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1.
Medicine (Baltimore) ; 99(8): e19178, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080099

RESUMO

RATIONALE: Primary melanocytic tumors of central nerve system (CNS) are rare, primary diffuse leptomeningeal melanomatosis (PDLM), a subtype of malignant melanomas of CNS, is extremely rare,especially in pediatrics. As the clinical manifestation of PDLM is not characteristic, It is often misdiagnosed as tubercular meningitis and hemorrhage. PATIENT CONCERNS: A 13-year-old boy was admitted to our department with symptoms of recurrent headache and vomiting twice. As the brain imaging revealed a lesion located in the left temporal lobe mimicked hemorrhage, so there was a misdiagnosis of hemorrhage in first hospitalization. He was admitted again for the recurrence of the headache and vomiting. Detailed physical examination showed multiple melanin changes in the skin of the whole body which were ignored in last hospitalization. Brain imaging showed the significantly enlarged lesion in the left temporal lobe and several smaller lesions in the left parietal lobe and cerebellum which indicated metastasis. DIAGNOSIS: According to the history,physical examination and the radiological finding, the patient was diagnosed with malignant melanoma of central never system possibly. INTERVENTIONS: The patient underwent left temporal and parietal lesions total resection with a craniotomy. OUTCOMES: The diagnosis of PDLM was established according to pathological characteristics and the negative finding of positron emission tomography (PET)-computed tomography (CT) outside CNS. The patient got no further treatment for economic reasons and experienced the progression and died 5 months after operation. LESSONS: PDLM is extremely rare in CNS, as the clinical manifestation, radiological changes are not special, early diagnosis is difficult. The confirmed diagnosis is established by leptomeningeal biospy or surgical tissue. PET-CT can help differential diagnosis with metastastic leptomeningeal melanomas. The prognosis is dismal due to the inefficiency of chemotherapy or radiotherapy.


Assuntos
Melanoma/diagnóstico , Melanoma/patologia , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Adolescente , Craniotomia , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
2.
Medicine (Baltimore) ; 99(3): e18783, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011473

RESUMO

RATIONALE: Primary melanin-producing tumors are rare extra-axial neoplasms OPEN of the central nervous system. In the literature, few case reports have discussed neoplasms involving the cavernous sinus; of these, only 4 have reported on neoplasms originating in Meckel cave. The diagnostic approach, including clinical and radiological analysis, is challenging, and cytopathological assessment with a molecular basis is the best approach to discriminate between these lesions. Herein, we discuss the pathophysiology, diagnostic approach, intraoperative features, and postoperative management in a unique case of primary pigmented meningeal melanocytoma originating in Meckel cave in a patient who was diagnosed with Carney complex (CCx) and sickle cell disease (SCD). PATIENT CONCERNS: A 23-year-old man diagnosed with SCD had also been diagnosed previously with CCx, without any familial history or neurocutaneous melanosis. He had experienced headaches accompanied by left facial pain and paresthesia for 2 months. DIAGNOSIS: The initial computed tomography scan and magnetic resonance imaging (MRI) revealed a mass arising from the left Meckel cave. On MRI, it followed the signal intensity of melanin. He underwent subtotal resection of the mass. Considering the patient's history of CCx, melanocytic schwannoma was the most relevant diagnosis. A postoperative histopathological examination was suggestive of benign pigmented meningeal melanocytoma. INTERVENTIONS: The patient underwent an uneventful subtotal resection of the mass through a left temporal linear incision. OUTCOMES: The patient showed progressive improvement of neurologic deficits, and after 2 years of follow-up, he did not present with any new complaints. LESSONS: To the best of our knowledge, this is the first report of the unusual presentation of both SCD, as well as of primary pigmented meningeal melanocytoma in a patient with CCx. Complete surgical resection can be curative in most cases of melanocytoma. The presence of CCx with SCD suggests potential shared genetic contributions that will require further exploration.


Assuntos
Complexo de Carney/complicações , Melanoma/complicações , Melanoma/diagnóstico , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Anemia Falciforme/complicações , Diagnóstico Diferencial , Humanos , Masculino , Melanoma/patologia , Melanoma/cirurgia , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Base do Crânio , Adulto Jovem
3.
World Neurosurg ; 135: 141-145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843730

RESUMO

BACKGROUND: Rosai-Dorfman disease (RDD) is a rare, benign histiocytosis disorder with only approximately 100 reported central nervous system cases in the literature. Even less common is skull base involvement of RDD, with about 41 reported cases. Radiographically, RDD can appear similar to a meningioma; the true diagnosis is only found with histologic analysis. Although "benign," RDD can lead to significant neurologic morbidity from the disease or unnecessary surgical and nonsurgical treatment. While rare, intracranial RDD has been treated with chemotherapy or radiotherapy, with surgery playing a limited role to relieve mass effect. Surgical approaches to the skull base are invasive and pose risk, especially for a benign and self-limiting disease like RDD. CASE DESCRIPTION: Here we present the case of a 63-year-old woman with a presumed spheno-orbital meningioma for which the patient previously underwent radiation therapy. On presentation to our facility, the patient noted pressure headaches and blurry vision, and imaging demonstrated progression of her disease. For these reasons, surgical debulking and biopsy were undertaken. CONCLUSIONS: This report demonstrates the role of EEA for tissue biopsy and decompression of the affected cranial nerves and orbit. This paradigm seems to provide a safe and effective way to manage patients with compressive symptoms, while also allowing for tissue sampling.


Assuntos
Descompressão Cirúrgica , Histiocitose Sinusal/terapia , Cirurgia Endoscópica por Orifício Natural , Base do Crânio/cirurgia , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Feminino , Histiocitose Sinusal/diagnóstico , Humanos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Retratamento , Base do Crânio/diagnóstico por imagem
4.
Medicine (Baltimore) ; 98(47): e18076, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764840

RESUMO

RATIONALE: Hemangioblastoma (HB) is a benign tumor that is typically located in the subtentorial region of the brain. HB that originates from dura mater is extremely rare. PATIENT CONCERNS: Herein, we reported a single case of a patient who presented with dizziness and headache lasting for 1 year that progressively aggravated within 1 month. DIAGNOSIS: After admission, the patient underwent head magnetic resonance (MR); a nodular long T1-T2 signal was found on the right side of parietal falx cerebri; the lesion appeared with high intensity on FLAIR and DWI, and with isointensity on ADC map. In addition, significant homogeneous enhancements were observed on the enhanced scan. According to clinical and imaging features, the lesion was diagnosed as meningioma. However, after performing tumor resection by craniotomy, the diagnosis of HB is clear. Additional pathological examination data were found: Ki-67(+1%), NSE(-), CD31(+), CD34(+), CD56(+), S-100(-), α-inhibin(+), Vimentin(-), EGFR-), GFAP(-), CK-pan(-), EMA(-), PR(-). INTERVENTIONS: The mass with abundant blood supply was removed. OUTCOMES: Ten days after operation, the patient was discharged from hospital and no signs of recurrence were observed three months later. LESSONS: To sum up, obvious high signal intensity in T2WI sequence and homogeneous enhancement are main characteristics that differentiate dural hemangioblastoma from meningioma lesion.


Assuntos
Dura-Máter , Hemangioblastoma , Neoplasias Meníngeas , Idoso , Feminino , Hemangioblastoma/diagnóstico , Hemangioblastoma/cirurgia , Humanos , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirurgia
5.
Clin Lab ; 65(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31532104

RESUMO

BACKGROUND: The Cavernous Angioma in Posterior Sagittal Sinus is exceedingly rare. METHODS: We report for the case of a 10-year-old male patient who was diagnosed with Cavernous Angioma in Posterior Sagittal Sinus. RESULTS: Our case is the second reported case of Cavernous Angioma in Posterior Sagittal Sinus in the world. CONCLUSIONS: It is very rare for the cavernous hemangioma to occur in the sinus, preoperative conventional MR scan lacks specificity and easily leads to misdiagnosis. Head MR enhancement, MRBTI, and SWI can provide more useful diagnostic information. The final diagnosis depends on the pathology examination.


Assuntos
Seio Cavernoso/patologia , Dura-Máter/irrigação sanguínea , Hemangioma Cavernoso/diagnóstico , Neoplasias Meníngeas/diagnóstico , Seio Cavernoso/diagnóstico por imagem , Criança , Dura-Máter/diagnóstico por imagem , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
6.
Clin Nucl Med ; 44(12): 987-988, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31524680

RESUMO

A 59-year-old man had developed within a few months walking disorders and rigidity of the left upper limb. I-FP-CIT SPECT/CT was performed in response to the suspicion of atypical parkinsonian syndrome. It showed an anomaly in presynaptic dopaminergic transmission on the right striatum and a voluminous expansive process on CT. MRI revealed an atypical meningioma. The patient had surgery for tumor removal. Later I-FP-CIT SPECT/CT showed normalization of presynaptic dopaminergic transmission on the right striatum.


Assuntos
Erros de Diagnóstico , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Meningioma/complicações , Meningioma/diagnóstico , Transtornos Parkinsonianos/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Neostriado/diagnóstico por imagem , Neostriado/metabolismo , Transtornos Parkinsonianos/metabolismo , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos
7.
World Neurosurg ; 132: 69-74, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470167

RESUMO

BACKGROUND: Immunoglobulin (Ig)G4-related disease (IgG4-RD) was defined only recently and can be found in many organs. As intracranial lesions, hypophysitis and pachymeningitis are well known, whereas intracranial pseudotumor is unusual. This case involved multiple intracranial pseudotumors without extracranial lesions, mimicking multiple meningioma. CASE DESCRIPTION: A 72-year-old woman was referred to our hospital with an incidental mass lesion at the craniocervical junction on magnetic resonance imaging (MRI). MRI showed diffuse enhanced extra-axial nodules around the medulla and middle cranial fossa. Surgery was performed for the gradually enlarging tumor. Intraoperative findings showed hard nodules around the vertebral artery. We performed subtotal resection. Neuropathological findings showed diffuse lymphoplasmacytic infiltration with lymphoid follicles. Immunohistochemical studies for IgG4 and IgG showed the histological criteria for IgG4-RD were met. Given the high IgG4 serum level, we diagnosed IgG4-RD. Steroid was administered initially but was then tapered, and nodules have since remained small. CONCLUSIONS: This case demonstrates IgG4-RD mimicking meningioma with multiple masses but without extracranial lesions. This case and previous descriptions suggest the possibility of pseudotumor due to IgG4-RD in the presence of multiple extra-axial lesions at the dura and supplying artery, hard nodules with thickening of the artery, and frozen section findings of lymphoplasmacytes surrounded by rich collagen fibers. In such cases, the pseudotumor due to IgG4-RD should be resected, and total resection might not be warranted.


Assuntos
Doença Relacionada a Imunoglobulina G4/patologia , Bulbo/patologia , Idoso , Fossa Craniana Média/diagnóstico por imagem , Fossa Craniana Média/patologia , Diagnóstico Diferencial , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/cirurgia , Bulbo/diagnóstico por imagem , Bulbo/cirurgia , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico
8.
J Neurooncol ; 144(2): 275-282, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31401721

RESUMO

INTRODUCTION: Measurement of tumor growth rates over time for patients with meningiomas has important prognostic and therapeutic implications. Our objective was to compare two methods of measuring meningioma volume: (1) the simplified ellipsoid (ABC/2) method; and (2) perimetric volume measurements using imaging software modules. METHODS: Patients with conservatively managed meningiomas for at least 1.5 years were retrospectively identified from the VCU Brain and Spine Tumor Registry over a 10-year period (2005-2015). Tumor volumes were independently measured using the simplified ellipsoid and computerized perimetric methods. Intra class correlations (CC) and Bland-Altman analyses were performed. RESULTS: A total of 26 patients representing 29 tumors were identified. Across 146 images, there were 24 (16%) images that were non-measurable using standard application commands with the computerized perimetric method. The mean volume obtained using the ABC/2 and computerized perimetric methods were 3.2 ± 3.4 cm3 and 3.4 ± 3.5 cm3, respectively. The mean volume difference was 0.2 cm3 (SE = 0.12; p = 0.10) across measurement methods. The concordance correlation coefficient (CCC) between methods was 0.95 (95% CI 0.91, 0.98). CONCLUSIONS: There is excellent correlation between the simplified ellipsoid and computerized perimetric methods of volumetric analysis for conservatively managed meningiomas. The simplified ellipsoid method remains an excellent method for meningioma volume assessment and had an advantage over the perimetric method which failed to allow measurement of roughly one in six tumors on imaging.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Fatorial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Carga Tumoral
9.
World J Surg Oncol ; 17(1): 150, 2019 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-31445511

RESUMO

BACKGROUND: Spinal psammomatous meningioma with calcification is commonly observed, but distinctive osseous differentiation rarely occurs. CASE PRESENTATION: Here, we described a 52-year-old female complaining of chronic back pain for 5 years. CT and MRI examinations revealed an intradural extramedullary mass at the T4 level. The tumor was meticulously excised en bloc. Under the microscope, the tumor was found to be composed of conspicuous calcified psammoma bodies with remarkable immature bone formation. A primary diagnosis of psammomatous meningioma was made based on the recent WHO classification of tumors of the CNS, whereas other pathologists focused on the osseous components and preferred metaplastic meningioma as the proper subtype. A literature review was conducted, and only five cases have been reported with the same histopathological condition. Experts finally reached a consensus based on the acknowledged notion of the preferential diagnosis of psammomatous meningioma, as well as the current evidence and popular opinion that ossification is generated from osteogenic differentiation of pluripotent cells rather than the accumulation of psammoma bodies. CONCLUSIONS: A final diagnosis of psammomatous meningioma with osseous metaplasia was made. The rigid and adherent features complicate total resection of the tumor and increase the risk of neurologic deficits.


Assuntos
Calcinose/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Metaplasia/diagnóstico , Ossificação Heterotópica/diagnóstico , Neoplasias Torácicas/diagnóstico , Calcinose/complicações , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Meníngeas/complicações , Meningioma/complicações , Metaplasia/complicações , Pessoa de Meia-Idade , Ossificação Heterotópica/complicações , Prognóstico , Neoplasias Torácicas/complicações
10.
J Craniofac Surg ; 30(8): e755-e757, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449204

RESUMO

A 78-year-old woman with progressive worsening vertigo and new onset of diplopia. Neurological examination revealed bilateral abducens nerve paralysis and gait disturbance with truncal ataxia. Neuroimaging revealed a mass lesion within the clivus with brain stem compression. The patient was operated with provisional diagnosis of clivus chordoma by neuro-navigation-guided extended endoscopic endonasal approach. Subtotal resection of the tumor was achieved with no intra- or postoperative complications. Histopathologic examination revealed intraosseous meningioma (WHO grade I). To the authors' best knowledge this is the first case reporting clivus site of intraosseous meningioma.


Assuntos
Cordoma/cirurgia , Fossa Craniana Posterior/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias da Base do Crânio/cirurgia , Idoso , Cordoma/complicações , Cordoma/diagnóstico , Fossa Craniana Posterior/patologia , Diplopia/complicações , Feminino , Neoplasias de Cabeça e Pescoço , Humanos , Neuroimagem , Complicações Pós-Operatórias , Neoplasias da Base do Crânio/complicações , Neoplasias da Base do Crânio/diagnóstico
11.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2297-2306, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31377848

RESUMO

PURPOSE: The present study examined the efficacy and complications associated with intensity-modulated radiation therapy (IMRT) for optic nerve sheath meningioma (ONSM) in 15 cases and compared visual function before and after treatment. METHODS: Consecutively diagnosed patients with ONSM treated with IMRT were evaluated from 2012 to 2017. We categorized ONSM with three growth patterns (diffuse, fusiform, or globular). Visual acuity, visual fields, and optic disc findings were assessed before and after IMRT. Ocular and systemic complications were evaluated during and after treatment. RESULTS: The 15 patients selected for analysis ranged in age from 33 to 77 years. Post-treatment observation periods were 8 to 57 months. After IMRT, tumor enlargement was not detected in any eyes, and tumor reduction was seen in 2 eyes. At final post-treatment follow-up, eyes with fusiform and globular growth maintained better visual acuity compared with pre-treatment, whereas 2 of 5 eyes with diffuse growth showed reduced vision. Five eyes with no apparent optic disc abnormality maintained better visual acuity compared with pre-treatment, whereas 8 of 10 eyes with disc edema and atrophy remained stable or showed reduced vision. Improvements were seen in all 5 eyes with optic discs negative for pre-treatment abnormalities. Final post-treatment visual field abnormalities improved in 11 eyes. All adverse events identified during IMRT improved rapidly during the treatment period. CONCLUSION: IMRT for the treatment of ONSM achieved improvement and preserved visual function. In particular, early treatment with IMRT before the appearance of optic disc abnormalities can be more effective for improving visual function.


Assuntos
Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Neoplasias do Nervo Óptico/radioterapia , Nervo Óptico/patologia , Acuidade Visual , Campos Visuais/fisiologia , Adulto , Idoso , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Neoplasias do Nervo Óptico/diagnóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
World Neurosurg ; 130: 187-191, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299307

RESUMO

BACKGROUND: Cranioplasty is a common procedure in neurosurgery. However, cosmetic and neuroprotective reconstructions are necessary after cranioplasty. Treatment of patients with a meningioma with bone infiltration requires removal of the tumor-infiltrated bone and subsequent cranioplasty. We report an efficient technique for cosmetic and neuroprotective reconstructions using a custom-made ultra-high-molecular-weight polyethylene cranial plate (SKULPIO, Kyocera Medical, Kyoto, Japan) in a single-step surgery involving tumor removal and skull reconstruction. METHODS: We present 2 illustrative cases of a 49-year-old female with a right frontal convexity meningioma and 69-year-old male with a bilateral parasagittal atypical meningioma, both involving extensive skull invasion. We preoperatively planned craniotomy size to facilitate the removal of the tumor-infiltrated skull bone using the patients' 3-dimensional cranial models followed by the construction of a custom-made cranial plate. After tumor removal, we drilled out the outer table and the diploe of the cranial edge until the custom-made bone plate accurately fit the bone defect. Finally, the cranial plate was fixed using titanium plates and screws. RESULTS: Postoperative magnetic resonance imaging for each case revealed total meningioma removal and an aesthetically reconstructed skull. Using this technique, precise adjustment of the cranial edge to the plate contributes to a gapless and aesthetic reconstruction. Furthermore, the intact inner table of the skull firmly supports the custom-made bone plate. CONCLUSIONS: This technique involving the placement of a custom-made cranial plate during a single-step surgery was found to be efficient for cosmetic and neuroprotective reconstructions.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Polietilenos , Neoplasias Cranianas/cirurgia , Crânio/cirurgia , Idoso , Placas Ósseas , Feminino , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Cranianas/diagnóstico
14.
World Neurosurg ; 130: 211-215, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302277

RESUMO

BACKGROUND: Patients with a renal transplant are an ever-increasing demographic. Their life expectancy is also on the rise and thus malignancies or tumors in these cases are more frequent. These patients are often on immunosuppressive drugs that are known to cause changes in the microvasculature, especially of the deep white matter. However, benign dural-based lesions are a rarity in these cases with very few (<5) ever being reported. Imaging findings in such cases are altered, which leads to an altered set of differential diagnosis. CASE DESCRIPTION: We present a case of a right parasagittal lesion in case of postrenal transplant with imaging findings suggestive of an inflammatory lesion. The lesion was excised and histopathology was that of a fibrous meningioma. Pathological basis of altered imaging is discussed and potential causes elaborated along with a thorough review of similar cases and their findings. CONCLUSIONS: Renal transplants and long-term survival are now a reality; calcineurin inhibitors are a staple for these cases. The drugs alter imaging findings and hence cases need to be carefully evaluated with a host of differential diagnosis. Knowledge of these changes is now necessary for these new spectra of cases.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Meníngeas/patologia , Meningioma/patologia , Transplantes/patologia , Neoplasias Encefálicas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade
15.
BMC Neurol ; 19(1): 176, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337352

RESUMO

BACKGROUND: Primary intraosseous meningioma is a subset of extradural meningioma that arises in the bone, and only a few cases have been reported to date. CASE PRESENTATION: An 80-year-old man presented with decreased hearing on the right side accompanied by a disturbance of balance 10 months prior to admission. Magnetic resonance imaging revealed an 8 × 7 cm osteolytic mass in the right posterior fossa related to the petrous bone, with extension to the cervical region. During surgery, the tumor was found to be located extradurally, with no invasion of the dura. The tumor was removed entirely, apart from a small portion around the jugular foramen to avoid lower cranial nerve injury. CONCLUSION: The final diagnosis was primary intraosseous osteolytic meningioma with atypical pathology. Here, we report a rare case of an osteolytic skull lesion in the skull base not invading the dura and with extensive bone destruction.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias Cranianas/cirurgia , Idoso de 80 Anos ou mais , Dura-Máter/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Osteólise , Osso Petroso/patologia , Osso Petroso/cirurgia , Neoplasias Cranianas/diagnóstico
16.
World Neurosurg ; 130: 506-511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349075

RESUMO

BACKGROUND: Angioleiomyoma (ALM) is a soft tissue neoplasm rarely described in the intracranial site. Because of their uncommon presentation, atypical neuroradiologic and pathologic features, ALMs are often misdiagnosed. CASE DESCRIPTION: We describe the neuroradiologic, clinical, and pathologic data of a 37-year-old male patient suffering from a tentorial ALM. He was admitted at our hospital because of a posterior cranial fossa mass. Magnetic resonance imaging (MRI) showed a left tentorial tumor, hypointense on T1-weighted sequences, with heterogeneous contrast enhancement after gadolinium injection ("salt-and-pepper" fashion) and slightly hyperintense signal on T2-weighted sequence. After surgery, pathological examination showed a tumor composed of several thick-walled blood vessels mixed with a population of deeply eosinophilic spindle-shaped smooth muscle cells arranged in bundles. Necrosis was absent. Neither cellular pleomorphism nor mitoses were detected. Immuno-histochemical analysis confirmed the smooth muscle phenotype of the spindle cell component: diffuse and strong positivity for alpha-smooth muscle actin, desmin, and h-caldesmon. Based on both morphologic and immunohistochemical findings, a diagnosis of primary intracranial ALM was rendered. CONCLUSIONS: We add to the literature the tenth case of this exceedingly rare tumor and submit that ALM should be suspected when a tentorial mass with a "flame-like" time-dependent pattern of contrast enhancement on MRI, a "salt-and-pepper" post-contrast appearance on MRI T1-weighted sequences, and a relation with large intracranial feeding vessels are present.


Assuntos
Angiomioma/diagnóstico , Angiomioma/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Adulto , Angiomioma/complicações , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/complicações , Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Humanos , Masculino , Neoplasias Meníngeas/complicações
17.
World Neurosurg ; 130: e383-e392, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31233926

RESUMO

OBJECTIVE: Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) and meningioma exhibit similar radiographic features; however, they differ in their prognoses. Preoperative differentiation between them is important for determining the treatment and follow-up plan. The aim of this study was to determine the factors that can be used to differentiate SFT/HPC from meningioma and World Health Organization (WHO) grade I from grade II meningioma. METHODS: The analysis included 84 cases: 5 of SFT/HPC, 72 of WHO grade I meningioma, and 7 of WHO grade II meningioma. Clinical characteristics and conventional magnetic resonance imaging, perfusion magnetic resonance imaging, and magnetic resonance spectroscopy (MRS) LCModel parameters were evaluated via multivariate logistic regression analysis to identify the factors that distinguish SFT/HPC from meningioma. RESULTS: Patients with SFT/HPC were mostly men and were younger than those with meningioma. The percentage of T2-weighted images in meningioma was greater than that in SFT/HPC. There were significant differences between SFT/HPC and meningioma in levels of glutamate, phosphocholine, myo-inositol, or glycerophosphocholine + phosphocholine derived from long echo-time MRS, and myo-inositol derived from short echo-time MRS. Stepwise logistic regression analysis revealed that the age of <45 years and myo-inositol in short echo-time MRS of ≧6.347 were associated with a diagnosis of SFT/HPC with high sensitivity and specificity. However, no factors were found that differentiated WHO grade I meningioma from WHO grade II meningioma. CONCLUSIONS: Age and myo-inositol level calculated from MRS are useful factors for distinguishing SFT/HPC from meningioma preoperatively.


Assuntos
Hemangiopericitoma/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Tumores Fibrosos Solitários/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico Diferencial , Feminino , Hemangiopericitoma/diagnóstico por imagem , Hemangiopericitoma/patologia , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/patologia , Meningioma/diagnóstico por imagem , Meningioma/patologia , Pessoa de Meia-Idade , Gradação de Tumores , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/patologia , Adulto Jovem
18.
Clin Neuropathol ; 38(4): 168-173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31131824

RESUMO

Although Schwann cell-derived tumors show typical histological features, the broad variety of spindle cell tumors that exist can impede the diagnostic procedure. In this study, we present aldehyde dehydrogenase 1 (ALDH1) as a new, viable diagnostic marker for Schwann cell tumors. Protein expression was examined by immunohistochemistry in schwannomas, neurofibromas, and malignant peripheral nerve sheath tumors (MPNST) as well as in non-neoplastic peripheral nerve sheath specimens. Meningiomas and other spindle cell-like tumors served as control tissue. ALDH1 immunohistochemistry was performed on human FFPE samples. Staining evaluation was performed according to a defined immunoreactive score. All schwannomas and neurofibromas were strongly positive for ALDH1. MPNST were positive too, but with a clear reduction of ALDH1 expression. All non-Schwann-cell-derived tumors showed no immunoreaction. This leads to the conclusion that ALDH1 can serve a as viable diagnostic marker for schwannomas and neurofibromas as it was expressed and detected by IHC in all samples. Furthermore, ALDH1 expression seems to be a sign for differentiation as it diminishes during malignization of Schwann cell tumors. Hence, its expression level provides information about the biological behavior of the tumor.


Assuntos
/metabolismo , Biomarcadores Tumorais/análise , Neurilemoma/patologia , Células de Schwann/metabolismo , Adulto , Feminino , Humanos , Imuno-Histoquímica/métodos , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Meningioma/diagnóstico , Meningioma/patologia , Neoplasias da Bainha Neural/diagnóstico , Neoplasias da Bainha Neural/patologia , Neurilemoma/diagnóstico , Neurofibroma/patologia
19.
World Neurosurg ; 129: 176-180, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31146040

RESUMO

BACKGROUND: Quite a few cases of intramedullary meningioma have been described in previously reported studies. We have presented a rare case of intramedullary thoracic meningioma, which was quite different from subdural extramedullary meningioma, and the preliminary diagnosis was mistakenly given as hemangioblastoma. CASE DESCRIPTION: A 46-year-old man with complaints of gait problems and pain in the right lower extremity was admitted to our hospital. The neurological examination revealed 3 of 5 motor strength, spastic paraparesis, hyperreflexia, increased tone, and sensory deficits in the right lower extremity. Contrast-enhanced images showed a T6-T7 intramedullary lesion and an evident and homogeneously enhanced lesion with clearly defined borders on the sagittal, coronal, and axial views. The preliminary diagnosis was hemangioblastoma. However, he underwent tumor resection, and the histopathological examination findings confirmed the diagnosis of intramedullary meningioma. CONCLUSION: Intramedullary thoracic meningiomas are extremely rare and differ from the common subdural extramedullary meningiomas. Clinicians should be aware of this when diagnosing intramedullary tumors. Gross total resection using a microsurgical technique will be the best treatment strategy.


Assuntos
Neoplasias Meníngeas/patologia , Meningioma/patologia , Neoplasias da Medula Espinal/patologia , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/diagnóstico , Vértebras Torácicas
20.
Medicine (Baltimore) ; 98(18): e15548, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045846

RESUMO

RATIONALE: Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis. Petroclival RDD is extremely rare. To the best of our knowledge, only 7 cases of petroclival RDD have been reported so far. Herein, we present the 8th case of intracranial RDD with the petroclival and parasellar involvement mimicking multiple meningiomas. PATIENT CONCERNS: A 57-year-old woman presented with a 1-year history of vision diminution and 1-month hearing loss in her right ear. DIAGNOSES: Contrast-enhanced Magnetic resonance imaging (MRI) of the brain demonstrated multiple well-defined, homogenous mass which closely related to the dura mater in the bilateral parasellar and petroclival regions range from the basement of anterior to posterior cranial fossa. The lesions were T1 isointense, T2 hypointense, and homogeneously enhanced. Initial diagnosis of multiple meningiomas was made according to MRI findings. Final diagnosis of RDD was confirmed by histopathological and immunohistochemical examinations after subtotal surgical resection. INTERVENTIONS: The patient received subtotal resection because multiple lesions were extensive. OUTCOMES: The vision diminution recovered well after the surgery but the hearing loss in her right ear was still persisted. LESSONS: Although rare, a standard RDD typically are dural-based, extra-axial, well-circumscribed masses mimicking meningioma, and presenting with characterized hypo to isointense on T1-weighted images, hypo to isointense on T2-weighted images, and obvious enhancement. Resection of the intracranial lesion is the most effective treatment. In case of subtotal resection, the application of adjunctive radiotherapy and/or steroid agents should be advised. Final diagnosis of RDD should be confirmed by histopathological and immunohistochemical examinations.


Assuntos
Encefalopatias/diagnóstico , Histiocitose Sinusal/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Encefalopatias/patologia , Diagnóstico Diferencial , Feminino , Histiocitose Sinusal/patologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia
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