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1.
Isr Med Assoc J ; 22(1): 53-59, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927807

RESUMO

BACKGROUND: Primary retroperitoneal neoplasms (PRN) arise from diverse retroperitoneal tissues. Soft tissue sarcomas (STS) comprise the majority and are well studied. Other non-sarcomatous PRN are very rare and less familiar. OBJECTIVES: To evaluate the clinicopathologic and radiologic features of non-sarcomatous PRN, as well as the outcome of complete tumor resection (TR). METHODS: Retrospective data were collected on consecutive patients (June 2006 to January 2015) who underwent resection of retroperitoneal lesions at our department. Final pathology of non-sarcomatous PRN was included. RESULTS: The study population included 36 patients (26% with PRN). PRN were neurogenic (17%), fat-containing (3%), and cystic (6%). The preoperative diagnosis was correct in only 28%. All patients underwent TR via laparotomy (72%) or laparoscopy (28%), for mean operative time of 120 ± 46 minutes. En bloc organ resection was performed in 11%. Complete TR was achieved in 97%. Intra-operative spillage occurred in 8%. Intra-operative, 90-day postoperative complications, and mortality rates were 11%, 36%, and 0%, respectively. The mean length of stay was 6.5 ± 5.5 days. The median overall survival was 53 ± 4.9 months. CONCLUSIONS: Familiarity with radiologic characteristics of PRN is important for appropriate management. Counter to STS, other PRN are mostly benign and have an indolent course. Radical surgery is not required, as complete TR confers good prognosis. Expectant management is reserved for small, asymptomatic, benign neoplasms.


Assuntos
Neoplasias Retroperitoneais/diagnóstico , Idoso , Feminino , Ganglioneuroma/diagnóstico , Ganglioneuroma/diagnóstico por imagem , Ganglioneuroma/patologia , Ganglioneuroma/cirurgia , Humanos , Lipoma/diagnóstico , Lipoma/diagnóstico por imagem , Lipoma/patologia , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neurilemoma/cirurgia , Neurofibroma/diagnóstico , Neurofibroma/diagnóstico por imagem , Neurofibroma/patologia , Neurofibroma/cirurgia , Paraganglioma/diagnóstico , Paraganglioma/diagnóstico por imagem , Paraganglioma/patologia , Paraganglioma/cirurgia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
2.
World Neurosurg ; 133: 14-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31557553

RESUMO

BACKGROUND: Schwannoma is a tumor arising from peripheral nerve sheaths and commonly occurs in the head, neck, and upper and lower extremities. Schwannoma in the presacral space is relatively rare and is often misdiagnosed before pathologic diagnosis is made. CASE DESCRIPTION: Here we discuss a case of giant presacral schwannoma in a 34-year-old man with an emphasis on imaging findings. CONCLUSIONS: Solid and encapsulated, round or oval, with rich blood supply may be the characteristic imaging findings of presacral schwannoma, which may narrow the differential diagnosis of hypervascular pelvic lesions.


Assuntos
Neurilemoma/diagnóstico por imagem , Sacro/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto , Humanos , Imagem por Ressonância Magnética , Masculino , Neurilemoma/cirurgia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
3.
World Neurosurg ; 133: e97-e104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505279

RESUMO

BACKGROUND: Intraspinal tumors are 10 to 15 times less common than brain tumors. The midline approach with extensive laminectomies represents the current gold-standard for resection, causing instability, muscle damage, and kyphosis among other well-known complications. Minimally invasive series reported their results using retractor-based systems. We analyzed a patient series treated with a non-expansile tubular approach, describing the technique, grade of resection, and clinical outcomes. METHODS: A series of consecutive cases operated between 2016 and October 2018 were analyzed retrospectively. The database included age, sex, clinical presentation, intraspinal location (intra/extradural), number of laminotomies, grade of resection, surgical time, bleeding, and follow-up. The initial and follow-up clinical condition was analyzed using the Frankel scale. RESULTS: A total of 13 patients underwent surgery: 3 intraspinal/extradural (23%), 8 intradural/extramedullary (61.5%), and 2 intramedullary tumors (15.3%); these were classified as 5 meningiomas (38.4%), 4 neurofibromas (30.7%), 2 schwannomas (15.3%), 1 hemangioblastoma (7.6%), and 1 astrocytoma (7.6%). Eleven (84.61%) patients had complete motor improvement, 1 patient had partial improvement, and 1 patient had no improvement (7.6% each). An 18-mm working channel tube was used for extramedullary lesions and 20-mm tubes for intramedullary injuries. Total tumor resection was achieved in 11 patients (84.6%) and subtotal in 2 patients (15.38%) corresponding to intramedullary tumors. CONCLUSIONS: Although this study consisted of a small series, we have shown the possibility of resecting intraspinal tumors (some intradural-intramedullary) with non-expansile tubes in a safe and effective way with no complications. Most of the patients had complete neurological improvement at the end of follow-up.


Assuntos
Descompressão Cirúrgica/métodos , Fixadores Internos , Microcirurgia/métodos , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/instrumentação , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neurofibroma/diagnóstico por imagem , Neurofibroma/cirurgia , Estudos Retrospectivos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto Jovem
4.
J Exp Ther Oncol ; 13(2): 155-158, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31881132

RESUMO

Objective: Schwannomas are benign slow growing tumors that arise from myelin producing Schwann cells. Schwannomas developing in cervical-dorsal region are rare benign neoplasms which are emerges leisurely remains asymptomatic some times and functionally inactive tumours. Giant Schwannomas extending over two or more vertebral levels have been documented and attempts have been made to classify these in available literature, however inadequate. Advancement in imaging modalities and microsurgery has bettered management of these tumors. A rare case of intradural extramedullary cervicodorsal schwannoma extending along seven vertebral levels to thoracic levels is reported in a 55 year old male patient with progressive weakness and numbness of over one and a half years. MRI of cervical spine showed a heterogeneously lesion with cord oedema till D7 level on T1contrast saggital view. Histological examination revealed encapsulated spindle cell lesion with hypocellular and hypercellular areas with verucay bodies, occasional bizzare nuclei, hyalinized blood vessels, with no evidence of necrosis/atypical mitosis, suggestive of schwannoma. In the prone position, C4 to D7 enbloc laminotomy was done and total excision of intradural extramedullary lesion was done. Post-operative CT scans revealed normal spinal canal dimensions with implants in situ. At quarterly follow up upto one year post-operative, the patient had near normal power in all four limbs and normal bladder function.


Assuntos
Neurilemoma , Neoplasias da Medula Espinal , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 98(51): e18149, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860962

RESUMO

RATIONALE: Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels. PATIENT CONCERNS: A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year. DIAGNOSES: Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis. INTERVENTIONS: A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification. OUTCOMES: The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic. LESSONS: Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.


Assuntos
Laparoscopia/métodos , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/patologia , Idoso , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Comunicação Interdisciplinar , Extremidade Inferior , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neurilemoma/diagnóstico por imagem , Doenças Raras , Neoplasias Retroperitoneais/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento
6.
Pan Afr Med J ; 33: 242, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692794

RESUMO

The sciatic nerve is the terminal branch of the sacral plexus. Sciatalgia is a nerve root pain. In most cases, sciatica originates from degenerative disc disease. Tumor involving the sciatic nerve is extremely rare. We here report the case of a 33-year old patient with nerve tumor detected on MRI performed for drug-resistant sciatica. Tumor involving the sciatic nerve is rare and diagnosis is difficult. MRI data are crucial for establishing an effective surgical approach.


Assuntos
Imagem por Ressonância Magnética/métodos , Neurilemoma/diagnóstico por imagem , Neurofibroma/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Nervo Isquiático/patologia , Ciática/diagnóstico
7.
J Cardiothorac Surg ; 14(1): 182, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665049

RESUMO

BACKGROUND: The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. CASE PRESENTATION: Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. CONCLUSION: This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.


Assuntos
Cisto Broncogênico/cirurgia , Neoplasias do Mediastino/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neurilemoma/cirurgia , Neoplasias do Timo/cirurgia , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/patologia , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Vértebras Torácicas , Toracoscopia/métodos , Timectomia/métodos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios X
8.
Medicine (Baltimore) ; 98(42): e17341, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626091

RESUMO

RATIONALE: Schwannomas grow slowly, originating from the Schwann cells of the nerve sheath. Schwannomas of cranial origin have the highest incidence, followed by intraspinal schwannomas. However, paravertebral schwannoma is rare, and to our knowledge, giant paravertebral schwannomas near the lumbar nerve roots with bone destruction are extremely rare. PATIENT CONCERNS: A 47-year-old Chinese woman complained of lower back soreness and a sensation of a bulging lumbar disc with no obvious cause for the past 3 years. DIAGNOSIS: Lumbar magnetic resonance imaging showed a large mass with uneven density, 17 × 12 × 15 cm in size, located to the right of the 4th lumbar with obvious bony destruction. Histopathology and immunohistochemistry confirmed that this mass was a benign schwannoma. INTERVENTIONS: Complete resection of the tumor (measuring about 17 × 12 × 15 cm in size) and vertebral reconstruction using internal fixation were performed. OUTCOMES: The patient was discharged without complications after surgery. The 3-year follow-up revealed that the patient recovered well with no evidence of recurrence. LESSONS: Here, we emphasize the importance of careful radiological examination and reflect on the difficulty of tumor resection. Furthermore, understanding the treatment and diagnosis of lumbar paravertebral schwannoma is critical for plastic surgeons and radiologists when encountering similar cases.


Assuntos
Vértebras Lombares/patologia , Neurilemoma/patologia , Neoplasias da Coluna Vertebral/patologia , Raízes Nervosas Espinhais/patologia , Feminino , Humanos , Dor Lombar/etiologia , Vértebras Lombares/virologia , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/cirurgia , Resultado do Tratamento
9.
Pain Res Manag ; 2019: 5392945, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31662812

RESUMO

Background: Recurrent painful ophthalmoplegic neuropathy (RPON), previously known as ophthalmoplegic migraine (OM), is an uncommon disorder with repeated episodes of ocular cranial nerve neuropathy associated with ipsilateral headache. The age of presentation is most often during childhood or adolescence. MRI has a central role in the assessment of the RPON, especially to distinguish orbital, parasellar, or posterior fossa lesions that mimic symptoms of RPON. Actually, oculomotor nerve tumors may be masquerade as RPON so that MRI follow-ups are required to detect the possibility of tumor etiology. Case presentation: We report a 16-year-old boy with a 7-year follow-up and multiple brain MRI data, previously diagnosed as OM. The last brain MRI, performed during an acute phase of oculomotor paresis with ipsilateral headache, showed a nodular lesion described as schwannoma of III cranial nerve. Then, we reviewed the literature on OM and RPON in pediatric age with a focus on brain MRI findings. Conclusions: This review highlights the important role of serial brain MRIs in the long-term follow-up of RPON, especially in the cases with childhood onset, in order to not delay the diagnosis of a possible oculomotor nerve schwannoma.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Doenças do Nervo Oculomotor/diagnóstico por imagem , Enxaqueca Oftalmoplégica/etiologia , Adolescente , Neoplasias dos Nervos Cranianos/complicações , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Neurilemoma/complicações , Doenças do Nervo Oculomotor/complicações
10.
World Neurosurg ; 132: e40-e52, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520759

RESUMO

BACKGROUND: Schwannomas encompassing the superior parapharyngeal space are challenging lesions because of the anatomical complexity of this region and the frequent involvement of the neurovascular structures of the jugular foramen. The purpose of this study is to report the technical aspects and the advantages of the anterolateral approach, here proposed for schwannomas of this complex area. METHODS: The main steps of the anterolateral approach are described in detail, along with the results of a consecutive series of 38 patients with a retrostyloid superior parapharyngeal schwannoma involving the jugular foramen operated on by means of this route between 1999 and 2019. RESULTS: The supine position is generally preferred. The medial border of the sternocleidomastoid muscle, mastoid tip, and superior nuchal line are the landmarks for the hockey-stick skin incision. The accessory nerve is retrieved and mobilized cranially. Detachment of the sternocleidomastoid, digastric, and nuchal muscles allows for a 180° exposure of the extracranial side of the jugular foramen. Three working corridors, namely the pre-carotid, pre-jugular, and retro-jugular, allow access to the deeper part of the jugular foramen area and the superior parapharyngeal space. In the present series, a gross total resection was achieved in 89.4% of the patients. Three recurrences occurred after an average follow-up of 80.5 ± 51 months. CONCLUSIONS: The anterolateral approach is highly effective in the treatment of retrostyloid superior parapharyngeal space schwannomas involving the jugular foramen. Its simplicity of execution, versatility, and very low morbidity are among its main strengths.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Faringe/cirurgia , Adulto , Idoso , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/epidemiologia , Músculos Faríngeos/anatomia & histologia , Músculos Faríngeos/cirurgia , Faringe/diagnóstico por imagem , Decúbito Dorsal , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
World Neurosurg ; 132: 182-187, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476472

RESUMO

BACKGROUND: Intraosseous petrous apex schwannomas are an exceedingly rare entity; little is known about their epidemiology, natural history, and postoperative outcomes. CASE DESCRIPTION: Here, we present the fourth known case of a primary intraosseous schwannoma of the petrous apex: a 68-year-old woman presenting with diplopia, facial numbness, progressive intermittent vertigo, tinnitus, diminished hearing, and ataxia. She underwent a transtemporal approach for subtotal resection of the tumor with subsequent stereotactic radiosurgery. CONCLUSIONS: Our 2-year follow-up demonstrates slow growth and success of multimodal management in the treatment of these tumors. We review the 3 prior reports of petrous apex schwannomas and identify unifying radiographic and clinical characteristics to aid future diagnostic considerations of lesions of the petrous apex.


Assuntos
Neoplasias Ósseas/cirurgia , Neurilemoma/cirurgia , Osso Petroso/cirurgia , Idoso , Angiografia Digital , Neoplasias Ósseas/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Neurilemoma/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Osso Petroso/diagnóstico por imagem , Radiocirurgia/métodos , Osso Temporal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413058

RESUMO

A 69-year-old woman presented with an 8-month history of diplopia and examination findings consistent with a right third-nerve palsy. Head MRI identified the presence of a 5.8 mm, nodular, isointense lesion in the suprasellar cistern, which demonstrated enhancement with gadolinium contrast. The lesion did not show any evidence of growth over a 3-month follow-up period. These MRI findings, alongside the clinical features, suggest oculomotor nerve schwannoma. Oculomotor schwannomas are a rare cause of third-nerve palsy. The presenting features and management options for oculomotor schwannomas are discussed to provide a framework for the diagnosis and management of these patients.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Neurilemoma/diagnóstico , Doenças do Nervo Oculomotor/etiologia , Nervo Oculomotor , Idoso , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Diagnóstico Diferencial , Diplopia/etiologia , Feminino , Humanos , Angiografia por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem
13.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439570

RESUMO

A constellation of newly diagnosed benign tumours and glioblastoma is an uncommon occurrence in a single individual. We present a case of a patient with a history of skin lipomas who presented with seizures and was found to have a left frontotemporal multifocal enhancing mass on MRI. Work-up for metastatic disease revealed a benign lung carcinoid tumour, a cervical schwannoma, adrenal masses, a growth hormone-secreting pituitary adenoma, and lastly a glioblastoma following brain biopsy.


Assuntos
Neoplasias Encefálicas/diagnóstico , Tumor Carcinoide/diagnóstico , Glioblastoma/diagnóstico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neurilemoma/diagnóstico , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico por imagem , Vértebras Cervicais , Evolução Fatal , Lobo Frontal , Glioblastoma/complicações , Glioblastoma/diagnóstico por imagem , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Convulsões/etiologia , Tomografia Computadorizada por Raios X
14.
Jpn J Radiol ; 37(10): 694-700, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31396824

RESUMO

PURPOSE: To investigate whether whole-tumor histogram analyses of diffusivity measurements derived from q-space imaging (QSI) improves the differentiation between meningioma and schwannoma. MATERIALS AND METHODS: Fifteen extra-axial tumors (11 meningiomas and 4 schwannomas) with MR examinations from April 2011 to May 2013 were included. Three-dimensional regions of interest (ROI) encompassed the whole tumor, including cystic areas. Histogram analyses of mean displacement (MD) derived from QSI and apparent diffusion coefficient (ADC) for the ROI were performed at mean, the five percentiles of MDn and ADCn (n = 5, 25, 50, 75, 95th), kurtosis, and skewness. To determine the diagnostic ability of MDn and ADCn, we also compared the area under the curve (AUC) on receiver operating characteristic (ROC) analysis. RESULTS: Histogram analyses revealed significant differences between meningioma and schwannoma in MD75, ADC25, ADC50, ADC75, and kurtosis of ADC. The ROC analysis of kurtosis of ADC and MD75 resulted in an AUC of 1.0 and 0.96, respectively. There were no significant differences between the AUC of MD75 and that of kurtosis of ADC (p = 0.41). CONCLUSION: The histogram analyses of MD and ADC derived from QSI were both equally useful in differentiating between intracranial meningioma and schwannoma.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Imagem Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Meningioma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Área Sob a Curva , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos
15.
World Neurosurg ; 131: 53-57, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376556

RESUMO

BACKGROUND: Intracranial schwannomas are rarely confined to the skull. We here report a large schwannoma localized in the petrous apex that presented with intratumoral hemorrhage. CASE DESCRIPTION: A 35-year-old woman with mild hearing disturbance and ear fullness underwent computed tomography scan and magnetic resonance imaging, which demonstrated a tumor accompanied with intratumoral hematoma in the right petrous apex. Bone marrow was totally destroyed, but the bone cortex was relatively preserved. Pathologic specimen showed that the tumor was composed of proliferation of elongated neoplastic cells and positive for S-100 protein. It showed a nuclear palisading pattern, compatible with schwannoma. The lack of any cranial nerve signs and relative preservation of canals through which cranial nerves pass suggested the neurilemma cells surrounded vessels or mismigrated fetal neurilemma cells in the petrous apex as origin of the tumor. Benign nature of the tumor and total disappearance of the symptoms, supposedly due to the spontaneous absorption of the hematoma, made the patient choose a wait-and-watch approach. Magnetic resonance imaging studied 7 years after the diagnosis showed significant decrease of the tumor volume and disappearance of the hematoma. CONCLUSIONS: Although it is a large intraosseous schwannoma in the petrous apex, it has a benign nature, its size is reduced due to the hematoma absorption, and the patient is asymptomatic. We observed the patients for 7 years after the diagnosis.


Assuntos
Hemorragias Intracranianas/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Osso Petroso/diagnóstico por imagem , Adulto , Biópsia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Hemorragias Intracranianas/complicações , Imagem por Ressonância Magnética , Neurilemoma/irrigação sanguínea , Neurilemoma/complicações , Neurilemoma/patologia , Carga Tumoral
16.
Mymensingh Med J ; 28(3): 685-688, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391445

RESUMO

Brachial plexus tumors are rare. Schwannomas are benign nerve sheath tumors and only about 5% arise from brachial plexus. Diagnosis of these tumors are challenging for radiologists as well as clinicians as they are rare and the anatomy of the neck is complex. We report a case of a middle aged woman who was admitted in Mymensingh Medical College in Neurosurgery Department on 15th December 2017 with right supraclavicular swelling; based on the clinical findings was provisionally diagnosed as supraclavicular lymphadenopathy; Ultrasonography and Magnetic Resonance Imaging suggested schwannoma. Complete excision of the mass through supraclavicular approach showed the origin of it from the brachial plexus, which subsequently was confirmed to be a schwannoma with histopathology.


Assuntos
Plexo Braquial , Neurilemoma , Neoplasias do Sistema Nervoso Periférico , Plexo Braquial/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Ultrassonografia
17.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302617

RESUMO

We present an unusual case of spinal neurinoma with intralesional and subarachnoid bleeding with acute cauda equina syndrome. A 38-year-old man was admitted to our department after a minor thoracic spinal trauma with right lower limb plegia and urinary retention. MRI showed a T11 intradural tumour with intralesional and subarachnoid haemorrhage. The patient was operated of spinal cord decompression and complete tumour resection. The histological examination documented a schwannoma with large haemorrhagic intratumoural areas. A full neurological recovery was documented at 6-month follow-up.


Assuntos
Síndrome da Cauda Equina/etiologia , Neurilemoma/complicações , Neoplasias da Coluna Vertebral/complicações , Hemorragia Subaracnóidea/etiologia , Adulto , Descompressão Cirúrgica , Humanos , Imagem por Ressonância Magnética , Masculino , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Hemorragia Subaracnóidea/cirurgia
18.
J Med Case Rep ; 13(1): 230, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31311599

RESUMO

INTRODUCTION: Extradural schwannoma arising from high cervical spinal root is a rare entity in children. We report a case of extradural cervical schwannoma in a 14-year-old boy. CASE PRESENTATION: Our patient is a 14-year-old Madhesi boy presenting with swelling in the posterior triangle of his neck. The radiological features suggested solitary extradural cervical schwannoma which was confirmed later by histopathological findings. There were no postoperative neurological complications in our patient. CONCLUSION: Extradural spinal schwannoma is a benign tumor. Gross total resection with good clinical outcome can be achieved with minimal risks.


Assuntos
Neurilemoma/patologia , Neoplasias da Medula Espinal/patologia , Adolescente , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Medula Cervical/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pescoço , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia
19.
J Comput Assist Tomogr ; 43(5): 741-746, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31356524

RESUMO

OBJECTIVE: To identify the computed tomographic features to differentiate gastric schwannoma from gastric gastrointestinal stromal tumor. METHODS: Computed tomographic images of 103 pathologically confirmed patients with gastric schwannoma (n = 23) or gastric gastrointestinal stromal tumor (n = 80) were retrospectively studied. Sex, morphology, location, border, growth pattern, enhancement pattern, necrosis, calcification, ulceration, and perigastric lymph nodes were analyzed. Age, short diameter, long diameter, and the degree of enhancement were measured. Statistical analyses were performed, and receiver operating characteristic curve, sensitivity, and specificity values were analyzed. RESULTS: Female, age younger than 57.5 years, round or ovoid morphology, extraluminal growth, homogeneous enhancement, lack of necrosis, presence of perigastric lymph nodes, and an enhancement degree of less than 15.4 Hounsfield units in the arterial phase were significant variables for differentiating gastric schwannoma from gastric gastrointestinal stromal tumor (P < 0.05). CONCLUSIONS: Dual-phase contrast-enhanced computed tomography can help to differentiate gastric schwannoma from gastric gastrointestinal stromal tumor.


Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Feminino , Tumores do Estroma Gastrointestinal/patologia , Humanos , Iopamidol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Neurilemoma/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Gástricas/patologia
20.
Medicine (Baltimore) ; 98(24): e16095, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192973

RESUMO

INTRODUCTION: Schwannomas, also known as neurilemmoma, are benign neoplasms that originating from Schwann cells in peripheral nerve sheaths. The head, neck, and extremities are the most common sites; however, pancreatic schwannomas are rare neoplasms. Accurate preoperative diagnosis of these tumors is very tough because of pancreatic schwannomas usually mimicking other cystic tumors. Here we present a case of pancreatic schwannoma misdiagnosed as pancreatic cystadenoma. PATIENT CONCERNS: We presented a rare case of a 55-year-old female admitted to our hospital for abdominal distension. The physical examination and results of laboratory testing reveal no abnormalities. DIAGNOSIS: A computed tomography (CT) scan detected a hypodense 2.4 cm × 2.6 cm mass with a clear margin at the neck of the pancreas. Pancreatic cystadenoma was strongly suspected. INTERVENTIONS: The patient underwent robotic distal pancreatectomy with splenectomy. The gross specimen showed a pale and solid mass with a capsule. OUTCOMES: Histological examination of the surgical specimen demonstrated a pancreatic schwannoma. Immunohistochemistry results were as follows: S-100 (+), CD117 (-), SMA (-), and Desmin (-). She was discharged on postoperative day 6 and no recurrence of the tumor happened during the 12-month follow-up. CONCLUSION: Precise preoperative diagnosis of pancreatic schwannomas is very difficult despite the application of multiple imaging modalities. Surgery is the most effective treatment for this rare disease and the final diagnosis usually relies on pathology. Following complete tumor removal, patients with pancreatic schwannomas generally have a good prognosis.


Assuntos
Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Cistadenoma/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/patologia , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Neoplasias Pancreáticas/patologia
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