RESUMO
Epithelioid hemangioendothelioma is a rare vascular tumour, with features between hemangiomas and angiosarcomas. Evolution remains mainly local but may also metastasize. Here, we report a case of a patient with a spinal epithelioid hemangioendothelioma. After a first resection, local recurrence required a new excision and external radiotherapy. It was achieved by helical TomoTherapy® with intensity modulation. During the follow-up, a second inoperable spinal location necessitated a new sequence of radiotherapy in modulation of intensity with integrated boost. The patient was alive at 24 months of follow-up without evidence of local relapse or distance. This observation is followed by a discussion with review of the literature on other epithelioid hemangioendothelioma cases treated with radiation.
Assuntos
Hemangioendotelioma Epitelioide/radioterapia , Neoplasias da Coluna Vertebral/radioterapia , Vértebras Torácicas , Idoso , Humanos , MasculinoRESUMO
From the seed and leaf extracts of Eryngium species, two new compounds were isolated, along with an aliphatic ketone and several known terpenoids reported from a member of Umbelliferae for the first time. Their structures were elucidated by chemical methods and spectroscopic analysis.
Assuntos
Eryngium/química , Extratos Vegetais/química , Terpenos/isolamento & purificação , Eryngium/metabolismo , Cromatografia Gasosa-Espectrometria de Massas , Ressonância Magnética Nuclear Biomolecular , Rotação Ocular , Extratos Vegetais/metabolismo , Folhas de Planta/química , Folhas de Planta/metabolismo , Sementes/química , Sementes/metabolismo , Terpenos/química , Terpenos/metabolismoRESUMO
A 48-year-old woman was admitted for acute urinary retention. Clinical pelvic examination disclosed a voluminous retro-rectal mass. Plain X-rays, pelvic echography, computerized tomography and MRI were all consistent demonstrating the presence of a 15cm-diameter lesion in the pelvic space with sacral erosion at S3-S4 and extension in the sacral canal up to S2. After a preoperative embolization, the tumor was removed in a two-stage procedure. First, an anterior transabdominal approach dissected the superior and lateral aspects of the tumor. To make easier the intra-abdominal dissection and to avoid any rectosigmoid necrosis, hysterectomy and rectosigmoid section with an end-colostomy were performed. Lastly, a piecemeal removal of the whole tumor was achieved using a posterior approach. At 6 months postoperatively, she recovered a satisfactory urinary control and the colo-rectal anastomosis was then successfully performed. Clinically only a slight hypesthesia of the left perineum was present. In the recent literature, 21 cases were described with similar clinical presentation and similar technical problems to achieve a complete treatment. In the discussion, details of the surgical anterior and posterior approaches are given. Before deciding the most appropriate surgical approach for such a mass, a biopsy is useful to determine whether total removal is relevant. A preoperative embolization can help to reduce the duration of the procedure and the loss of blood.
Assuntos
Neurilemoma/cirurgia , Sacro , Neoplasias da Coluna Vertebral/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neurilemoma/patologia , Pelve , Neoplasias da Coluna Vertebral/patologiaRESUMO
Four cases of thoracic spondylotic myelopathy are reported, one man and three women, respectively 61, 66, 67 and 76 years old. Clinical presentation was numbness and weakness in the lower limbs in two cases, weakness alone in one and numbness alone in the last one. Diagnosis was settled by both myelography and CT-myelogram in three cases, by both MRI and CT-scan in the other one. The involved thoracic levels were both T9-T10 and T10-T11 for two cases and T11-T12 for the other one. The stenosis was due to hypertrophic ossification of the ligamentum flavum in three cases and to osteophytic changes in one. A laminectomy was performed for each patient and three patients had a significant recovery and the fourth a mild one. Thoracic myelopathy is an uncommon disease which requires a meticulous study of myelogram and now MRI to be recognized and to be cured by laminectomy. As for cervical myelopathy, it results from mechanical and ischemic factors which can lead to a definitive myelomalacia.
Assuntos
Disco Intervertebral , Compressão da Medula Espinal/etiologia , Estenose Espinal/complicações , Vértebras Torácicas , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/fisiopatologia , Estenose Espinal/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
In a 64-year-old male with pain and weakness of the right lower limb, investigations disclosed a cervical tumor, several dorsal tumors, and tumoral infiltration of the lumbosacral area. Histological and, above all, immunohistochemical and ultrastructural features were suggestive of meningeal melanocytoma. Before the use of immunohistochemical and electron microscopy techniques, meningeal melanocytoma was designated by the term pigmented meningioma because its histological features bear some resemblance to those of meningioma. However, only a few cases of meningeal melanocytoma have been documented by immunohistochemistry and electron microscopy. Previously reported patients with meningeal melanocytoma had solitary tumors. In contrast, a review of the literature showed that multiple intraspinal or intraspinal and intracranial meningiomas are not exceptional, although meningiomatous infiltration is considerably less frequent. Treatment of such cases rests on surgery, radiotherapy, and chemoimmunotherapy.
Assuntos
Melanoma/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias Primárias Múltiplas , Neoplasias da Medula Espinal/diagnóstico , Terapia Combinada , Humanos , Imageamento por Ressonância Magnética , Masculino , Melanoma/patologia , Melanoma/terapia , Neoplasias Meníngeas/patologia , Meningioma/terapia , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/patologia , Tomografia Computadorizada por Raios XRESUMO
Twenty cases of ependymomas of the intradural filum terminale in adults have been reviewed. Their pathology was quite uniform, of a myxopapillary type, similar to the low grade ependymoma described by Kernohan, which represent about 23% of the tumours of cauda equina. Mean age of the patients was 35.7 years. Mean time between the first symptom and the diagnosis was 46 months. Clinical symptoms were often non specific, with low back pain and radiculalgias. At the time of operation, clinical signs were essentially motor deficits usually moderate (11 cases), sphincter disturbances (10 cases), and sensory loss (9 cases). In 3 patients with rapid worsening, an intratumoral haemorrhage was found. In 2 other cases, intracranial hypertension was the main symptom: in the first, it was related to hydrocephalus probably caused by spinal subarachnoid haemorrhage; in the second, there was no ventricular dilatation. In this series, neuroradiological examinations had consisted mainly in myelographies. C.T. scan has been performed in 3 patients; in only one case it has allowed to visualize a presacral extension. One patient had preoperative M.R.I.: the association of an expansive lesion with upper cyst in conus medullaris and presence of blood in the sacral area permitted the diagnosis of ependymoma of the filum terminalis. The average size of the tumours was 8 cm. Total removal has been possible in 15 cases (and in 2 of the 5 giant tumours), subtotal removal in 2 cases, and partial removal in 3 cases. In 4 patients where existed an intraspinal cord extension above the conus, it has been resected completely, except for one case with recurrence. Patients with a total removal had a good functional recovery (13/15). No recurrence has been observed in this group. In conclusion, with M.R.I., one may hope an earlier diagnosis, condition of radical surgery. So, radiotherapy which is not without risk, could be avoided.
Assuntos
Cauda Equina , Ependimoma/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Adolescente , Adulto , Idoso , Dor nas Costas/etiologia , Ependimoma/complicações , Ependimoma/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielografia , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico , Radiculopatia/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XAssuntos
Artéria Renal/lesões , Trombose/etiologia , Adulto , Humanos , Masculino , Trombose/patologiaRESUMO
A case is reported of an acute intracranial subdural haematoma following an accidental dural puncture during an epidural anaesthesia. A seventy-year old man, class ASA I, was operated on for prostatic adenoma under epidural anaesthesia. Dural puncture occurred during the first introduction of the needle into the L4-L5 epidural space. Epidural anaesthesia was nevertheless obtained by introducing the catheter at the L3-L4 level. The immediate peroperative and postoperative course was uneventful, apart from persisting headache. After removing the epidural catheter at 24 h postoperatively, the patient received calcium heparinate. 26 h later, he complained of worsening headache and became rapidly deeply comatose. The computer tomographic scan showed air in the ventricles and a large right-sided subdural haematoma which was immediately discharged. Although the link between subdural haematoma and dural puncture is well known, the acuteness and rapidly fatal evolution of this case were exceptional and may have been facilitated by the big size of the needle, dehydration and hypercoagulability.
Assuntos
Anestesia Epidural/efeitos adversos , Dura-Máter/lesões , Hematoma Subdural/etiologia , Ferimentos Penetrantes/complicações , Idoso , Desidratação/complicações , Cefaleia/etiologia , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/fisiopatologia , Heparina/efeitos adversos , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
The authors report on the case of a young woman, seven months gone, with an history of sudden onset of successive lobar intracerebral hematomas. They revealed a Rendu-Osler-Weber disease. The mechanism is discussed.
Assuntos
Hemorragia Cerebral/etiologia , Hematoma/etiologia , Complicações Cardiovasculares na Gravidez , Telangiectasia Hemorrágica Hereditária/complicações , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Hematoma/diagnóstico por imagem , Humanos , Gravidez , Radiografia , Recidiva , Fatores de TempoRESUMO
The authors report a case of L4-L5 foraminal disc herniation revealed by symptoms of bi-radicular and medullary lesions. Anatomical study allows to understand such association of symptoms.
Assuntos
Deslocamento do Disco Intervertebral/complicações , Isquemia/etiologia , Medula Espinal/irrigação sanguínea , Raízes Nervosas Espinhais/irrigação sanguínea , Idoso , Feminino , Humanos , Vértebras Lombares , Ciática/etiologiaRESUMO
A case of a surgically verified neurinoma of the oculomotor nerve is presented. The diagnostic difficulties due to the parasellar localisation are discussed. Computed tomography scan data rarely allow to distinguish the nature of the tumor and in all cases are insufficient to distinguish a trigeminal nerve neurinoma of the oculomotor nerves.
Assuntos
Neurilemoma/diagnóstico por imagem , Nervo Oculomotor , Angiografia Cerebral , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Three cases of spinal cord tumor, revealed by hydrocephalus, are reported. Two patients showed symptoms of increased intracranial pressure and the third one presented himself with ataxic gait without intellectual impairment nor incontinence. In two cases ventriculo atrial shunt was initially inserted and the correct diagnosis was made only later on myelogram because lombosciatalgia or syndrome of the cauda equina. Clinical outcome was satisfying after surgical removal of the tumor. The nature of which was a neurinoma of the cauda equina; a lumbar intradural granuloma and an ependymoma of the cauda equina. The mechanism by which spinal cord tumors raised intracranial hypertension is discussed.
Assuntos
Hidrocefalia/etiologia , Pseudotumor Cerebral/etiologia , Neoplasias da Medula Espinal/complicações , Adolescente , Adulto , Cauda Equina , Ependimoma/complicações , Feminino , Granuloma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Doenças da Medula Espinal/complicaçõesRESUMO
Dysphagia due to a traumatic lesion of the foramen lacerum posterior is relatively rare. Two cases are described in which swallowing troubles were perceived when the post-traumatic coma improved; these were ascribed to a traumatic lesion of the foramen lacerum posterior injuring the cranial nerves. Treatment involves preventing inhalation and nasogastric feeding whilst starting active and early rehabilitation of swallowing. Recovery is possible in most cases without surgery.