Supratentorial Extraventricular Anaplastic Ependymoma Presenting with Repeated Intratumoral Hemorrhage

Supratentorial extraventricular anaplastic ependymomas are extremely rare. We report the case of a 23-year-old male with a supratentorial extraventricular anaplastic ependymoma that presented with repeated intratumoral hemorrhage. The patient was diagnosed with an intracerebral hematoma in the left occipital lobe and underwent operation. The hematoma did not reveal tumor cells, but a new tumor grew in the same location 5 years later. Magnetic resonance imaging showed a tumor with intratumoral hemorrhage. The patient underwent the tumor resection. Intraoperative findings showed that the tumor had no continuity with the ventricle. Histopathological examinations confirmed an anaplastic ependymoma. The spinal evaluation was unremarkable, and radiotherapy was administered to the left occipital lobe. Four years later, the tumor recurred at the cervicomedullary junction and T8-T9 levels. This case demonstrates that anaplastic ependymomas should be included in the differential diagnoses of supratentorial extraventricular tumors presenting with repeated intratumoral hemorrhage.

An Intracranial Chondroma with Intratumoral Hemorrhage: A Case Report and Review of the Literature

A 55-year-old female presented to the emergency room with a complaint of aphasia. Her initial brain computed tomography scan showed an intracranial hemorrhage in the left frontal area. After surgery, histopathological examination confirmed the diagnosis of a chondroma. Intradural chondroma is a rare, slow growing, benign intracranial neoplasm, but is even rarer in combination with an intratumoral hemorrhage. Chondromas are generally avascular cartilaginous lesions. Our case was thought to be caused by the rupture of abnormally weak vessels derived from the friable tumor. Intradural chondromas may be included in the differential diagnosis of intracranial tumors with acute hemorrhages.

Cerebellar Ganglioglioma in an Old Patient

Gangliogliomas could be found anywhere throughout the central nervous system and mainly affect children and young adults during the first three decades of life. Cerebellar gangliogliomas may be rarely found, especially in old ages. Here, we present a case of ganglioglioma of the cerebellum in an old patient. The cystic cerebellar mass was associated with calcifications, intratumoral hemorrhage without ng edema. When a cystic cerebellar mass is associated with calcifications and intratumoral hemorrhage, ganglioglioma should be included in differential diagnosis. Gangliogliomas usually have good prognoses. Radiation therapy should be deferred even in subtotally removed cases.

Silent Adenomas of Pituitary Gland: It's Immunohistochemical Features and Clinical Characteristics

OBJECTIVE: The aim of the study was to review the clinical and radiological findings of those non-functioning adenomas(NFAs) with positive immnoreactivity for anterior pituitary hormones. METHODS: Sixty patients with pituitary adenoma were treated at the author's institution between January 2000 and July 2005. All consecutive patients were underwent transsphenoidal surgery by same operator. In addition to the routine histopathological examination, surgical specimen was examined by immunohistochemical staining against adenohypophyseal cells. And clinical analysis was performed by retrospective review of medical records, neuroimaging examinations and immunohistochemical technique. We classified these pituitary adenomas into functioning adenomas (group F), immunopositive NFAs (group S, so-called silent adenoma) and immuno-negative NFAs (group N), and compared clinical and radiological differences between group F, N, and S. RESULTS: Of the 60 cases, group F was 25, group S was 25, and group N was 10. Among the group S, 5 cases showed reactivity against PRL, 1 against GH, 1 against both PRL and GH, 1 against TSH and GH, 2 against ACTH, 11 against FSH and 4 against both LH and FSH. Radiologically, invasiveness was noted in 8 in group S, compared to 3 in group N and 1 in group F (p=0.02). Intratumoral bleeding was noted in 7 of group S, 2 of group N and 2 of group F (p>0.05). CONCLUSION: Silent adenomas were thought to behave more aggressive than other subgroups of pituitary adenomas. And so we suggest the immunohistochemical study against adenohypophyseal cells may be helpful for evaluating clinical course of pituitary adenoma, expecially for, NFAs.

Subependymal Giant Cell Astrocytoma with a Large Third Ventricular Hematoma

Subependymal giant cell astrocytoma(SEGA) is the most common intracranial tumor in patients with tuberous sclerosis(TS) and relatively benign tumor that arises in the subependymal layer of the lateral ventricle. It may occur independently, or in association, with TS and usually is found in adolescents and young adults. However, it is extremely rare that SEGA has caused intratumoral and intraventricular hemorrhage. We are reporting a case with a large third ventricular hematoma well encapsulated with fibrous tissue, originating in SEGA around foramen Monro of the lateral ventricle.

Meningioma with Intratumoral Hemorrhage

Meningioma associated with intratumoral hemorrhage is rarely reported. We present two patients with intratumoral hemorrhage. One 70-year-old man was admitted to our department with a decreased level of consciousness and left hemiparesis. CT scan and MRI scan revealed huge tumor with intratumoral hemorrhage in the frontal lobe. After surgical removal of the tumor, histopathological diagnosis was a meningotheliomatous meningioma. The other seemed patients was 56-year-old woman with headache and vomiting. She showed no specific neurological deficit. CT and MRI scan revealed large size tumor with intratumoral hemorrhage that looks like meningioma. The patient died suddenly before surgery. We reviewed the relevant literature and discussed the possible mechanism of hemorrhage in the meningioma.

A Vestibular Schwannoma Associated with Massive Intratumoral Hemorrhage

The report of massive intratumoral hemorrhage from vestibular schwannoma is rare. A 66-year-old female who had suffered from disturbance of hearing for one year developed severe headache and dizziness. Brain MRI showed crescent shaped mass in the left cerebellopontine angle. A left suboccipital approach revealed an 3X3cm-sized encapsulated mass. The tumor was totally extirpated together with clot. Histologically the tumor was schwannoma with massive hemorrhage. Postoperative course was uneventful. The authors report the rare case of vestibular schwannoma presenting with intratumoral hemorrhage with review of possible pathophysiology and associated factor.

Spontaneous Cystic Degeneration of Solid Suprasellar Germinoma

Intracranial germinomas are malignant neoplasms arising from remnants of primitive germ cells that have failed to migrate to the genital crest during embryonic life. They are usually solid tumors, but focal cysts may occasionally be found within them and are thought to represent proteinaceous fluid. Cystic degeneration of the whole tumor, however, that is caused by intratumoral hemorrhage, has not yet been reported. We present a case of cystic degeneration of solid suprasellar germinoma. During surgery, cyst content was shown to be liquefied hematoma, and bleeding of the tumor had occurred. The exact time of intratumoral hemorrhage in the presented case is unknown, but since there had been no episode of apoplexy, we believe that degeneration occurred chronically. The patient's postoperative course was uneventful. On the basis of our findings we suggest that in diagnosing suprasellar cystic tumors, the possibility of germinomas must be taken into consideration and that spontaneous cystic degeneration of suprasellar germinoma can occur as a result of tumor bleeding.

Chondrosarcoma with Intratumoral Hemorrhage: Case Report

We present a case of a 64-year-old man with chondrosarcoma complicated with intratumoral hemorrhage. Cartilage cell tumors within the cranium are very rare. Only less than 0.2% of all intracranial tumors. However chondrosarcoma with intratumoral hemorrhage has not been reported. We report a rare case of chondrosarcoma with intratumoral hemorrhage in parasella region with a literatures review.

A Case of Falx Meningioma Diagnosed due to Intratumoral Hemorrhage: Case Report

The authors report a case of falx meningioma which was first diagnosed with apopletic symptom due to intratumoral hemorrhage. A 72-year-old man was admitted to our hospital with a sudden deterioration of his level of consciousnesss down to a deep drowsiness, generalized seizure, and right hemiparesis. Radiological examinations, including brain CT(Computed Tomographic) scan and MRI(Magnetic Resonance Image) revealed a giant falx meningioma with intratumoral hemorrhage. During the operation the authors found a massive hemorrhage inside the tumor. Histologically, the tumor was meningotheliomatous meningioma and showed a hemorrhagic area with diffuse hemosiderin deposition. The authors also review the relevant literature and discuss the possible mechanism of hemorrhage in the meningioma.

An Acoustic Neurinoma with Intratumoral Hemorrhage

Acoustic neurinoma are the most frequent tumors in the region of the cerebellopontine angle. They usually present with a gradual onset of symptoms and slow progression. Development of spontaneous hemorrhage with sudden aggravation of symptoms is rare. The authors present a case of acoustic neurinoma associated with a spontaneous intratumoral hemorrhage. Sudden aggravation of symptoms was noticed. The cranial computed tomography revealed multiple blood-fluid levels within the cysts of the tumor which was located in the region of the right cerebellopontine angle. Operation was performed, which confirmed recent hemorrhage within the tumor. Pathological study revealed a typical neurilemmoma associated with hemorrhage, vascular proliferation and macrophages which phagocytosed hemosiderin pigments. The rare sudden aggravation of symptoms in cases of acoustic neurinoma may suggest hemorrhage.