ABSTRACT
Here, we report a rare case of L3 chordoma progressed to an intradural extramedullary (IDEM) mass and distant metastasis to the fascia lata. A 64-year old female patient presented to a local university hospital due to back pain and received excisional biopsy for a L3 destructive bony lesion. Local radiation therapy was initially administered, assuming a malignancy of unknown origin, but she developed cerebrospinal fluid leakage during adjuvant radiation therapy, which was managed by wound revision and lumbar drainage. As the destructive lesion progressed, she visited our hospital for a second opinion 3 months after the biopsy. After review of outside pathology, we diagnosed the lesion to be a chordoma, and performed a L3 corpectomy with cage and plate fixation. One and a half years later, positron emission tomography and computed tomography (PET-CT) revealed a right tensor fascia lata hypermetabolic lesion. Excisional biopsy confirmed a distant metastasis of the chordoma. One year later, she complained of L2 radiating pain. PET-CT and CT myelogram revealed an IDEM lesion. Surgical excision confirmed the transdural invasion of the chordoma. To our knowledge, this is the first report of an iatrogenic IDEM invasion and distant metastasis to the tensor of the fascia lata by a L3 chordoma.
ABSTRACT
Choroid plexus tumors are uncommon brain tumors that primarily occur in children. Most of these tumors originate from the intraventricular area, and the most common clinicalpresentation is increased intracranial pressure. Dissemination through the cerebrospinal fluid space is the inevitable natural course of the disease. Here, we present 2 rare cases of adult choroid plexus carcinoma (CPC), each with distinct clinical presentation and progression. The first case was a 40-year-old male who presented with multiple intraventricular masses. After surgical biopsy, radiation and intrathecal chemotherapy failed to elicit any response. The patient progressed with spinal cord dissemination and expired 1 year later. The second case presented with visual disturbance, and brain MRI revealed a large ovoid juxtaventricular mass with peritumoral edema. This 49-year-old female patient underwent craniotomy for what was thought to be a high-grade glioma; however, the mass was connected to the choroid plexus at the operative field. Her pathology specimen was diagnosed as CPC, and adjuvant systemic chemotherapy was administered. She has now been free of recurrence for 10 months. The description of the presentation and progression of these rare adult-onset CPC provides insight for the diagnosis and treatment of other rare instances of choroid plexus tumors.
Subject(s)
Adult , Child , Female , Humans , Male , Middle Aged , Biopsy , Brain , Brain Neoplasms , Cerebrospinal Fluid , Choroid Plexus Neoplasms , Choroid Plexus , Choroid , Craniotomy , Diagnosis , Drug Therapy , Edema , Fourth Ventricle , Glioma , Intracranial Pressure , Magnetic Resonance Imaging , Pathology , Recurrence , Spinal CordABSTRACT
A 74-year-old woman presented with a month-long nausea and vomiting, then she could not take a meal. She had found an asymptomatic 4th ventricular mass 6 year ago as a preoperative work-up for ovarian cancer. And during the yearly follow-up, the mass had grown continuously over 6 years, and caused symptoms in the seventh year. MRI revealed a large ovoid extra-axial mass in the fourth ventricle compressing adjacent medulla and cerebellum. Surgery achieved near total resection since the tumor tightly adhered to the brain stem of 4th ventricle floor. The histological diagnosis was ependymoma (WHO grade II). She transferred rehabilitation facility for mild gait disturbance, hoarseness and swallowing difficulty. Fourth ventricle ependymoma in the elderly is extremely rare and the growth rate has not been reported. Here, we present a rare care of 4th ventricle ependymoma found asymptomatic at elderly but continuously grow to cause local pressure symptoms.
Subject(s)
Aged , Female , Humans , Brain Stem , Cerebellum , Deglutition , Diagnosis , Ependymoma , Follow-Up Studies , Fourth Ventricle , Gait , Hoarseness , Magnetic Resonance Imaging , Meals , Nausea , Ovarian Neoplasms , Rehabilitation , VomitingABSTRACT
Surgery, anticoagulation therapy, pregnancy, and hormone treatments, such as bromocriptine, are well-characterized precipitating factors for pituitary apoplexy. However, whether cytotoxic chemotherapy for systemic cancer could cause pituitary apoplexy has not been investigated. Here, we present a case of a 41-year-old woman who developed a severe headache with decreased visual acuity after intravenous cytotoxic chemotherapy to treat metastatic breast cancer. Preoperative neuroimaging revealed pituitary adenoma with necrosis. Operative findings and pathologic examination concluded extensive necrosis with a small intratumoral hemorrhage in a pre-existing pituitary adenoma. We reviewed two additional previously published cases of pituitary apoplexy after systemic chemotherapy and suggest that cytotoxic chemotherapy may induce pituitary apoplexy.
Subject(s)
Adult , Female , Humans , Pregnancy , Breast Neoplasms , Breast , Bromocriptine , Drug Therapy , Headache , Hemorrhage , Necrosis , Neuroimaging , Pituitary Apoplexy , Pituitary Neoplasms , Precipitating Factors , Visual AcuityABSTRACT
Bronchogenic cyst has been recognized as remnants of foregut which abnormally were developed tracheobronchial tree during embryonic period. The anomaly was found in the lung or mediastinum but rarely in the neck. Histologic diagnosis can be made by the identification of the airway tissue lined by ciliated pseudostratified columnar or cuboid epithelium. A 4-year-old patient was admitted due to increase in the size of right neck mass which was incidentally found 2 years ago. In anterior triangle of neck, soft, non-tender and movable mass was presented in right lymph node measured by 1.2X0.7 cm in size. On admission, soft and non-tender mass was palpated at the right neck between right thyroid gland and right sternocleidomastoid muscle measured by 2.0x1.0 cm in size. After the excisional operation, histopathologic examination revealed the smooth muscle and muco-serous gland lined by ciliated pseudostratified columnar epithelium, and was diagnosed of bronchogenic cyst surrounded by enlarged lymph nodes which were reflecting reactive hyperplasia. We are reporting a case of bronchogenic cyst presenting as neck mass with brief review of the literature.