Primary malignant lymphoma of the cavernous sinus--case report.

A 59-year-old female presented with a very rare case of primary malignant lymphoma of the cavernous sinus manifesting as diplopia and right facial hypesthesia. Magnetic resonance (MR) imaging showed the tumor located in the right cavernous sinus as low intensity with marked enhancement by gadolinium. The tumor was partially removed by the transzygomatic extradural approach. The histological diagnosis was malignant lymphoma. Chest and abdominal computed tomography and gallium-67 scintigraphy revealed no other lesions in the body. The patient received conventional radiotherapy and her diplopia and right facial hypesthesia gradually improved. At 1 month after radiotherapy, MR imaging showed no evidence of residual tumor. Primary cavernous sinus malignant lymphoma is extremely rare, but should be considered in the differential diagnosis of cavernous sinus lesions. Histological confirmation of tumors in this region is essential for choosing the most appropriate treatment to achieve a better outcome.

Successful surgical removal of a large arteriovenous malformation in a patient with hemophilia: case report.

OBJECTIVE AND IMPORTANCE: This is the first reported case of the successful surgical removal of a large arteriovenous malformation (AVM) in a patient with hemophilia A. CLINICAL PRESENTATION: A 19-year-old male patient was admitted to our department with intracranial hemorrhage. He had previously been diagnosed with hemophilia A and a cerebral AVM. Carotid angiography revealed a large AVM in the right temporal and parietal lobes. The neurological and neuroradiological findings, especially those of single photon emission computed tomography, identified an area of devitalization around the lesion, which was thought to reduce the risk of new deficits resulting from surgical manipulation. INTERVENTION: We resected the AVM in conjunction with supplemental infusions of Factor VIII before, during, and after the operation. A slight cerebral hemorrhage on the 7th postoperative day was observed despite control with Factor VIII, but the patient was discharged without any new deficits. CONCLUSION: We evaluated and managed all problems of a patient with multiple complications and achieved a medical cure.

Pathologic significance of meningeal enhancement ("flare sign") of meningiomas on MRI.

BACKGROUND: The purpose of this study was to clarify the pathologic features and clinical significance of the meningeal enhancement surrounding meningiomas ("flare sign") on contrast-enhanced T1-weighted magnetic resonance images (MRI). METHODS: The marginal dura mater of tumors was resected from nine cases of meningioma exhibiting a flare sign and used for histopathologic evaluation. RESULTS: Connective tissue proliferation was found in the dura mater in all cases, vascular proliferation was found in three, and tumor cell nests were observed in four cases. In one case, tumor cells were found 4.5 mm from the edge of the tumor. In another case, a meningothelial cell cluster was found. CONCLUSIONS: These results suggest that tumor cell nests are present frequently in dura mater that exhibits the flare sign, and that the dura mater near these lesions should be resected as widely as possible.

Secretory meningioma with severe perifocal edema--case report.

An 82-year-old male presented with a small parasagittal meningioma associated with disproportionately severe perifocal edema. Histological examination including immunohistochemical staining and electron microscopy resulted in a diagnosis of secretory meningioma. In addition to tumor size, the edema could not be explained by location, growth rate, vascular involvement, or other factors. We conclude that secretory meningiomas may possess an innate ability to cause brain edema.

[Calvarial metastasis of cervical carcinoma showing the dural tail sign on magnetic resonance imaging].

A 42-year-old female was admitted to our department on 3 August, 1993 with a 3-month history of steadily enlarging subgaleal mass (3.2 x 3.0 cm) in the parietal region. She had been doing well following radiotherapy for cervical carcinoma of the uterus one year previously. Neurological examination on admission was negative. Axial T1-weighted MR images showed a low-intensity mass with marked homogeneous enhancement in the area of bone destruction, and a dural tail adjacent to the tumor (flare sign) after Gd-DTPA administration. The tumor was totally resected, and was pathologically diagnosed as a calvarial metastasis of the cervical carcinoma. However, 5 months later the tumor recurred anterior to the site of the resection. Since the dura mater adjacent to the tumor exhibited collagen fiber proliferation, the dural tail sign was appeared to represent a reaction to the tumor. Other calvarial metastatic lesions appeared adjacent to the initial lesion 5 months after the initial lesion was resected, however, suggesting that tumor cell nests were present in the dura mater which exhibited the dural tail sign. Extensive pathological examination of the dura mater appears necessary whenever a dural tail sign is detected by magnetic resonance imaging.

[Werner's syndrome associated with meningioma and a cerebrovascular disorder].

We present a case of Werner's syndrome associated with intracranial meningioma and a cerebrovascular disorder. A 49-year-old male was transferred to this hospital with a head injury as a result of a car accident, and a CT scan revealed a traumatic intracerebral hemorrhage. The patient displayed the characteristic clinical features of Werner's syndrome, including premature senility, juvenile cataract, atrophic skin, and a tendency to ward familial occurrence was present. MRI and cerebral angiography revealed multiple intracerebral hemorrhages, perhaps due to amyloid angiopathy, multiple lacunar infarctions and parasagittal meningioma. This is the first report on the MRI findings in the brain of a patient with Werner's syndrome. We suspect that of Werner's syndrome also shows evidence of premature aging on MR images.