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1.
Prague Med Rep ; 120(2-3): 95-102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31586508

RESUMO

Malignant transformation of an epidermoid tumour is a rare entity that in almost all patients occurs at the same site of the primary lesion. We report a case of an epidermoid tumour with malignant transformation to squamous cell carcinoma (SCC) at the adjacent site but without any relation to the primary site of the tumour. A 30-year-old patient with a history of cranial surgery and resection of cerebellopontine (CP) angle epidermoid cyst five years ago, presented with a headache, nausea, and vomiting. Physical examination showed no neurological deficit. The brain magnetic resonance imaging (MRI) demonstrated a well-defined lesion within left middle cerebellar peduncle with no relation to CP angle cistern (the previous tumour site). It was isointense on T1, isointense on T2 and had a rim enhancement on gadolinium (GD) injection. Via retrosigmoid and transcortical approach, total resection of the tumour was performed. During the surgery, there was no visible relationship between the current lesion and the previously resected lesion site. Histopathology revealed squamous cell carcinoma. The systemic survey to finding a probable origin of the tumour was negative and the patient referred for performing brain radiotherapy. We are reporting a case of malignant transformation of epidermoid cyst separate from primary location. Moreover, malignant transformation can occur years after index surgery even after gross total resection.


Assuntos
Carcinoma de Células Escamosas/patologia , Transformação Celular Neoplásica , Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino/patologia , Cisto Epidérmico/patologia , Adulto , Humanos , Imagem por Ressonância Magnética
2.
World Neurosurg ; 132: 375-376, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493615

RESUMO

Facial nerve identification and preservation is a critical step in the resection of vestibular schwannoma. The use of intraoperative neurostimulation to positively identify the facial nerve along its entire course is essential to prevent injury. To our knowledge, this is the first reported case of a bifid facial nerve with a dual origin at the brainstem, which we observed during resection of vestibular schwannoma via the translabyrinthine approach. Both roots were visualized to join as one facial nerve trunk outside the brainstem in the cisternal segment of the facial nerve, and both trunks demonstrated positive signal with neurostimulation. This case highlights an important anatomic variation and also the importance of correct identification of facial nerve anatomy during resection of vestibular schwannoma and other pathologies within the cerebellopontine angle.


Assuntos
Nervo Facial/anormalidades , Nervo Facial/patologia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos , Ângulo Cerebelopontino/patologia , Orelha Interna/cirurgia , Estimulação Elétrica , Humanos , Masculino , Pessoa de Meia-Idade
3.
Medicine (Baltimore) ; 98(32): e16756, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393392

RESUMO

RATIONALE: In some cases, surgery of cerebellopontine angle meningioma (CPAM) might result in multiple cranial nerve injury, which could bring serious impact on the patients, especially when it affects the function of facial muscles and eyeballs. This report describes a successful application of acupuncture for rehabilitation in a patient after surgery for CPAM. PATIENT CONCERNS: A 27-year-old patient presented with limitation of left eye abduction, accompanied with frontal and facial sensory disturbance on the left after resection of the pontocerebellar angle tumor. The patient also suffered from significant anxiety and depression as concomitant symptoms. DIAGNOSES: Based on medical history, clinical symptoms, and magnetic resonance imaging results, the patient was diagnosed with the fourth, fifth, sixth, and seventh cranial nerve injury after surgery for CPAM. INTERVENTIONS: Acupuncture treatment was applied for this patient. One acupuncture session was given every 2 days in 35 days, and the needles were retained for 30 minutes per session. OUTCOMES: After acupuncture treatment, the limitation of left eye abduction had totally recovered. The superficial sensory disturbance in the frontal and facial region was significantly relived. Besides, the scores of Hamilton Anxiety and Depression Scale showed a significant reduction. However, the superficial sensory of the alar and nasolabial groove on the left side still decreased mildly when compared with the right side. CONCLUSION: Acupuncture might be an option for rehabilitation after surgery for CPAM.


Assuntos
Terapia por Acupuntura/métodos , Neoplasias Cerebelares/cirurgia , Traumatismos dos Nervos Cranianos/reabilitação , Meningioma/cirurgia , Adulto , Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino/patologia , Traumatismos dos Nervos Cranianos/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino
4.
World Neurosurg ; 130: 378-379, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306840

RESUMO

Vestibular schwannomas (VSs) are rare in children and, when present, are usually part of neurofibromatosis 2 and bilateral. Sporadic unilateral VSs in the pediatric age group itself are rare in medical literature and giant sporadic unilateral pediatric VSs (>4 cm) are extremely rare. Herein, we describe the largest reported case of giant sporadic left-sided VS in a 10-year-old boy.


Assuntos
Neoplasias Cerebelares/patologia , Neuroma Acústico/patologia , Ângulo Cerebelopontino/patologia , Criança , Humanos , Masculino , Tratamentos com Preservação do Órgão/métodos , Resultado do Tratamento , Carga Tumoral
6.
J Clin Neurosci ; 67: 93-98, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239198

RESUMO

Cerebellopontine angle (CPA) medulloblastoma is rare and short of system description. We attempted to clarify its epidemiology, clinical manifestations, imaging features, pathological and molecular types, and surgical outcomes. 8 patients from 7 to 52 years old were enrolled in this retrospective study, with mean age 21.6 ±â€¯16.4 years. The most frequent symptoms were raised intracranial pressure (100%), followed by cerebellar signs (50%), decreased hearing (50%), facial paralysis (50%), abducent paralysis (50%), and facial paresthesia (37.5%). MRI demonstrated a solid CPA lesion with heterogeneously weak or significant enhancement after gadolinium administration, accompanied with peritumoral oedema (75%), cystic change (62.5%) and dural tail sign (50%), while CT showed petrous bone and internal auditory canal intact. All cases received tumor excision, with 6 (75%) cases undergoing gross total resection, and the remaining (25%) getting partial excision. Pathological examination confirmed 5 (62.5%) classic, 2 (25%) desmoplastic, and 1 (12.5%) anaplastic. Further molecular analysis identified 5 (62.5%) WNT and 3 (37.5%) SHH. Immediately after the primary surgery, 7 (87.5%) cases gained improvement of the symptoms and signs and 1 (12.5%) kept the preoperative status stable. Follow up was available ranged from 5 to 34 months, during that period 5 cases kept symptom free and 3 cases recurred/progressed. In conclusion, CPA medulloblastoma is rare and lacking of special clinical manifestations and radiological features, and should be considered in the differential diagnosis of CPA lesions. In this series the most frequent pathological and molecular type is classic and WNT. Microsurgery excision is effective to prevent progressive decline of neurological status.


Assuntos
Neoplasias Cerebelares , Ângulo Cerebelopontino/patologia , Meduloblastoma , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
7.
World Neurosurg ; 129: 157-163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31103763

RESUMO

BACKGROUND: Vestibular schwannomas (VS) are common slow-growing tumors that typically present with the insidious progression of unilateral hearing loss, tinnitus, vertigo, and gait imbalance. Clinically significant intratumoral acute hemorrhage is exceedingly rare and can present with the acute onset of symptoms, neurologic deterioration, and significant dysfunction of cranial nerves VII and VIII. We discuss a 40-year-old man who developed mild hearing loss and headaches over the course of a month before presenting with a large acutely hemorrhagic vestibular schwannoma. In addition, we review the current literature pertaining to this pathology. CASE PRESENTATION: A previously healthy 40-year-old man with a 1-month history of mild headaches, dizziness, and left-sided hearing loss, tinnitus, and facial numbness presented with the acute onset of severe headache, vomiting, complete left-sided hearing loss, and left-sided facial weakness. Computed tomography and magnetic resonance imaging revealed a 4.1 × 2.7 cm hemorrhagic mass in the left cerebellopontine angle most consistent with VS. The patient subsequently underwent a retrosigmoid craniotomy and resection of the tumor. Pathology was consistent with hemorrhagic VS. Imaging at 1-year follow-up demonstrated no residual or recurrent disease, and facial motor function had completely recovered. CONCLUSIONS: Histologically, vascular abnormalities and microhemorrhages are nearly ubiquitous across vestibular schwannomas and may contribute to cystic degeneration and rapid tumor growth. However, clinically significant hemorrhage is rarely encountered and is more commonly associated with more profound neurologic sequelae and cranial nerve VII dysfunction. Surgical resection at the time of presentation should be strongly considered to remove the risk of repeat hemorrhage and further deterioration. Our case represents a typical presentation and clinical course for a patient presenting with this rarely encountered pathology.


Assuntos
Hemorragia/etiologia , Neuroma Acústico/complicações , Neuroma Acústico/patologia , Adulto , Ângulo Cerebelopontino/patologia , Humanos , Masculino
8.
World Neurosurg ; 127: e221-e229, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30880202

RESUMO

OBJECTIVE: We evaluated the tumor control and cranial nerve (CN) outcomes after adjuvant stereotactic radiosurgery (SRS) for petroclival, cavernous sinus, and cerebellopontine angle meningiomas. METHODS: From our prospectively maintained database of 2022 patients with meningioma who had undergone Leksell SRS during a 30-year interval, we found 43 patients with petroclival, 94 with cavernous sinus, and 13 patients with cerebellopontine angle meningiomas who had undergone adjuvant SRS after surgical resection of the meningioma. The patients included in the present report had had ≥1 CN deficit at the initial presentation and a minimum follow-up period of 12 months. The median age at SRS was 54 years (range, 22-81). SRS was performed for residual tumor in 104 patients (69%) and recurrent tumor in 46 patients (31%). The median tumor volume treated with SRS was 8.1 cm3 (range, 0.3-42), and the median margin dose was 13 Gy (range, 10-20). RESULTS: Tumor control was achieved in 135 patients (90%) at a median follow-up point of 75 months. The progression-free survival rate after SRS was 99.5% at 1 year, 98% at 3 years, 95% at 5 years, and 90% at 10 years. Overall, 29 of the 150 patients (19%) reported improvement in CN function. Deterioration in CN function after SRS developed in 15 patients (10%). The rate of deterioration was 3.5% at 1 year, 5.5% at 3 years, and 7% at 5 years. CONCLUSIONS: Adjuvant SRS provides effective tumor control and a low rate of new or worsening CN deficits.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Radiocirurgia/métodos , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Seio Cavernoso/patologia , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/patologia , Nervos Cranianos/patologia , Bases de Dados Factuais , Progressão da Doença , Feminino , Seguimentos , Humanos , Hidrocefalia/etiologia , Estimativa de Kaplan-Meier , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia , Meningioma/complicações , Meningioma/patologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/etiologia , Intervalo Livre de Progressão , Radiocirurgia/efeitos adversos , Reoperação , Estudos Retrospectivos , Neoplasias da Base do Crânio/complicações , Resultado do Tratamento , Adulto Jovem
9.
Am J Otolaryngol ; 40(2): 133-136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30717992

RESUMO

OBJECTIVES: To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology. DESIGN: Retrospective chart review. PARTICIPANTS: Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017. MAIN OUTCOME MEASURES: Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses. RESULTS: Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (p = 0.001) and facial weakness (p = 0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (p = 0.02) but not with differences in surgical pathology (p > 0.05). CONCLUSIONS: Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.


Assuntos
Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino , Neuroma Acústico/diagnóstico , Neuroma Acústico/patologia , Adulto , Idoso , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/patologia , Diagnóstico Diferencial , Neoplasias Faciais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas , Meningioma , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Neuroma , Neuroma Acústico/cirurgia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária
10.
Nat Protoc ; 14(2): 541-555, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30617350

RESUMO

Neurofibromatosis type II (NF2) is a disease that lacks effective therapies. NF2 is characterized by bilateral vestibular schwannomas (VSs) that cause progressive and debilitating hearing loss, leading to social isolation and increased rates of depression. A major limitation in NF2 basic and translational research is the lack of animal models that allow the full spectrum of research into the biology and molecular mechanisms of NF2 tumor progression, as well as the effects on neurological function. In this protocol, we describe how to inject schwannoma cells into the mouse brain cerebellopontine angle (CPA) region. We also describe how to apply state-of-the-art intravital imaging and hearing assessment techniques to study tumor growth and hearing loss. In addition, ataxia, angiogenesis, and tumor-stroma interaction assays can be applied, and the model can be used to test the efficacy of novel therapeutic approaches. By studying the disease from every angle, this model offers the potential to unravel the basic biological underpinnings of NF2 and to develop novel therapeutics to control this devastating disease. Our protocol can be adapted to study other diseases within the CPA, including meningiomas, lipomas, vascular malformations, hemangiomas, epidermoid cysts, cerebellar astrocytomas, and metastatic lesions. The entire surgical procedure takes ~45 min per mouse and allows for subsequent longitudinal imaging, as well as neurological and hearing assessment, for up to 2 months.


Assuntos
Ângulo Cerebelopontino/patologia , Diagnóstico por Imagem/métodos , Modelos Animais de Doenças , Perda Auditiva/patologia , Neurofibromatose 2/patologia , Neuroma Acústico/patologia , Animais , Linhagem Celular Tumoral , Ângulo Cerebelopontino/metabolismo , Ângulo Cerebelopontino/cirurgia , Expressão Gênica , Genes Reporter , Audição/fisiologia , Perda Auditiva/genética , Perda Auditiva/fisiopatologia , Testes Auditivos , Humanos , Injeções Intraventriculares , Luciferases/genética , Luciferases/metabolismo , Camundongos , Camundongos Knockout , Neurofibromatose 2/genética , Neurofibromatose 2/fisiopatologia , Neurofibromina 2/deficiência , Neurofibromina 2/genética , Neuroma Acústico/genética , Neuroma Acústico/fisiopatologia , Técnicas Estereotáxicas
12.
J Int Adv Otol ; 14(3): 488-492, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30541730

RESUMO

Schwannoma arising from the intermediate nerve is very rare, with only a few cases reported in the literature. Here, we report a rare case of a rapidly growing schwannoma that originated from the intermediate nerve in a 17-year-old woman. We performed tumor resection using the translabyrinthine approach with continuous intraoperative monitoring, in which the facial nerve root was used to evoke muscle action potential. The monitoring revealed the tumor origin and enabled complete surgical resection with the preservation of facial nerve motor function. The facial nerve root evoked muscle action potential-based continuous monitoring revealed the origin of the rare intermediate nerve schwannoma. Appropriate surgery using this monitoring system could spare facial nerve function even in this rare case and retain the patient's quality of life.


Assuntos
Ângulo Cerebelopontino/patologia , Nervo Facial/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Neurilemoma/patologia , Adolescente , Ângulo Cerebelopontino/cirurgia , Orelha Interna/cirurgia , Eletromiografia/métodos , Feminino , Humanos , Neurilemoma/cirurgia
14.
Medicine (Baltimore) ; 97(46): e13179, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30431593

RESUMO

RATIONALE: Cystic meningioma located at the cerebellopontine angle (CPA) is an extremely rare occurrence. It is frequently misdiagnosed preoperatively. Little is known about the clinical features and outcome of this rare disease. PATIENT CONCERNS: A 70-year-old male presenting with progressive headache and gait disturbance. DIAGNOSIS: According to the symptoms, signs, and Gd-enhanced magnetic resonance images (MRI), a preoperative diagnosis of hemangioblastoma located in left CPA was made. Finally, the histological examination revealed a meningioma. INTERVENTIONS: A complete resection, including the part of the solid mass together with cyst, was performed. OUTCOMES: The postoperative course of the patient was uneventful, and no residual or recurrent tumor was found during the 24-month follow-up period. LESSONS: Cystic meningioma should be included in the differential diagnosis of a CPA mass with atypical radiologic features, such as a large cyst and enhanced mural nodule. By summarizing the related literature, we found that the most common pathological subtype of CPA cystic meningioma is the clear cell subtype, which belongs to WHO grade II. Gross total resection including the enhanced cyst wall is extremely important. A close follow-up is necessary because of the high recurrence rate in this subset of meningioma.


Assuntos
Neoplasias Cerebelares/diagnóstico , Ângulo Cerebelopontino/patologia , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Idoso , Neoplasias Cerebelares/cirurgia , Cistos/diagnóstico , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia
15.
Acta Biomed ; 89(3): 411-414, 2018 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-30333469

RESUMO

Schwannomas affect mainly head and neck peripheral nerves, are benign tumors and derive from Schwann cells. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. Case report: A 47-year-old female was diagnosed by MRI with a tumor of right cerebellopontine angle.. Cytologic material from the tumor was obtained intraoperatively and diagnosed cytologically as a neurilemoma. Conclusion: This case is presented here to focus the ability of cytology in diagnosis of schwannoma in intraoperative material of the tumor, using immunohistochemistry and confirmed by histology- immunohistochemistry.


Assuntos
Neoplasias Cerebelares/diagnóstico , Ângulo Cerebelopontino/patologia , Neurilemoma/diagnóstico , Biomarcadores Tumorais , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/diagnóstico por imagem , Ângulo Cerebelopontino/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neurilemoma/cirurgia
16.
World Neurosurg ; 119: e855-e863, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30099190

RESUMO

OBJECTIVE: To evaluate a new surgical tool combining suction and monopolar neurostimulation (stimulation sucker) for cerebellopontine angle (CPA) tumors. The usefulness for continuous (time) and dynamic (space) facial nerve mapping was studied. METHODS: Patients operated on with the stimulation sucker for a CPA tumor between April 2016 and May 2017 in a tertiary care center were identified. Clinical charts were retrospectively evaluated. The minimum follow-up time of patients was 12 months. RESULTS: The study population included 17 patients with tumor (6 women and 11 men). The age range was from 2 to 77 years (mean age, 45.7 years; standard error of the mean, 22.7 years). Most CPA tumors were large (Koos grade 4) vestibular schwannomas (n = 10); other pathologies included petrous meningioma (n = 1), metastasis (n = 1), medulloblastoma (n = 2), ependymoma (n = 2), and pilocytic astrocytoma (n = 1). One patient with trigeminal neuralgia served as the normal control subject. No complications because of the stimulation sucker were encountered. Clinical and radiologic outcomes compared favorably with institutional experience and literature. The stimulation sucker allowed for continuous (time) mapping of the facial nerve at the site of resection (space). This real-time feedback allowed early identification of the facial nerve. Handling and ergonomy were excellent and workflow improved. The shortcomings compared with a bayonet-shaped bipolar probe were decreased visibility of neurovascular structures and lower spatial discrimination. The new device did not simplify delicate at the brainstem and on the nerve. We think it should be considered as a complementary tool in the surgeon's armamentarium. CONCLUSIONS: Until now, nerve damage as assessed by neuromonitoring (e.g., facial nerve electromyography, motor evoked potential) served as surrogate for nerve function. This concept should be challenged. The studied stimulation sucker detected the facial nerve earlier than conventional techniques, preventing harm by surgical trauma. A larger, prospective study is warranted to better define its role in CPA surgery.


Assuntos
Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/cirurgia , Nervo Facial/patologia , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/fisiopatologia , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/fisiopatologia , Estimulação Elétrica/métodos , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Projetos Piloto , Estudos Retrospectivos
17.
Neuropathology ; 38(5): 510-515, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29876981

RESUMO

Intracranial epidermoid cysts are rarely known to increase in size over a brief period. While malignant transformations of epidermoid cyst have been previously described, no reports to date have described rapid proliferation accompanied by mature hair follicles and sebaceous glands without malignant transformations. The present case involved a 71-year-old man who visited a local physician with disturbance of equilibrium. A mass lesion was detected at the left cerebellopontine angle and was subsequently removed. Histopathological diagnosis of this lesion was as an epidermoid cyst. Seventeen years after this initial surgery, worsened left hypoacusis, disorientation, eating disorder and gait disturbance appeared, and the patient visited the physician again. Local recurrence of the lesion was observed, and the patient was referred to our hospital for its removal. Intraoperative findings revealed a pearly white tumor, histopathologically diagnosed as an epidermoid cyst. Three years later, local recurrence was observed, and the cyst was again removed. Intraoperative findings revealed a partially pearly white tumor similar to the tumor observed during the second surgery, but the majority of the tumor was non-shiny, ochre-colored and suckable. Histopathological diagnosis was an epidermoid cyst with an epidermis-like structure. Postoperative activities of daily living were independent thereafter, but from March of the following year, he began to experience increasing difficulty in walking and subsequently visited our hospital again. Tumor recurrence was observed and was removed again in November of the same year. Intraoperative findings revealed a tumor that was primarily ochre-colored, non-shiny, brittle and suckable. The histopathological diagnosis was folliculosebaceous epithelial proliferative lesion accompanied by an epidermis-like epithelium and a differentiation into hair follicles and sebaceous gland,s and the tumor was determined to be an epidermoid cyst with proliferative folliculosebaceous epithelium.


Assuntos
Doenças Cerebelares/patologia , Ângulo Cerebelopontino/patologia , Cisto Epidérmico/patologia , Folículo Piloso/patologia , Glândulas Sebáceas/patologia , Idoso , Epitélio/patologia , Humanos , Masculino , Recidiva
18.
Neuropathology ; 38(5): 503-509, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29876986

RESUMO

A malignant component in an epidermoid cyst is rare. We report an exceptionally rare case of a malignant melanoma arising in an epidermoid cyst located in the cerebellopontine (CP) angle. A 26-year-old woman presented with headache, vomiting, ataxia and difficulty in swallowing over the previous 3 months. The radiological finding suggested an epidermoid cyst and the lesion was excised. The histopathology confirmed a CP angle epidermoid cyst. Within 1 month of discharge, she developed hydrocephalus for which a ventriculo-peritoneal shunt was performed. Postoperatively she developed weakness in lower limbs. A contrast-enhanced MRI was done which showed dilated CSF cisternal spaces with a small enhancing lesion in the pineal region and enhancement of meninges extending to the spinal cord. Re-exploration showed gelatinous material with gross adhesions in the CP angle cistern. A dural biopsy was done which showed sheets of poorly differentiated tumor cells which expressed S100 and Melan A and were immunoreactive with Human Melanoma Black (HMB)-45 antibody, consistent with the diagnosis of malignant melanoma. Histology of the excised epidermoid cyst was re-evaluated in deeper sections and showed scattered atypical melanocytes in the basal layer of the epidermis which were highlighted with HMB-45 antibody. The patient expired within 3 days of the second procedure due to respiratory failure. A very aggressive fulminant course of the disease was evident after surgery for the epidermoid cyst. Treatment options are limited. Criteria for identification of malignancy in an intracranial epidermoid cyst were identified in our case retrospectively and have been highlighted.


Assuntos
Doenças Cerebelares/patologia , Cisto Epidérmico/complicações , Cisto Epidérmico/patologia , Melanoma/patologia , Carcinomatose Meníngea/patologia , Adulto , Transformação Celular Neoplásica/patologia , Doenças Cerebelares/complicações , Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino/patologia , Evolução Fatal , Feminino , Humanos , Melanoma/complicações , Carcinomatose Meníngea/complicações
19.
World Neurosurg ; 117: 221-224, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29929035

RESUMO

BACKGROUND: Anaplastic gangliogliomas at the cerebellopontine angle (CPA) are exceptionally rare with only a few reported cases in published literature. These are composed of atypical ganglion cells and astrocytes accounting for nearly 1% of all central nervous system tumors. The authors report the case of anaplastic ganglioglioma in an adult patient presenting as a CPA mass lesion. The presentation was bizarre, and the diagnosis was possible only after histopathologic examination of the resected mass. CASE DESCRIPTION: A 32-year-old lady presented with complaints of gradually progressive hearing loss and tinnitus in her right ear along with headache and ataxia. Neurologic evaluation revealed right-sided sensorineural hearing loss and truncal ataxia. Magnetic resonance imaging of the brain was suggestive of a well-defined, contrast-enhancing, solid-cystic mass at the CPA cistern that extended into the porus acusticus, causing enlargement of the internal acoustic meatus. The features were suggestive of vestibular schwannoma of the CPA. CONCLUSIONS: This unusual appearance of anaplastic ganglioglioma has not been previously described. Neurosurgeons need to keep in mind the possibility of anaplastic gangliogliomas in the differential diagnosis of CPA lesions.


Assuntos
Neoplasias Encefálicas/diagnóstico , Ganglioglioma/diagnóstico , Neuroma Acústico/diagnóstico , Adulto , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Ângulo Cerebelopontino/diagnóstico por imagem , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/cirurgia , Diagnóstico Diferencial , Feminino , Ganglioglioma/patologia , Ganglioglioma/cirurgia , Humanos , Neuroma Acústico/patologia
20.
J Clin Neurosci ; 52: 115-119, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29656000

RESUMO

Primary central nervous system lymphoma (PCNSL) is an uncommon extranodal manifestation of non-Hodgkin's lymphoma with those presenting at the cerebellopontine angle (CPA) being rare presentations with limited reported cases in the literature. We report a 60-year old female presenting with PCNSL of the left CPA radiologically mimicking a trigeminal schwannoma with corresponding clinical signs. Imaging showed a left CPA lesion that was biopsied and confirmed as diffuse large B-cell lymphoma. Given its rarity, PCNSL should be considered in the differential diagnosis for all CPA tumours.


Assuntos
Neoplasias do Sistema Nervoso Central/patologia , Ângulo Cerebelopontino/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Neuroma Acústico/patologia , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Ângulo Cerebelopontino/patologia , Diagnóstico Diferencial , Feminino , Humanos , Linfoma Difuso de Grandes Células B/patologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem
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