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1.
Nihon Shokakibyo Gakkai Zasshi ; 117(11): 1008-1017, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33177253

RESUMO

Upon abdominal ultrasonography, a woman in her 36 years old was diagnosed with a hypoechoic tumor with a diameter of 60mm surrounding the bile duct in the hepatic portal region. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed a tumor-like mass in the bile duct. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed the diagnosis of schwannoma. Considering the lesion location, it appeared to rise from the hepatoduodenal ligament. She was unwilling to undergo tumor resection;however, a year after the diagnosis, no change was observed in the tumor. Here, we report a case of schwannoma in the hepatoduodenal ligament, wherein EUS-FNA was useful for establishing a diagnosis and determining a treatment strategy.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neurilemoma , Adulto , Colangiopancreatografia por Ressonância Magnética , Feminino , Humanos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
2.
No Shinkei Geka ; 48(10): 909-913, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071226

RESUMO

Trochlear nerve neurinomas are rare and solitary tumors without neurofibromatosis are extremely rare. We report a case of trochlear nerve neurinoma presenting with pathological laughter and diplopia. A 40-year-old male patient presented with diplopia and pathological laughter 2 months before admission. MRI showed a multicystic enhanced mass in the left tentorial incisura compressing the midbrain and the upper pons. The tumor was excised using the left trans-Sylvian approach with partial uncal resection. After excision of the tumor, the left trochlear nerve was identified on the surface of the lateral midbrain. The nerve was connected to the tumor. Pathological laughter completely resolved after the operation. This is the second reported case of trochlear nerve neurinoma presenting with pathological laughter. The lesion responsible for pathological laughter could be the midbrain, upper pons, diencephalon, or all of these.


Assuntos
Neoplasias dos Nervos Cranianos , Riso , Neurilemoma , Adulto , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Nervo Troclear
3.
Clin Nucl Med ; 45(11): 921-922, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32910042

RESUMO

A 55-year-old woman underwent FDG PET/CT to evaluate a pancreatic mass. The images showed elevated FDG activity in the uncinated process of the pancreas, suggestive of malignancy. However, pathological examination from the resected lesion demonstrated pancreatic schwannoma.


Assuntos
Fluordesoxiglucose F18 , Neurilemoma/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/patologia , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Neoplasias Pancreáticas/patologia
4.
Medicine (Baltimore) ; 99(33): e21603, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872015

RESUMO

RATIONALE: Schwannomas of the seminal vesicles are extremely rare, and only cases of single seminal vesicle schwannomas have been reported. Here, we report a case of multiple schwannoma of the seminal vesicle. PATIENT CONCERNS: We report a rare case of multiple schwannoma of the seminal vesicle that occurred in a 48-year-old man during physical examination. Multiple mixed masses in the left region of the seminal vesicle were documented with transrectal ultrasonography and magnetic resonance imaging. The patient presented no clinical symptoms, no family history of the disease and no history of genetic disease. DIAGNOSIS: Postoperative pathology revealed a diagnosis of seminal vesical schwannoma. INTERVENTIONS: The patient underwent robotic-assisted laparoscopic surgery to remove the mass. OUTCOMES: The patient recovered rapidly and the length of hospitalization was 6 days after operation. At present, there is no recurrence in 10 month follow up. LESSONS: Whether benign or malignant, single or multiple, schwannomas still need to be diagnosed by pathology because of the limitations of examination methods. Surgical resection is still the preferred treatment.


Assuntos
Neoplasias dos Genitais Masculinos/patologia , Neurilemoma/patologia , Glândulas Seminais/patologia , Neoplasias dos Genitais Masculinos/diagnóstico por imagem , Neoplasias dos Genitais Masculinos/cirurgia , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Glândulas Seminais/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(38): e22307, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957393

RESUMO

RATIONALE: Schwannoma is a benign peripheral nerve sheath tumor composed of Schwann cells and caused by genetic mutation or deletion. It rarely occurs in seminal vesicles. The optimal therapic strategy for asymptomatic cases is still unclear. PATIENT CONCERNS: A 42-year-old man presented no clinical symptoms. A mass in his left seminal vesicle was found incidentally in a computed tomography scan and transrectal ultrasound-guided biopsy revealed the mass was schwannoma. DIAGNOSIS: The patient was diagnosed as schwannoma of the seminal vesicle with no significant extension to the surrounding tissues. INTERVENTIONS: The patient underwent computed tomography or magnetic resonance imaging scans periodically to estimate the alteration of the lesion and further strategy. OUTCOMES: After 20-month follow-up, computed tomography scans showed no significant alteration to the lesion and no clinical symptoms were reported by the patient. LESSONS: Conservative strategy might be an effective treatment option for asymptomatic patients with seminal vesical schwannoma. The period of follow-up depends on the size of the tumor.


Assuntos
Tratamento Conservador/métodos , Neoplasias dos Genitais Masculinos/terapia , Neurilemoma/terapia , Adulto , Neoplasias dos Genitais Masculinos/diagnóstico por imagem , Neoplasias dos Genitais Masculinos/patologia , Humanos , Achados Incidentais , Imagem por Ressonância Magnética , Masculino , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Glândulas Seminais/diagnóstico por imagem , Glândulas Seminais/patologia , Tomografia Computadorizada por Raios X
6.
Arch. argent. pediatr ; 118(4): e410-e413, agosto 2020. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1118594

RESUMO

El schwannoma es un tumor primario, habitualmente, benigno, procedente de las células de Schwann, productoras de la vaina de mielina que recubre los nervios periféricos. Constituye menos del 10 % de los tumores intracraneales y es infrecuente en la edad pediátrica.Se presenta a un paciente de 6 años y 11 meses de edad, previamente sano, con antecedente de cefalea holocraneana intermitente asociado a proptosis y disminución de la agudeza visual del ojo izquierdo, epífora y estrabismo, con evidencia tomográfica de una masa retroocular. Se realizó la exéresis macroscópicamente completa, con diagnóstico anatomopatológico de schwannoma orbitario


Schwannoma is a usually benign primary tumor. It develops from the Schwann cells, which produce the myelin sheath that surrounds the peripheral nerves. It represents less than 10 % of the intracranial tumors, and it is infrequent in the pediatric age.We hereby present a 6-year-and-11-month-old previously healthy patient, with a history of intermittent generalized cephalea associated with proptosis and a diminished visual acuity of the left eye, epiphora and strabismus, with radiological evidence of retro-ocular mass. A macroscopically complete exeresis was performed, with an anatomopathological diagnosis of orbital schwannoma


Assuntos
Humanos , Masculino , Criança , Células de Schwann , Neurilemoma/diagnóstico por imagem , Órbita/lesões , Exoftalmia , Neoplasias , Neurilemoma/cirurgia
7.
Clin Nucl Med ; 45(10): 808-810, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32604115

RESUMO

Schwannoma is a slow-growing benign tumor, which originates from Schwann cells and is usually asymptomatic. The most common sites of schwannomas are the head, neck, and extremities. However, a schwannoma located in the liver is extremely rare. Here, we report a 53-year-old woman with a hepatic lesion accidentally found by ultrasound. It was highly suggestive of hepatic cholangiocarcinoma by MRI. F-FDG PET/CT could not exclude hepatic malignant tumor due to its high metabolism. Finally, it was confirmed as hepatic schwannoma by postoperative pathology.


Assuntos
Fluordesoxiglucose F18 , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Feminino , Humanos , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/cirurgia , Período Pós-Operatório
8.
Medicine (Baltimore) ; 99(29): e20940, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702833

RESUMO

RATIONALE: Schwannomas are mesenchymal tumors with low malignant potential that originate from Schwann cells. They can occur in most parts of the body, such as the head, neck, and extremities. Schwannoma in the hepatoduodenal ligament is extremely rare, and only four cases have been reported in the literature. PATIENT CONCERNS: Herein, we describe a 58-year-old female who presented with right epigastric pain for 10 days. Preoperative computed tomographic (CT) revealed a 4.5 cm × 3.8 cm tumor in the hepatic hilar area. DIAGNOSES: Schwannoma in the hepatoduodenal ligament with portal vein invasion. INTERVENTIONS: Intraoperative findings revealed that the tumor was identified in the hepatoduodenal ligament, and the left branch of the portal vein was compressed. Complete tumor resection with reparation of the portal vein was performed for the patient. Postoperative pathological examination confirmed the final diagnosis of benign schwannoma, characterized by abundant spindle-shaped cells and positive reactivity for S-100 protein. OUTCOMES: The patient had a good prognosis and had no recurrence after 37 months of follow-up. LESSONS: Our case of schwannoma in the hepatoduodenal ligament is unique owing to the portal vein invasion, aimed at helping recognize the difficulty of preoperative diagnosis.


Assuntos
Ligamentos/patologia , Neurilemoma/patologia , Omento/patologia , Neoplasias Peritoneais/patologia , Veia Porta/patologia , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Omento/diagnóstico por imagem , Omento/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Tomografia Computadorizada por Raios X
9.
J Card Surg ; 35(8): 2084-2086, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652658

RESUMO

Primary benign schwannomas of the heart are very rare. We report the case of a patient with a huge schwannoma of unique aortic origin. The complete resection of the rare tumor has been successfully performed. There is no recurrent tumor in the 5 years follow-up. We focus our attention on the surgical technique.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/métodos , Neurilemoma/cirurgia , Neoplasias Vasculares/cirurgia , Aorta/diagnóstico por imagem , Aorta/patologia , Ponte Cardiopulmonar , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Procedimentos Cirúrgicos Reconstrutivos , Esternotomia/métodos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia
10.
J Cancer Res Ther ; 16(3): 641-646, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32719282

RESUMO

Schwannoma, a benign nerve sheath tumor, is quite rare and more so in jawbones. We report a rare case of a plexiform variant of mandibular schwannoma in a 12-year-old female with a swelling in the left mandible. Clinical features were suggestive of dentigerous cyst as a result of missing premolars and canine. Occlusal and panoramic radiography revealed an osteolytic lesion with scalloping margins, bicortical plate expansion, and agenesis of several teeth. Odontogenic keratocyst, central giant cell granuloma, odontogenic myxoma, and ameloblastic fibroma were given as radiological differential diagnoses. Histopathological examination revealed features of plexiform schwannoma which was given as the final diagnosis. The lesion was treated with surgical excision. Although odontogenic cysts/tumors are often thought of in differential diagnosis whenever well-defined radiolucencies in the jaw are encountered, it is prudent to include schwannoma. This exceptional case adds light to the fact that schwannoma should not be overlooked though it is a rare possibility and must be included in differential diagnosis of odontogenic cysts/tumors.


Assuntos
Neoplasias Mandibulares/diagnóstico , Neoplasias/diagnóstico , Neurilemoma/diagnóstico , Radiografia Panorâmica/métodos , Criança , Diagnóstico Diferencial , Feminino , Granuloma de Células Gigantes/diagnóstico , Granuloma de Células Gigantes/diagnóstico por imagem , Granuloma de Células Gigantes/cirurgia , Humanos , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/cirurgia , Neoplasias/diagnóstico por imagem , Neoplasias/cirurgia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Cistos Odontogênicos/diagnóstico , Cistos Odontogênicos/diagnóstico por imagem , Cistos Odontogênicos/cirurgia , Tumores Odontogênicos/diagnóstico , Tumores Odontogênicos/diagnóstico por imagem , Tumores Odontogênicos/cirurgia
12.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 105-111, mayo-jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-192414

RESUMO

ANTECEDENTES/OBJETIVOS: Los tumores de los nervios periféricos son lesiones poco frecuentes que se categorizan en general dentro de los tumores de partes blandas, por lo que suelen ser manejados por diferentes disciplinas quirúrgicas, como cirugía plástica, cirugía ortopédica y traumatológica, dermatología, cirugía general y neurocirugía. Un conocimiento apropiado en cuanto a la indicación terapéutica y el manejo quirúrgico es fundamental de cara a evitar un déficit neurológico en el paciente. MATERIALES Y MÉTODOS: Estudio restrospectivo donde se presenta la experiencia conjunta de 2 equipos quirúrgicos especializados en la cirugía de los nervios periféricos, 66 lesiones tumorales, en un total de 64 pacientes. RESULTADOS: La localización más frecuente fue el miembro inferior y el miembro superior con 48 lesiones tumorales. El diagnóstico anatomopatológico más frecuente fue el de schwannoma, con un 51,5%. La resección tumoral completa se logró en el 81,8% de las lesiones y siempre con estimulación o monitorización neurofisiológica. La complicación posquirúrgica más frecuente fue el dolor neuropático o un trastorno sensitivo transitorio en el 15% de las cirugías, apareciendo solo un déficit motor persistente en 2 casos que requirieron reconstrucción con injerto nervioso. CONCLUSIONES: Si bien el manejo terapéutico de los tumores benignos como los schwannomas puede considerarse relativamente sencillo aplicando los conceptos básicos en microcirugía de los nervios periféricos, los tumores malignos, si bien son muy infrecuentes, requieren de un manejo multidisciplinar. La opción de la biopsia prequirúrgica a día de hoy sigue siendo un tema controvertido y sin acuerdo entre los diferentes autores; en nuestra opinión, no es necesaria su realización de forma percutánea en la mayoría de los casos


BACKGROUND/OBJECTIVES: Peripheral nerve tumours (PNT) are rare lesions that are generally categorised as soft tissue tumours, so they are usually managed by a range of surgical disciplines such as plastic, orthopaedic and trauma surgery, dermatology, general surgery and neurosurgery. Appropriate knowledge of the therapeutic indication and surgical management are essential in order to avoid neurological deficit. MATERIALS AND METHODS: This is a retrospective study of 66 tumour lesions in 64 patients, acquired from the joint experience of 2 surgical teams specialised in peripheral nerve surgery. RESULTS: The most common location was the lower limb and upper limb with 48 tumour lesions. The most common pathological diagnosis was Schwannoma, accounting for 51.5%. Complete tumour resection was achieved in 81.8% of the lesions and always with neurophysiological stimulation and/or monitoring. The most common postsurgical complication was neuropathic pain and/or a transient sensory disorder in 15% of surgeries, with only one persistent motor deficit appearing in 2cases that required nerve graft reconstruction. CONCLUSIONS: Although the therapeutic management of benign tumours such as Schwannomas can be considered to be relatively simple thanks to the application of the basic concepts of peripheral nerve microsurgery, malignant tumors, despite being very rare, require multidisciplinary management. The option of pre-surgical biopsy remains a controversial issue and no consensus has been reached among the different authors. In our opinion, percutaneous biopsy is not necessary in most cases


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias do Sistema Nervoso Periférico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Estudos Retrospectivos , Neurilemoma/diagnóstico por imagem , Dor Pós-Operatória/complicações , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/patologia
13.
Medicine (Baltimore) ; 99(25): e20747, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569218

RESUMO

RATIONALE: Optic Schwannoma is rarely observed clinically as optic nerve had anatomically impossibility for the location of Schwannoma. However, several reports described the established cases of optic Schwannoma, of which the locations were in orbit or within optic canal. The occurrence of optic Schwannoma intracranially has been not reported. PATIENT CONCERNS: A 60-year-old female complained of visual impairment in the right eye and the frequent headache and the dizziness over 2 years with unknown reasons. The result of magnetic resonance imaging (MRI) showed a round, well-circumscribed, heterogeneously enhancing signal with cystic change displayed on the right suprasellar cistern. DIAGNOSES: Intracranial optic Schwannomas. INTERVENTIONS: The patient accepted microneurosurgery assisted by endoscopy. We observed a gray and yellow lesion located near the right anterior clinoid process with a mid-sized cyst. And there was a vague boundary between the tumor and the right optic nerve which was compressed by the tumor. Optic chiasm and left optic nerve were also compressed. Meanwhile, the tumor had also adhesion to the right anterior cerebral artery (ACA). OUTCOMES: After the tumor was totally resected, the patient had satisfactory recovery. LESSONS: We reported an intracranial optic Schwannoma removal with the lateral supraorbital keyhole approach assisted by neuroendoscopy. Intracranial optic Schwannoma was rarely seen clinically. Neuroendoscopy imaging suggested the close relationship between the tumor and ACA, supporting vasculature-origin hypothesis for the optic Schwannoma.


Assuntos
Microcirurgia/métodos , Neurilemoma/cirurgia , Neuroendoscopia/métodos , Neoplasias do Nervo Óptico/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/cirurgia , Neoplasias do Nervo Óptico/diagnóstico por imagem
14.
Neurochirurgie ; 66(3): 179-182, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32387428

RESUMO

BACKGROUND AND OBJECTIVES: More and more surgeons are changing their surgical procedures by using mini-invasive technology with the aim of reducing morbidity. Robotized technology for the surgery of narrow spinal space, for the resection of intervertebral foramen tumor, is a valuable option that should be considered. The authors report the case of a patient who underwent robotic surgery for the treatment of a paravertebral schwannoma and show the benefits of this approach. CASE REPORT: A 53-year-old man was treated, in 1995, via an open right latero-thoracic approach for a T8-T9 thoracic schwannoma with a complete resection. Twenty years later, the patient complained of recurrent T8-T9 thoracic pain with unilateral radicular irradiation related to a recurrent schwannoma with a right foraminal extension. Using robotic technology (Da Vinci®), a complete resection was achieved and confirmed by a postoperative MRI. The patient, who was free of neurological symptoms, discharged the hospital at day 2. COMMENTS: Robot-assisted surgery by Da Vinci® robot is a very useful approach for the treatment of spinal paravertebral schwannoma. Thanks to multi-directional arms and 3D vision, this technology is safe and effective about quality of resection. The use of mini-invasive technology should be routinely discussed for lesions in that specific location.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neurilemoma/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
15.
PLoS One ; 15(5): e0233623, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469953

RESUMO

OBJECTIVES: To retrospectively determine the diagnostic ability of MRI in differentiating between intradural extramedullary spinal schwannomas and meningiomas. METHODS: A total of 199 patients with spinal intradural extramedullary tumors who underwent preoperative contrast-enhanced MRI between January 2012 and December 2018 were included in this study. Two radiologists independently analyzed the presence of cystic change, dural tail sign, and neural foraminal extension. Clinical and MRI features between the two groups were compared by univariable and multivariable analyses using logistic regression. Interobserver agreements were calculated using kappa statistics. RESULTS: Patients with schwannoma showed significantly higher frequency of cystic change (96% vs 24%, P < 0.001), neural foraminal extension (29% vs 3%, P = 0.001), and lumbar location (41% vs 5%, P = 0.008). Patients with meningioma showed significantly higher frequency of dural tail sign (64% vs 1%, P < 0.001), thoracic location (75% vs 31%, P = 0.007), older age (59.7 years vs 47.6 years, P < 0.001), higher female predominance (83% vs 50%, P < 0.001), and smaller size (19.8 cm vs 28.8 cm, P < 0.001). Multivariable analysis showed that cystic change (P < 0.001; odds ratio [OR], 0.02), dural tail sign (P < 0.001; OR, 36.23), age (P = 0.032; OR, 1.06), and lumbar location (P = 0.006; OR, 0.02) were independent factors. Interobserver agreements were almost perfect for all analyses. CONCLUSIONS: MRI features were useful in differentiating between intradural extramedullary schwannomas from meningiomas. The presence of cystic change and dural tail sign were independently significant discriminators.


Assuntos
Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Células de Schwann/patologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia
16.
World Neurosurg ; 138: 440-443, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251817

RESUMO

BACKGROUND: Spinal schwannomas are benign nerve sheath neoplasms that constitute about 30% of extramedullary spinal cord tumors. They are usually small, well-encapsulated tumors with low mitotic activity and concurrently carry a low risk of recurrence. Here, we report a case of atypical histologic variant of spinal schwannoma that had higher cellular density, nuclear atypia, and lack of encapsulation. To our best knowledge, no such cases of this atypical variant with regards to lumbar spine have been reported in the literature. CASE DESCRIPTION: A 66-year-old male had an incidental left-sided paraspinal mass discovered while undergoing workup for cholecystitis. On examination, the patient was neurologically intact. Imaging revealed the presence of a contrast-enhanced, partially cystic mass arising from the L3-4 intervertebral foramen and causing left psoas muscle displacement. A minimally invasive left L3-4 posterior extracavitary resection was done. Histopathologic examination revealed a partly unencapsulated tumor with higher than usual cellular density and nuclear atypia, resulting in a diagnosis of "atypical schwannoma." Imaging at 6 months' follow-up showed stable postsurgical changes and residual tumor with no evidence of progression/recurrence. CONCLUSIONS: Atypical schwannoma has higher cellular density and nuclear atypia and lacks encapsulation. A review of the literature suggests an increased risk of recurrence when compared with typical variants, and complete tumor removal should be attempted.


Assuntos
Vértebras Lombares/patologia , Neurilemoma/patologia , Neoplasias da Medula Espinal/patologia , Idoso , Colecistite/complicações , Colecistite/diagnóstico por imagem , Forame Magno/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias da Bainha Neural/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
17.
World Neurosurg ; 139: 31-38, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32289509

RESUMO

BACKGROUND: Tumors arising from oculomotor nerve are rare, with few cases reported in the literature. Generally, whereas schwannomas are well encapsulated tumors, neurofibromas tend to invade the entire nerve fibers. These differences influence surgical resection and neurological clinical outcome, with neurofibroma often requiring the sacrifice of the nerve. Accordingly, an incorrect preoperative diagnosis can lead to incomplete patient counseling before surgery. CASE DESCRIPTION: We report 2 cases: a patient with oculomotor schwannoma and a patient with oculomotor neurofibroma. After tumor resection, the patient with a diagnosis of schwannoma recovered with 3rd nerve palsy, while patient with the neurofibroma developed a complete oculomotor nerve deficit. For each patient, surgical strategy and neurological outcome are elucidated in relation with differences in preoperative magnetic resonance imaging and histology. CONCLUSIONS: To the best of our knowledge, this is the first report of an oculomotor neurofibroma. When an oculomotor nerve tumor is suspected, a careful preoperative evaluation of magnetic resonance imaging guides in distinguishing the different histology, in selecting the treatment strategy, and in correctly informing the patient on expected postoperative neurologic outcome.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Neurofibroma/cirurgia , Doenças do Nervo Oculomotor/cirurgia , Adulto , Seio Cavernoso/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neurofibroma/diagnóstico por imagem , Neurofibroma/patologia , Doenças do Nervo Oculomotor/complicações , Doenças do Nervo Oculomotor/diagnóstico por imagem , Doenças do Nervo Oculomotor/patologia , Recuperação de Função Fisiológica , Resultado do Tratamento , Derivação Ventriculoperitoneal
18.
Acta Neurochir (Wien) ; 162(5): 1181-1185, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32198539

RESUMO

We describe a rare case of extradural schwannoma in the upper cervical spine compressing the dominant internal jugular vein (IJV) presenting with atypical headaches. A 50-year-old woman complained of a subcutaneous neck mass associated with atypical headaches. Radiological examinations revealed the right IJV was compressed anteriorly by C2 extradural mass and occluded with markedly dilated collateral cerebral venous drainage through deep cervical veins. Subtotal removal was performed via the posterolateral approach and the atypical headaches resolved immediately. This case demonstrates that extradural schwannoma in the upper cervical spine could compress the IJV and manifest as cerebral venous circulation disturbances.


Assuntos
Veias Jugulares/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Veias Cerebrais/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Radiografia
19.
J Craniofac Surg ; 31(4): e411-e413, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32195840

RESUMO

Schwannomas are the most common benign tumors arising from the peripheral nerve sheath, and the intraoral location is very atypical, representing less than 1% of all cases. Surgical excision is the treatment of choice, and a variety of surgical approaches have been described. The authors report the first described case of tongue base schwannoma treated with transoral robotic surgery (TORS). A 47-years-old female patient complaining mild dysphagia and snoring, presented a submucosal swelling at the right side of the tongue base. MRI showed a large well-circumscribed solid mass, homogeneously isointense in T1WI and hyperintense on T2WI, with no lymph node metastasis. According to size, location and radiological characteristic of the mass a TORS approach was chosen. An extracapsular dissection was performed, and the lesion was completely removed with no intraoperative complications. The final diagnosis based on histopathological examination and IHC analysis (S-100 positive) was a schwannoma of the tongue base. The post-operative course was uneventful, and no recurrence was observed after 6 months of follow-up. This study demonstrates the feasibility of TORS in the treatment of a tongue base schwannoma. This is a valid alternative to the common transoral approach in order to avoid more invasive external approaches, and further studies are recommended in order to clarify if this approach could be proposed as the first line treatment in selected cases.


Assuntos
Neurilemoma/cirurgia , Neoplasias da Língua/cirurgia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Metástase Linfática , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neurilemoma/secundário , Procedimentos Cirúrgicos Robóticos , Ronco/etiologia , Neoplasias da Língua/complicações , Neoplasias da Língua/diagnóstico por imagem , Neoplasias da Língua/patologia
20.
Can Assoc Radiol J ; 71(2): 161-173, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063006

RESUMO

Imaging studies of the hands and fingers are common, and radiologists are generally comfortable with traumatic and degenerative conditions which arise frequently in daily practice. However, a variety of common and uncommon soft-tissue tumors also occur in the hand, the appropriate diagnosis of which can be a source of confusion for both clinicians and radiologists. These lesions often have overlapping imaging characteristics; however, a structured approach can help provide a focused differential diagnosis and impact further workup and management. We discuss several such tumors, categorizing them as cystic-appearing, noncystic masses along tendons and aponeuroses, adipocytic tumors, vascular lesions, and miscellaneous lesions with imaging features that can aid diagnosis.


Assuntos
Fibroma/diagnóstico por imagem , Tumor de Células Gigantes de Bainha Tendinosa/diagnóstico por imagem , Tumor Glômico/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neurofibroma/diagnóstico por imagem , Sarcoma Sinovial/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Malformações Arteriovenosas/diagnóstico por imagem , Diagnóstico Diferencial , Cisto Epidérmico/diagnóstico por imagem , Fasciite/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Mãos , Humanos , Imagem por Ressonância Magnética , Radiografia , Cisto Sinovial/diagnóstico por imagem , Ultrassonografia
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