Atypical Virchow-Robin SpacesMimicking Cystic Primary Brain Tumor ­ Clinical Report and Literature Review

The Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuroimaging examinations, are small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Typically, they have similar physicochemical characteristics to cerebral spinal fluid (CSF) and there is no contrast enhancement on brain CT andMRI images. Its real meaning is unknown, although some contemporary studies have suggested that it might be related to certain traumatic brain injury or several other central nervous system (CNS) disorders, as degenerative diseases. Occasionally, some wide and atypical VRS may be mistaken for primary cystic brain tumors, especially in the context of large and symptomatic lesions, multiple clustered cysts, cortical lesions and if there is adjacent reactive gliosis. The present paper reports four patients who were affected by atypical VRS mimicking brain tumors that required imaging follow-up or even a biopsy to confirm the diagnosis or to indicate the correct approach. Although it is not so unusual, one of them occurred concomitantly and adjacent to a diffuse glioma (co-deleted 1p19q, WHO-GII).

A debate over the link between Salvador Allende, Max Westenhöfer, and Rudolf Virchow: contributions to the history of social medicine in Chile and internationally / Una discusión sobre el vínculo entre Salvador Allende, Max Westenhöfer y Rudolf Virchow: aportes a la historia de la medicina social chilena e internacional*

Abstract In the history of Latin American social medicine, numerous works have presented a harmonious link between Rudolf Virchow, Max Westenhöfer, and Salvador Allende, which establishes the origin of ideas of Latin American social medicine in a prestigious European source, represented by Virchow. A key to that story is that Allende was a student of Westenhöfer, a disciple of Virchow who lived in Chile three times (1908-1911, 1929-1932, and 1948-1957). Based on primary sources and contextual data, this article problematizes the relationship between Allende and Westenhöfer, and questions the influence of Virchow in Chilean social medicine.

Resumen En el marco de la historia de la medicina social latinoamericana, numerosos trabajos historiográficos han presentado un vínculo armónico entre Rudolf Virchow, Max Westenhöfer y Salvador Allende, afirmando una procedencia virtuosa de las ideas de la medicina social latinoamericana en una prestigiosa fuente europea, como es la que representa Virchow. Un dato crucial en ese relato es que Allende habría sido estudiante de Westenhöfer; un discípulo de Virchow que vivió en Chile en tres ocasiones (1908-1911, 1929-1932 y 1948-1957). Este trabajo problematiza, usando fuentes primarias y datos de contexto, la relación entre Allende y Westenhöfer, y cuestiona la influencia de Virchow sobre el pensamiento médico-social en Chile.

Analysis of the factors influencing expansion of Virchow-Robin spaces in basal ganglia and central semiovale / 中国医师进修杂志

Objective To investigate the factors influencing expansion of Virchow-Robin spaces (VRS) in basal ganglia and central semiovale.Methods One hundred and ninety-six patients with acute single lacunar infarction were analyzed retrospectively from June 2015 to June 2019 in Fukuang General Hospital of Liaoning Health Industry Group (Seventh Clinical College of China Medical University).Among them,108 patients with basal ganglia infarction and 88 patients with central semiovale infarction were included.MRI was used to evaluate the extent of VRS expansion.Univariate analysis and multivariable Logistic regression analysis were used to analyze the related factors affecting VRS expansion in basal ganglia and central semiovah.Results Univariate analysis showed that there were significant differences in the female,proportion of hypertension,systolic blood pressure and body mass index (BMI) between the mild enlarged group (48 cases) and the severe enlarged group (148 cases) of VRS expansion in basal ganglia:22 cases vs.40 cases,35.4％(17/48) vs.78.4％(116/148),(138.7 ± 14.2)mmHg (1 mmHg=0.133 kPa) vs.(150.3 ± 12.0) mmHg and (26.7 ± 2.5) kg/m2 vs.(24.1 ± 2.2) kg/m2,and there were statistical differences (P＜0.05 or ＜0.01);and there were significant differences in the proportion of hypertension,diabetes mellitus and BMI between the mild enlarged group (79 cases) and the severe enlarged group (117 cases) of VRS expansion in central semiovale (P＜0.05).Multivariable Logistic regression analysis showed that hypertension (OR=6.383,95％ CI 1.942 to 18.204,P=0.005),BMI (OR=0.768,95％ CI 0.620 to 0.938,P=0.010) significantly affected the expansion of VRS expansion in basal ganglia,while BMI significantly affected the expansion of VRS expansion in central semiovale (OR=0.784,95％ CI 0.642 to 0.921,P=0.003).Conclusions Hypertension is the independent risk factor of VRS expansion in basal ganglia,and BMI is the protective factor of VRS expansion in basal ganglia and central semiovale.

Troisier sign and Virchow node: the anatomy and pathology of pulmonary adenocarcinoma metastasis to a supraclavicular lymph node

ABSTRACT: Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the Virchow node (VN), leading to an appreciable mass that can be recognized clinically ­ a Troisier sign. The VN is of profound clinical importance; however, there have been few studies of its regional anatomical relationships. Our report presents a case of a Troisier sign/VN discovered during cadaveric dissection in an individual whose cause of death was, reportedly, chronic obstructive pulmonary disease. The VN was found to arise from an antecedent pulmonary adenocarcinoma. Our report includes a regional study of the anatomy as well as relevant gross pathology and histopathology. Our anatomical findings suggest that the VN may contribute to vascular thoracic outlet syndrome as well as the brachial plexopathy of neurogenic thoracic outlet syndrome. Further, the VN has the potential to cause compression of the phrenic nerve, contributing to unilateral phrenic neuropathy and subsequent dyspnea. Recognition of the Troisier sign/VN is of great clinical importance. Similarly, an appreciation of the anatomy surrounding the VN, and the potential for the enlarged node to encroach on neurovascular structures, is also important in the study of a patient. The presence of a Troisier sign/VN should be assessed when thoracic outlet syndrome and phrenic neuropathy are suspected. Conversely, when a VN is identified, the possibility of concomitant or subsequent thoracic outlet syndrome and phrenic neuropathy should be considered.

Técnicas de apertura del cadáver / Corpse opening techniques

La autopsia consiste en el estudio post mortem de un cuerpo. Este proceso que tiene comienzo desde el levantamiento del cadáver, consiste en un examen externo y un examen interno. El examen externo consiste en la inspección minuciosa del cadáver recogiendo todas las particularidades que puedan proporcionar indicios relativos a la identificación y causa de la muerte.El examen interno consiste en un estudio detallado de las posibles anormalidades anatómicas del cuerpo. Este estudio interno se hace en primera instancia mediante una observación macroscópica, si bien se puede completar con estudio microscópico, toxicológico, bioquímico, o inmunológico si fuera indicado.Para poder realizar el examen interno del cadáver se emplean técnicas de disección con la finalidad de obtener la causa y naturaleza de la muerte, así como la identidad del individuo en los casos que se desconozca.Dependiendo del estado del cuerpo, se emplearán unas técnicas determinadas. Estas técnicas tienen como fundamento el conocimiento de la anatomía normal y patológica, de la forma y estructura de los órganos y vísceras, de la relación topográfica entre los sistemas y aparatos que componen el cuerpo humano.El objetivo de este trabajo es realizar una revisión de las técnicas de apertura del cadáver, teniendo en cuenta que son de suma importancia en una autopsia, sea clínica o judicial, y no menos importante, por el respeto hacia al cadáver en la realización de las incisiones.

The autopsy is the post mortem study of a body. The process begins at the scene of death, and consists in an external and internal examination.The external examination is a thorough inspection of the cadaver collecting any particularity that may provide information regarding the identification and the cause of death.The internal examination consists in a detailed study of the possible anatomic abnormalities of the body. This internal study it´s performed firstly by a macroscopic observation that can be complemented with a microscopic, toxicological, biochemical or immunological study if indicated.To carry out the inner examination of the corpse, different dissection techniques are used in order to obtain the cause and manner of death, as well as the identity of the deceased when unknown. Depending on the etiology of death, different proceedings will be carried out. Those techniques are based on the knowledge of normal and pathological anatomy of organs and viscera morphology, and topographic relation between apparatus and systems that compound the human body.The aim of this paper is to review the techniques of cadaver opening, considering that are critical in the autopsy process, whatever clinical or judicial, and not least, by the respect for the corpse when practicing the incisions.

Mixed germ cell tumour of testis: a case report with review of literature.

Testicular tumours are rare neoplasm. Mixed germ cell tumour is the most common histological variant. Essentially, any admixture of the germ cell tumours as seen in pure form may be seen, one of the most common admixtures being embryonal carcinoma and teratoma. Unfortunately many of these patients present late usually with some complications. We present a rare case of mixed germ cell tumour with predominant embryonal carcinoma and yolk sac tumour in adolescent patient with multiple metastatic foci at the time of presentation.

Is the Severity of Dilated Virchow-Robin Spaces Associated with Cognitive Dysfunction?

BACKGROUND AND PURPOSE: Dilated Virchow-Robin spaces (dVRS) are not uncommon findings in the normal brain, particularly in the old people, and have been largely regarded as benign lesions. However, there is accumulating evidence that dVRS may serve as an neuroimaging marker of small vessel disease and are associated with cognitive decline. We investigated whether the severity of dVRS would be associated with cognitive dysfunction by comparing the subjects with subjective memory impairment (SMI), mild cognitive impairment (MCI), and Alzheimer's disease (AD). We also examined whether there were differences in the degree of correlation between dVRS and magnetic resonance imaging (MRI) markers of small vessel disease among the three groups. METHODS: In this retrospective study, a total of 225 subjects were included: those with SMI (n=65), MCI (n=100), and AD (n=60). We rated the severity of dVRS using the axial MRI slice containing the greatest number of dVRS in the basal ganglia (dVRS-BG) and in the deep white matter (dVRS-WM), separately. We also assessed baseline characteristics including vascular risk factors and MRI markers of small vessel disease such as white matter hyperintensities (WMH), lacunar infarcts and microbleeds. RESULTS: A cumulative logit model revealed that the severity of cognitive dysfunction was associated with age (p<0.001), hypertension (p=0.006), diabetes mellitus (p=0.042), the severity of dVRS-BG (p=0.001), the severity of WMH (p=0.074) and the presence of lacunar infarcts (p<0.001) and microbleeds (p=0.003) in univariate analysis. However, after adjusting for other confounding variables, the severity of dVRS-BG was not a significant discriminating factor among subjects with SMI, MCI, and AD. Spearman's correlation analysis showed a trend that the correlation between the severity of dVRS-BG and the severity of WMH became more prominent in subjects with AD than in those with MCI or SMI (r=0.191 in SMI; r=0.284 in MCI; r=0.312 in AD), and the same is true of the severity of dVRS-BG and the number of lacunar infarcts. CONCLUSIONS: The severity of dVRS was associated with cognitive dysfunction, which appeared to be confounded by other well-known risk factors. The correlation between dVRS-BG and small vessel disease markers tended to be more significant with the advancement of cognitive impairment. These results suggest that severe dVRS may reflect cerebral small vessel disease and contribute to cognitive impairment.

A Case of Meningioma in Temporo-occipital Lobe without Dural Attachment in a 14-yer-old Girl: Case Report

Meningiomas are thought to arise from the arachnoid cap or meningothelial cells. This frequent apposition to the dura mater probably accounts for the usual attachment of the neoplasm to this layer. We report a case of intraparenchymal meningioma without dural attachment in a 14-year-old girl. A survey of the literature reveals that the majority of cases of meningiomas without dural attachment occur either in children or below the tentorium, and most of them located in the ventricle, the cranial vault. Intraparenchymal meningioma without dural attachment, however, are extremely rare. The uncommon locations of meningiomas at sites distant from the duramater is believed to reflect the rare occurrence of arachnoid cap cells in the Virchow-Robin spaces along the cerebral vasculature or in the pial layers distant from the dura mater.

Unusual widening of Virchow-Robin spaces (report of 1 case) / 临床神经病学杂志

Objective To investigate the reasons of the unusual widening of Virchow-Robin spaces (VRS) and its clinical significance. Methods Clinic and MRI data of 1 case of VRS were analyzed retrospectively and related literatures were reviewed. Results VRS usually existed in the healthy adults and widening with age. In this case, VRS was a benign anatomic variant without special clinical significance. But in children, unusual widening of VRS suggested clinical significance. Conclusions Widening of VRS has no clear relation to clinical symptoms for adults. However, it is helpful in differentiation of diseases.