ABSTRACT
Tumours originating in peripheric nerves usually appear in patients with neurofibromatosis (NF) signs, presenting frequent combinations of tumours in nerves and cutaneous lesions. Nevertheless, this association is very rare in cases without NF. Therefore, the aim of the present article is to present a case of malignant melanoma and malignant schwannoma, without any described NF. A 69-year-old woman with antecedents of malignant melanoma diagnosed two years previously in the dorsum of the fifth finger of the left hand, treated by means of amputation of the finger. The patient presented a malignant epithelioid schwannoma adhered to the median nerve that required elbow amputation. One month later lung metastases appeared and the patient died. This case presented no known NF sign. However, a relationship must be searched for in the common origin of melanoma and schwannoma from the embryonic neural crest.
Subject(s)
Median Neuropathy/pathology , Melanoma/pathology , Neoplasms, Second Primary , Neurilemmoma/pathology , Peripheral Nervous System Neoplasms/pathology , Skin Neoplasms/pathology , Aged , Fatal Outcome , Female , HumansABSTRACT
Las tumoraciones originadas en los nervios periféricos ocurren mayoritariamente en individuos con signos típicos de neurofibromatosis (NF), apareciendo en estos una asociación de tumoraciones nerviosas y cutáneas, combinación muy extraña en ausencia de NF. Por ello, el objeto de este trabajo es presentar un caso de asociación de melanoma y schwannoma epiteliode maligno en ausencia de alguna de las NF conocidas. Mujer de 69 años de edad con antecedentes de melanoma en el dorso del 5ª dedo de la mano izq. dos años antes, tratada mediante amputación del dedo, que presentó un schwanoma maligno epitelioide (SME) de alta malignidad dependiente del nervio mediano en el antebrazo izquierdo, por lo que se procedió a la amputación por encima del codo. Un mes más tarde se descubrieron nódulos de aspecto metastático en ambos hemitórax, falleciendo posteriormente la paciente. En ningún momento apareció evidencia alguna de pertenecer a alguna neurofibromatosis conocida. Sin embargo, creemos que la relación etiológica debe buscarse en el hecho de que tanto el SME como el melanoma sean tumores de células procedentes de la cresta neural embrionaria (AU)
Tumours originating in peripheric nerves usually appear in patients with neurofibromatosis (NF) signs, presenting frequent combinations of tumours in nerves and cutaneous lesions. Nevertheless, this association is very rare in cases without NF. Therefore, the aim of the present article is to present a case of malignant melanoma and malignant schwannoma, without any described NF. A 69-year-old woman with antecedents of malignant melanoma diagnosed two years previously in the dorsum of the fifth finger of the left hand, treated by means of amputation of the finger. The patient presented a malignant epithelioid schwannoma adhered to the median nerve that required elbow amputation. One month later lung metastases appeared and the patient died. This case presented no known NF sign. However, a relationship must be searched for in the common origin of melanoma and schwannoma from the embryonic neural crest (AU)
Subject(s)
Aged , Female , Humans , Neoplasms, Second Primary , Fatal Outcome , Melanoma , Neurilemmoma , Median Neuropathy , Skin Neoplasms , Peripheral Nervous System NeoplasmsABSTRACT
We present the case of a 40-year-old man that presented a fast growing tumour on the external side of the left elbow. The tumour was extirpated by means of marginal exerectomy. The microscopic study corresponded to epithelioid malignant schwannoma, and the patient received radiotherapy and adjuvant chemotherapy. During the following years two local recidives and two new malignant schwannomas, one in the left sciatic common trunk and another paraspinal one, appeared and were extirpated. Radiotherapy and chemotherapy were again administered. In the last year, four new tumours have appeared: in the supraclavicular space, right posterior costofrenic, left costovertebral, and in the inferior abdominal wall, none of them has been extirpated or has hystologic diagnosis at the moment, however radiologic findings suggest malignant schwannomas. In this moment there is no neurologic deficiency except for the secondary ones to surgical procedures, and no neurofibromatosis types I to VII signs have been observed. So, the possibility of a new neurofibromatosis type is appointed.
Subject(s)
Neurilemmoma/pathology , Neurofibromatosis 1/diagnosis , Peripheral Nervous System Neoplasms/pathology , Adult , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , MaleABSTRACT
El síndrome de Insuficiencia Vertebro-Basilar es causado por una difusión transitoria de ciertas estructuras del Sistema Nervioso Central irrigadas por el complejo arterial Vertebro-Basilar. Durante este siglo este síndrome se ha conocido bajo distintos nombre debido a que ha sido atribuido a distintas etiopatogenias. En este artículo procedemos a explicar los cambios que ha sufrido este síndrome en su etiopatogenia y cómo ha afectado a su denominación (AU)
Subject(s)
Humans , History, 19th Century , History, 20th Century , Subclavian Steal Syndrome/history , Spinal Osteophytosis/historyABSTRACT
Se describe el caso de un paciente de 40 años de edad cuya clínica comenzó con la aparición de una tumoración en el codo izquierdo. Se realizó exéresis quirúrgica, siendo el diagnóstico anatomopatológico de "schwannoma maligno", por lo que se aplicó radioterapia local y quimioterapia. Durante los años siguientes aparecieron, y se extirparon, dos recidivas locales y dos nuevos schwannomas malignos uno en el nervio ciático izquierdo y otro paravertebral derecho, que también fueron tratados con radioterapia y quimioterapia. Últimamente han aparecido cuatro tumoraciones más: en zona supraclavicular derecha, seno costofrénico posterior derecho, costovertebral izquierdo y en la pared abdominal inferior derecha, aún no operados y sin que se haya realizado el diagnóstico anatomopatológico, pero con aspecto radiológico de schwannomas. Actualmente, el paciente, que ya tiene 46 años, se encuentra en buen estado general, no presenta defectos funcionales ajenos a las intervenciones quirúrgicas y, en especial, no se han observado estigmas de neurofibromatosis tipo I a tipo VII. Por todo ello se plantea la posibilidad de que se trate de un nuevo tipo de neurofibromatosis no descrito anteriormente (AU)
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Subject(s)
Adult , Male , Humans , Neurilemmoma , Neurofibromatosis 1 , Diagnosis, Differential , Magnetic Resonance Imaging , Peripheral Nervous System NeoplasmsABSTRACT
We studied 4 patients (14-21 years old) with continuous spike/wave epilepsy during slow wave sleep with visual evoked potentials (VEP) and somatosensory evoked potentials (SEP). All the patients presented the same focality and received the same medication (primidone plus sodium valproate). No case had another pathology not related with epilepsy which could alter the evoked potential findings. The results obtained in the initial evoked potentials were compared with those achieved after 5 years of treatment. In the initial study interhemispheric asymmetry in the latency of the early component (L.N1) of the SEP was observed with a mean of 10%. Five years later normal SEP were obtained with the asymmetry having disappeared thus leading to the deduction that the physiopathologic improvement found in these patients was due to the treatment of sodium valproate together with primidone.
