. The mean age at diagnosis was 44.3 (16-89). There were no mortalities during the follow-up period (mean 17.99 months). Mean numbers of scalp lesions and surgeries were 1.25 and 1.18, respectively. There were 32 distinct histopathological diagnoses, the 5 most common being trichilemmal cyst, epidermal cyst, lipoma, nevus and sebaceous cyst in order of frequency. The rate of "clinically significant" pathologies, meaning malignancies or those needing follow-up, was around 7.8 %. The incidence of correct preoperative diagnosis with respect to the departments was 13-27 %. CONCLUSIONS: Our series indicated that generally scalp masses were underestimated and detailed preoperative diagnostic workup or interdisciplinary consultations were not performed regularly. The overall incidence of clinically significant lesions warrants a high degree of vigilance for accurate diagnosis and management of these lesions, because their etiology can be so variable and challenging.

Spinal congenital dermal sinus associated with upper thoracic meningocele. Case Report.

The congenital dermal sinus is an abnormal epithelium-lined sinus tract between the skin surface and deeper tissues. It occurs during neurulation when the neural groove closes to form the neural tube on Day 26 of gestation and results from a failure of neuroectoderm to separate from the cutaneous ectoderm. The most frequent location is the lumbosacral area; an upper thoracic location is quite rare. This 37-year-old man presented with headache and numbness in both arms. No specific neurological findings were observed. Physical examination revealed a dimple at T-2. Radiography and magnetic resonance imaging of the thoracic spine revealed spina bifida at T1-3, a meningocele, and a dermal sinus tract complex. The treatment approach and outcome in this unusual case are presented.