B-Cell Lymphoma Intramedullary Tumor: Case Report and Systematic Review.

Intramedullary tumors represent the major cause of spinal cord injuries, and its symptoms include pain and weakness. Progressive weakness may concomitantly occur in the upper and lower limbs, along with lack of balance, spine tenderness, sensory loss, trophic changes of extremity, hyperreflexia, and clonus. The study protocol was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of the MEDLINE electronic database was performed to identify the studies reporting the clinical features of children and adults who presented with an intramedullary lymphoma. Twenty-one studies were included, reporting 25 cases. Manuscripts were excluded if the full-text article was not available, original data were not reported (e.g., review articles), or if the main disease was not intramedullary lymphoma. A structured data extraction form was employed to standardize the identification and retrieval of data from manuscripts. To enlighten the discussion, a case is also presented. An 82-year-old woman with Fitzpatrick skin type II, diagnosed and treated for non-Hodgkin's lymphoma 7 years ago, was admitted with mental confusion and memory loss for the past 2 months-evolving with recurring falls from her own height. One day before admission, she displayed Brown-Séquard syndrome. An expansive lesion from C2 to C4 in the cervical spinal cord was found and a hypersignal spinal cord adjacent was described at the bulb medullary transition to the C6-C7 level. A primary spinal cord tumor was considered, as well as a melanoma metastasis, due to the lesion's flame pattern. The patient presented a partial recovery of symptoms and a reduction of the spinal cord edema after being empirically treated with corticosteroids, but the lesion maintained its extent. Subsequently, a large diffuse B-cell lymphoma with nongerminal center was found in open body biopsy, infiltrating neural tissue. The main objective of the present study is to report a surgical case treated for a large diffuse B-cell lymphoma, in addition to presenting the results of a systematic review of primary intramedullary spinal cord lymphoma.

Success of lateral cervical spinal cord stimulation for the treatment of chronic neuropathic refractory pain.

BACKGROUND: Spinal cord stimulation (SCS) is traditionally performed by implanting surgical leads along the midline of the spinal cord, over the dorsal columns. Here, we present a patient who successfully underwent lateral cervical SCS to treat chronic refractory neuropathic pain. METHODS: A 46-year-old female, with a schwannoma involving the right axillary nerve, presented with a chronic refractory right upper extremity pain syndrome. The tumor was located between the fibers of the teres minor and the posterior deltoid, and measured 2.2 cm in diameter. After 8 months of analgesics, opioids, physiotherapy, and acupuncture, the patient underwent surgery; however, the tumor was unresectable (i.e., due to significant adjacent vascular/neural structures). Three months later, she had a midline C6-C7 laminectomy for placement of a right-sided epidural SCS lead (i.e., containing 16 electrode contacts). RESULTS: Within 4 days following this SCS procedure, the patient's pain completely resolved; at 10 postoperative months, she still remains pain free. CONCLUSION: Lateral SCS at the C6-C7 level provided a safe and effective option for the relief of chronic neuropathic pain attributed to an unresectable schwannoma of the right axillary nerve in a 46-year-old female.

Spinal intramedullary abscess due to Candida albicans in an immunocompetent patient: A rare case report.

BACKGROUND: A spinal intramedullary abscess is a rare clinical entity in which patients classically present with a subacute myelopathy and progressive paraplegia, sensory deficits, and/or bowel and bladder dysfunction. We report the second case of spinal intramedullary abscess caused by Candida albicans to ever be published and the first case of its kind to be surgically managed. CASE DESCRIPTION: A 44-year-old female presented with severe lumbar pain associated with paraparesis, incontinence, and paraplegia. She reported multiple hospital admissions and had a history of seizures, having already undergone treatment for neurotuberculosis and fungal infection of the central nervous system unsuccessfully. Nevertheless, no laboratory evidence of immunosuppression was identified on further investigation. Magnetic resonance imaging showed a D10-D11, well-circumscribed, intramedullary mass within the conus, which was hypointense on T1-weighted imaging and hyperintense on T2/STIR weighted. The patient underwent surgery for removal and biopsy of the lesion, which provided the diagnosis of an intramedullary abscess caused by C. albicans, a very rare condition with only one case reported in literature so far. CONCLUSION: C. albicans intramedullary abscess is a very rare clinical entity, especially in immunocompetent patients. We highlight C. albicans as an important etiology that must be considered in differential diagnosis. Critical evaluation of every case, early diagnosis, timely referral and surgical management of the abscess is essential to improve neurological outcome.

Rosai-Dorfman disease mimicking images of meningiomas: Two case reports and literature review.

BACKGROUND: Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytic proliferative disorder classically as a massive cervical lymphadenopathy. However, over the years, extranodal locations were confirmed with the central nervous system involvement in less than 5% of cases, which is marked as a significant differential diagnosis of meningiomas, with which they are widely confused due to the similarity of their radiological images. CASE DESCRIPTION: We report a 37-year-old man and 45-year-old man who were diagnosed with intracranial RDD but whose radiological images mimic meningiomas, requiring anatomopathological and tumor's immunohistochemistry for definitive diagnosis. Moreover, a review of 184 publications with 285 cases of intracranial involvement of this disease was also performed, comparing these findings with those brought in the previous studies. CONCLUSION: Intracranial Rosai-Dorfman tumors should always be remembered as differential diagnosis of meningiomas since they are similar radiologically and macroscopically. Once remembered and diagnosed, the lesion must be treated following the same pattern of resection done in meningiomas and, treatment's differences will not occur in the surgical excision technique, but in complementary chemotherapy implementation, radiotherapy, and even with radiosurgery aid, depending on the case. Thus, it is possible to obtain better results than with just the isolated surgical procedure.

An unusual case of lead migration in occipital nerve stimulation: A case report and literature review.

BACKGROUND: Lead migration is a complication associated with occipital nerve stimulation (ONS). We present a rare case in which fibrosis in the stress relief loop caused lead migration in the treatment of occipital neuralgia. CASE DESCRIPTION: A 30-year-old woman with a 5-year history of refractory occipital neuralgia, who had been under ONS therapy for 2 months, presented with a sudden onset of typical occipital neuralgia pain associated with cervical muscles spasms and myoclonus. A skull radiography showed lead migration. The patient underwent surgery for lead repositioning. During surgery, we identified extensive fibrosis throughout the stress relief loop that produced several constriction points. The fibrosis in the stress relief loop increased tension on the lead during head-and-neck movement, causing progressive migration of the lead. CONCLUSION: Although lead migration is a common complication of ONS, its association with fibrosis in the stress relief loop has not, to the best of our knowledge, been reported before. Lead migration can directly affect treatment outcome and it is, therefore, important to fully understand the possible mechanisms that can cause it and how to promptly manage them.

Avaliação da toxicidade materna e fetal em ratas wistar tratadas com esteroide anabolizante durante a prenhez / Evaluation of maternal and fetal toxicity in wistar rats treated with anabolic steroid during pregnancy / Evaluación de la toxicidad materna y fetal en ratas wistar tratadas con esteroides anabólicos durante el embarazo

Introdução: Esteroides anabolizantes são substâncias sintéticas derivadas da testosterona usadas no tratamento de várias doenças humanas. O uso indiscriminado dessas substâncias para hipertrofia muscular por indivíduos saudáveis tem se tornado um problema de saúde pública. O decanoato de nandrolona se destaca pelo uso sem fins terapêuticos. Objetivo: O objetivo do presente estudo foi avaliar os efeitos do decanoato de nandrolona em dose terapêutica em ratas prenhes e os reflexos do tratamento em seus fetos. Material e Método: 20 ratas foram distribuídas em dois grupos de 10, controle (GC) - recebeu óleo de milho e tratado (GT) ­ recebeu esteroide, administrados por via intraperitonial. No 21º dia de prenhez cesarianas foram realizadas. Nos fetos, foram analisados peso da ninhada, reabsorções e presença de malformações. As ratas foram avaliadas quanto ao peso gestacional, consumo alimentar e hídrico, concentrações séricas de colesterol, triglicérides, glicose, AST e ALT. Resultados: O peso corporal, consumo alimentar e hídrico não diferiram entre os dois grupos. Aumentos estatisticamente significantes nos níveis plasmáticos de AST (p=0,0014) e ALT (P=0,0045) foram observados nas ratas do GT. Nos fetos do GT, o peso da ninhada foi menor (p=0,002), o número de reabsorções foi maior (p=0,049) e a proporção de fetos malformados foi maior (p=0,0023). Conclusão: Os resultados sugerem que o decanoato de nandrolona, mesmo em doses terapêuticas, pode interferir no desenvolvimento fetal em ratos, resultando em malformações variadas.(AU)

Introduction: Anabolic steroids are synthetic substances derived from testosterone used in the treatment of various human diseases. The indiscriminate use of these substances for muscle hypertrophy by healthy individuals has become a public health problem. Nandrolone decanoate stands out for its therapeutic use. Objective: The objective of this study was to evaluate the effects of nandrolone decanoate in therapeutic dose in pregnant rats and the treatment reflexes in their fetuses. Material and Method: 20 rats were distributed in two groups of 10, control (CG) - received corn oil and treated (GT) - received steroid, administered intraperitoneally. On the 21st day of pregnancy, caesarean sections were performed. In fetuses, litter weight, reabsorption and presence of malformations were analyzed. Rats were evaluated for gestational weight, food and water intake, cholesterol serum concentrations, triglycerides, glucose, AST and ALT. Results: Body weight, food and water consumption did not differ between the two groups. Statistically significant increases in plasma levels of AST (p=0.0014) and ALT (P=0.0045) were observed in GT rats. In GT fetuses, litter weight was lower (p=0.002), the number of resorptions was higher (p=0.049), and the proportion of malformed fetuses was higher (p=0.0023). Conclusion: The results suggest that nandrolone decanoate, even at therapeutic doses, may interfere with fetal development in rats, resulting in varied malformations.(AU)

Introducción: Los esteroides anabólicos son sustancias sintéticas derivadas de la testosterona que se utilizan en el tratamiento de diversas enfermedades humanas. El uso indiscriminado de estas sustancias para la hipertrofia muscular por parte de individuos sanos se ha convertido en un problema de salud pública. El decanoato de nandrolona se destaca por su uso no terapéutico. Objetivo: El objetivo del presente estudio fue evaluar los efectos del decanoato de nandrolona en dosis terapéutica en ratas preñadas y los reflejos del tratamiento en sus fetos. Material y Métodos: Se distribuyeron 20 ratas en dos grupos de 10, control (GC) - recibieron aceite de maíz y tratadas (GT) - recibieron esteroides, administrados por vía intraperitoneal. El día 21 de gestación se realizaron cesáreas. En los fetos se analizó el peso de la camada, la reabsorción y la presencia de malformaciones. Las ratas fueron evaluadas por peso gestacional, consumo de alimento y agua, concentraciones séricas de colesterol, triglicéridos, glucosa, AST y ALT. Resultados: El peso corporal, el consumo de alimentos y agua no difirieron entre los...(AU)

Foramen magnum meningioma: Series of 20 cases. Complications, risk factors for relapse, and follow-up.

INTRODUCTION: Meningiomas account for 2.2% to 2.5% of all cerebral tumors, of which only 2% are located in the foramen magnum. Foramen magnum meningiomas (FMMs) are commonly found in women, with a mean age at onset of 52 years old. They generally behave more aggressively than other meningiomas. MATERIALS AND METHODS: We performed epidemiological, anatomical and surgical analyses of 20 patients diagnosed with FMMs who underwent surgical treatment from 1999 to 2019 at Santa Paula Hospital in Sao Paulo. This case series was compared with previously published ones to better understand this relatively rare disease. RESULTS: Twenty patients were included, with a mean follow-up of 110 months. Their mean age was 37.8 years old. The mean preoperative Karnofsky performance status scale (KPS) was 84%. We found a female (65%) and left hemisphere predominance (50%). Involvement of both hemispheres was found in 25% of patients. FMM locations were anterior, anterolateral, lateral and posterior, in 45%, 35%, 10%, and 10%, respectively. Simpson resection grades I, II, and III were achieved in 25%, 60%, and 15% of cases, respectively. Mean postoperative KPS was 79%. Three patients with anterior and bilateral located meningiomas had a worse postoperative KPS in comparison to the preoperative one. CONCLUSION: Anterior and bilateral FMMs seem to be related to a worse prognosis. A gross total resection can reduce the recurrence rates. The KPS is worse in patients with recurrence.