Giant cell reparative granuloma concurrent with squamous cell carcinoma of the temporal bone: a case report and review of the literature.

A case of giant cell reparative granuloma concurrent with squamous cell carcinoma of the right temporal bone in a 44-year-old man with clinically presenting otorrhea from the mass of the right acoustic canal with hearing loss is reported. The histopathological examination of the lesion characterizes by multinucleated giant cells with in a fibroblastic stroma and area of keratinizing squamous cell carcinoma. GCRG may have been a local reaction provoked by the squamous cell carcinoma. Clinical and pathological features with briefly reviewed relevant literatures of temporal GCRG describing 24 cases are discussed. The patients have the mean age of 34.8 years. The ages of the patients ranged from 4 months to 72 years old. Temporal bone GCRG shows a male predilection of approximately 3:1. The frequently presenting symptoms of temporal bone GCRG are hearing loss, mass, tinnitus, otalgia, otorrhea, vertigo, headache, facial weakness, and diplopia. This is the first reported description in the literature of temporal bone GCRG concurrent with squamous cell carcinoma.

Stereotactic radiation therapy for optic nerve sheath meningioma; an experience at Ramathibodi Hospital.

OBJECTIVE: To evaluate results of stereotactic radiotherapy for the treatment of optic nerve sheath meningioma (OM) at Ramathibodi Hospital. MATERIAL AND METHOD: Twelve patients with primary OM were treated with stereotactic radiation between 1998 and 2005. Five patients underwent surgery and had no light perception before radiation. All patients except one were treated with fractionated stereotactic radiotherapy (FSRT). Mean average dose of FSRT was 55. 7 Gy; 180 cGy/fraction. One patient was treated with 15-Gy stereotactic radiosurgery. RESULTS: With a median follow-up of 34 months, there was no visual improvement in the five patients who were completely blind before radiation. Visual acuity improved in four patients and remained stable in two patients. Four of six patients had improved visual field, and five of six decreased in proptosis. Follow-up images were available in six patients, showing minimal tumor regression in five and stable in one. No serious acute side effect was observed. Vision became worse in one patient, who developed vitreous hemorrhage two years after FSRT. CONCLUSION: Stereotactic radiotherapy is an effective treatment for primary OM. It provides tumor control and visual preservation with low risk of complications. However more patients and further follow-up are needed for long-term outcomes.

Evaluation of MR cisternography in diagnosis of cerebrospinal fluid fistula.

PURPOSE: To study the clinical usefulness and sensitivity of MR cisternography as noninvasive study in the diagnosis of CSF fistula in patients with clinical diagnosis CSF rhinorrhea or otorrhea. METHOD: Thirty-five patients with clinically diagnosed CSF leakage were examined for site of dural tear with MR cisternography with additional plain high-resolution CT in some cases from Jan. 1999 to Dec.2002. The MR imaging technique was performed as a heavily T2 weighted fast spin echo study with fat suppression in axial, coronal and sagittal projections. Criteria for positive results were demonstrable fistular tract connecting subarachnoid space to paranasal sinus/petrous bone, and/or dural discontinuity, and/or bone defect with pneumocephalus, and/or presence of brain herniation. Eighteen of the patients subsequently had exploratory surgery for fistula. Sensitivity analysis of the surgical results was compared with the findings at MR cisternography. RESULT: MR cisternography showed significant correlation with surgical findings with sensitivity of 89%. Additional high resolution CT were complete agreement with site of fistular tract. The pathogenesis of CSF leakage was related to trauma (86%). The commonly found dural/bony defect and location of connecting fislular tract were cribriform plate and ethmoid sinus of 58%, 55% respectively. CONCLUSION: In the presence of clinically diagnosed CSF leakage, the combination of MR cisternography and plain high-resolution CT are highly accurate in locating the site and extent of CSF fistula and should be considered a viable noninvasive alternative to CT cisternography and Tc-99m-DTPA cisternography.