Intraparenchymal supratentorial papillary meningioma: a case report.

Although intraparenchymal meningiomas have rarely been reported in the literature, the papillary type has been reported only as infratentorial. Here we report the case of a 21-year-old female patient with intraparenchymal lesion. To our knowledge, this case describes the first report of a patient with a supratentorial intraparenchymal papillary meningioma.

Carcinoma Showing Thymus-Like Elements: A Rare Malignant Tumor of the Thyroid Gland.

Carcinoma showing thymus-like elements (CASTLE) is a rare tumor arising in the thyroid gland. Fewer than 100 patients with this tumor, those predominantly from Eastern Asia, have been reported before. We present the first CASTLE case from Turkey. A 51-year-old male was admitted with a complaint of a neck mass and hoarseness. A laryngoscopic examination revealed left vocal cord paralysis. Neck ultrasonography showed a tumor which was compressing the esophagus and had invaded the left recurrent laryngeal nerve (RLN). The patient underwent a total thyroidectomy, a unilateral central-compartment neck dissection, and following adjuvant radiotherapy. Intraoperative nerve monitoring was performed during the operation to preserve the contralateral nerve. He completed a 3-year follow-up period after the completion radiotherapy, and no recurrence was observed. The treatment is controversial, although surgery with or without adjuvant radiotherapy appears to be the best choice. In cases of RLN destruction due to tumor invasion, we recommend using intraoperative nerve monitoring to preserve the contralateral RLN to avoid devastating complications, such as a tracheostomy.

Evaluation of Incidentally Detected Pathology Results of Patients with Vertebral Fracture Treated by Vertebroplasty and Kyphoplasty: A Retrospective Study.

BACKGROUND: Vertebroplasty and kyphoplasty are minimally invasive techniques used to treat vertebral compression fractures. The etiology of vertebral compression fractures varies among patients. Although osteoporosis and trauma are major etiologic factors in patients with a vertebral compression fracture, unexpected results were found in 11 patients in the present study. The aim of the present retrospective study was to determine the incidentally detected pathology results of patients with vertebral fracture treated by vertebroplasty and kyphoplasty. METHODS: From February 2010 to November 2015, 616 patients with a vertebral compression fracture were treated by kyphoplasty and vertebroplasty at our institution. Vertebral biopsies were obtained from 533 patients during a vertebral augmentation technique. The average patient age was 62.4 years. Of the 616 patients, 388 were female and 228 were male. Histological evaluation of the biopsy specimens from the vertebral compression fractures was performed. RESULTS: The biopsy results of 505 patients showed various stages of bone healing. Among these patients, malignancy was identified in 23 patients, and 43 patients had a history of malignancy. In 6 patients, an unsuspected malignancy was found, and 1 patient had Paget's disease. Infection was detected in 4 patients. In our study, the rate of unsuspected malignancy was 1.1%. CONCLUSIONS: Tissue examination is useful and could reveal pathologic fractures. An incidentally detected biopsy result could change the treatment of patients; however, bone biopsy should be reserved for those patients whose preoperative radiological diagnosis raises suspicion of a nonosteoporotic etiology.

Cavernous Angioma Mimicking Meningioma.

The authors present a rare case of cavernous angioma mimicking a meningioma in a 58-year-old man who presented with a headache and dizziness. There were no neurological deficits or other neurological symptoms or signs. An extra-axial mass lesion thought to be associated with diffusely well-enhanced falx in the postcontrast sections was noted in the posterior interhemispheric fissure near the posterior part of the corpus callosum splenium. Extra-axial cavernous angiomas (cavernomas) are extremely rare lesions. They most commonly occur in the parenchyma but have been occasionally reported to arise from the dura matter. Dural cavernous angiomas arise from dural sinuses, falx cerebri, tentorium cerebelli, cranial base dura, or internal auditory canal dura and convexity. Parenchymal cavernous angiomas classically have a ring of hemosiderin surrounding the lesions observed on magnetic resonance imaging, but dural cavernous angiomas do not display the same magnetic resonance imaging characteristics and occasionally exhibit a dural tail sign due to which they can often be misdiagnosed as meningiomas.

Metastasis of Renal Clear Cell Carcinoma to Thyroid Gland Mimicking Adenomatous Goiter.

BACKGROUND: Renal cell carcinoma is an interesting tumor due to its unpredictable behavior. Common metastatic sites of renal cell carcinoma are the lungs, lymph nodes, bones and liver. Concurrent thyroid metastasis of clear cell carcinoma is uncommon but it can appear as a rapidly growing cervical, painless nodular mass. CASE REPORT: We report a case of a 56-year-old male patient with clear cell renal carcinoma confirmed on a histopathological examination. The patient noticed a rapidly growing mass in the thyroid region when receiving medical anticancer therapy. Because of that, gray-scale thyroid ultrasonography and a fine-needle aspiration biopsy were performed. The histopathological examinationof the biopsy specimen revealed a lesion composed of malignant epithelial cells compatible with metastasis of renal carcinoma. CONCLUSIONS: In patients with with a history of RCC, both past and present, a thyroid mass, especially co-existing with an adenomatous goiter, should prompt a work-up for thyroid metastasis.

Atypical Localized Rheumatoid Nodule: Case Report.

Rheumatoid nodules can be seen in about 30% of patiens with rheumatoid arthritis. They are occasionally localized subcutaneous, but they can rarely seen in visceral organs. Their appearance can be confused with many clinical conditions when they have atypical localizations. To exclude the presence of a malignancy, these lesions should always be investigated. We aimed to discuss a patient with rheumatoid nodule localized in close neighborhood of hyoid bone, presumed as malignancy.

Primary mucinous cystadenocarcinoma of the breast with amplification of the HER2 gene confirmed by FISH - case report and review of the literature.

Fifty five-years-old woman was presented to the general surgery upon the palpation of a mass in her left breast. In the excisional biopsy performed, partially cystic tumor of 2 × 1 cm with solid areas was macroscopically observed. After through microscopic examination, the patient was diagnosed as invasive mucinous cystadenocarcinoma and the tumor was found to be ER- and PR-negative and C-erbB2 (2+). In the fluorescent in situ hybridization, HER2/neu gene amplification was observed. Here, we present the clinical, cytological, morphological and immunohistochemical features of a very rare type of breast carcinoma, mucinous cystadenocarcinoma of the breast, with the review of the relevant literature.

Orbital apex syndrome as a sign of unsuspected breast carcinoma.

Breast cancer, the most common form of cancer among women, rarely metastasizes to the paranasal sinuses and skull base. The disease usually proceeds insidiously, remaining asymptomatic until ocular symptoms appear. Orbital involvement is frequently seen in metastatic disease of the paranasal sinuses and skull base, but orbital apex syndrome is rare. Early presentation with clinical features of acute ethmoiditis can delay the diagnosis of metastatic disease. Here, we report the case of a 43-year-old woman with breast cancer who presented with orbital apex syndrome secondary to the skull base and paranasal sinus metastasis.

Prevention of anterior scar formation following discectomy with a MediShield adhesion barrier: randomized experimental trial.

AIM: To investigate whether carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel has a protective effect against epidural scar formation anterior to the dura following discectomy. MATERIAL AND METHODS: A barrier gel comprised of CMC and PEO (MediShield) was studied as a material to reduce anterior epidural scar formation in a rabbit laminotomy and discectomy model. After laminotomy and disc puncture, the surgical side was either treated with MediShield or used as a surgical control, as determined by random allocation. Two months after surgery, the animals were euthanized, and their lumbar spines were removed in an en bloc excision for pathological evaluation. Scar formation was evaluated as present or absent. RESULTS: The MediShield group contained 12 rabbits, and the control group contained 7 rabbits. Epidural fibrosis was observed in two out of twelve specimens (17%) in the MediShield group and in three of seven (43%) cases in the control group (P=0.305, Fisher's Exact Test). CONCLUSION: Though it was not statistically significant, we observed a difference between the MediShield and control group that favored the MediShield group. The application of the CMC/PEO gel might protect against epidural fibrosis after lumbar discectomy, but its efficacy needs to be investigated in larger experimental trials.

Lymphoma of the cervix: A diagnostic pitfall on cervicovaginal smear.

Malignant lymphoma that secondarily involves the cervix is a rare condition and may be difficult to distinguish from follicular cervicitis and small cell carcinoma. Cervical lymphoma is sometimes misdiagnosed on cervicovaginal cytology due to its rarity. We report a case of a cervical lymphoma in a 65-year-old woman, which was diagnosed as a squamous cell carcinoma on cervicovaginal cytology.

Parathyromatosis: critical diagnosis regarding surgery and pathologic evaluation.

Parathyromatosis, in which several nodules of hyperfunctioning parathyroid tissue form in the neck and mediastinum, is a rare cause of recurrent hyperparathyroidism. However, there are some theories regarding the origin of parathyromatosis, and seeding after rupture of the parathyroid gland capsule during surgical removal of a parathyroid lesions is the most regarded one. Herein, we report a 41-year-old man who presented with multiple parathyroid nodules in and around the left thyroid lobe 5 years after parathyroid surgery for secondary hyperparathyroidism that was finally diagnosed as parathyromatosis. We discuss the differential diagnosis of parathyromatosis from other parathyroid tumors, particularly from parathyroid carcinoma, which is important in the management of a suspected lesion.

The role of cytopathology in diagnosing HPV induced oropharyngeal lesions.

HPV detection in fine needle aspirates from suspected head and neck metastasis may be useful in clinching the diagnosis of HPV related oral squamous cell carcinoma. Ascertaining the HPV status of a particular tumor on cytological specimens could be useful for prognostication as HPV-related tumors appear to have a better prognosis and clinical outcome. The various techniques of detection are reviewed.

Epithelioid schwannoma of soft tissue: unusual morphological variant causing a diagnostic dilemma.

Epithelioid variant of peripheral nerve sheath tumors is a rare but, at the same time, a well-known entity especially in the malignant counterpart. However, peculiar epithelioid morphology in soft tissue schwannomas is unusual and has been defined recently. These tumors may cause diagnostic errors owing to their increased cellularity and epithelioid morphology. Typical histologic features of classic schwannoma such as Antoni A and B areas, Verocay bodies, and hyalinized vessels are either absent or only present in focal areas. Furthermore, strong and diffuse S-100 protein expression is seen in both benign and malignant counterparts of epithelioid schwannoma. The findings that are suggestive of the benign nature of the lesion are long-term clinical history, small size, superficial localization, encapsulation, bland morphology, lack of mitosis and necrosis, and a benign clinical course after complete excision. Pathologists should be aware of the epithelioid variant of schwannoma to avoid false diagnosis of malignancy. We hereby report 3 cases of unusual benign epithelioid schwannoma of the soft tissue with special regard to problems in differential diagnosis.

Partial spondylectomy for primary leiomyosarcoma of C2 vertebra.

STUDY DESIGN: A primary leiomyosarcoma located on the left side of the C2 is reported. Left-sided partial spondylectomy and anterior reconstruction with posterior stabilization was performed by a two-staged operation. OBJECTIVE: To emphasize the occurrence of primary leiomyosarcoma and the importance of proper stabilization in the upper cervical spine. SUMMARY OF BACKGROUND DATA: Leiomyosarcoma is a rare malignant neoplasm of the bone and the primary leiomyosarcoma of the spine is extremely rare. Radical tumor excision is the goal in case of vertebral leiomyosarcoma, but to both gain surgical access to the upper cervical spine and obtain anterior reconstruction is challenging. METHODS: Leiomyosarcoma of the C2 in a 25-year-old woman with mild neurologic deficits is reported. A left-sided partial spondylectomy of C2 was performed. The defect of the vertebral body was reconstructed by expandable titanium prosthesis, and posterior craniocervical fixation was performed by the polyaxial screws in the lateral masses and rod/plates. RESULTS: The surgical margin was very small. The pathology of the tumor was reported as leiomyosarcoma. No sign of local recurrence or metastasis was evident 1 year after surgery. CONCLUSION: Leiomyosarcoma, although rare, should be kept in mind as one of the possible diagnoses when a patient with an upper cervical tumor is presented and complete tumor removal must be the goal.

Inflammatory pseudotumor of the liver diagnosed by needle biopsy: report of three cases (one with neuroendocrine tumor of the rectum and lung).

Inflammatory pseudotumor of the liver is a rare disorder that can histologically and radiologically resemble malignant neoplasms. The prognosis of the patients with hepatic inflammatory pseudotumor is usually good with conservative therapy. Most of the reported cases are diagnosed in the surgical resection specimens; only very few reported cases have been diagnosed by needle biopsy. We report three additional cases of inflammatory pseudotumor of the liver diagnosed by liver biopsy. Two of these cases were treated successfully with antibiotics. The other case, who was resistant to medical treatment, had coexisting neuroendocrine neoplasms of the rectum and the lung. Since her general condition did not allow an extensive surgery, the mass of the liver could not be resected and she died approximately five months after she was voluntarily discharged from the hospital. Many of the inflammatory pseudotumor of the liver are found to be associated with variable neoplasms, but to our knowledge, the latter case is the first case of inflammatory pseudotumor associated with a neuroendocrine tumor.

Intraventricular glioblastoma multiforme: a pediatric case report.

SUMMARY: Glioblastoma multiforme (GBM) is the most common lethal primary central nervous system tumor in adults. GBM is rarely seen in childhood and adolescence as primary intraventricular tumors. Few cases of solitary intraventricular GBM in adolescence have been reported to date. We report a 16-year-old boy with progressive disorientation, diffuse headache, vomiting, and increased intracranial pressure. Computed tomography and magnetic resonance imaging confirmed that the tumor filled posterior body and occipital horn of the left lateral ventricle and also invaded the surrounding parenchyma. Incomplete removal of the lesion was achieved and a pathologic diagnosis of GBM was carried out. We present a case with an uncommon subtype of glial tumor (GBM) in childhood located in a very rare site. The clinical course, radiologic findings, and possible treatment regimens are reviewed.

[Differential diagnosis in cervical lymphadenopathies: efficacy of B-mode, color and power Doppler ultrasonography]. / Servikal lenfadenopatilerin ayirici tanisinda B-mod, renkli ve power Doppler ultrasonografinin etkinligi.

OBJECTIVES: Our purpose was to investigate cervical lymphadenopathies by using color Doppler spectral analysis and power Doppler ultrasonography methods as well as B-mode ultrasound and to classify them as malignant or benign lesions and to compare the results with the histopathological findings. PATIENTS AND METHODS: Sixty-nine lymph nodes of 69 patients were evaluated with color and power Doppler ultrasonography as well as B-mode ultrasonography. The shape and dimensions of the lymph nodes were assessed with B-mode ultrasonography; their vascularization pattern with power Doppler sonography and with color Doppler spectral analysis. Vascular pattern was evaluated according to the vascularization of the lymph node. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. We measured resistive index, pulsatility index, peak systolic velocity, and end diastolic velocity. Results of Doppler analysis were compared with clinical findings and histopathologic results. Nodes were grouped as metastasis, lymphoma, tuberculosis, and reactive benign lymphadenopathies with respect to ultrasonographic results. RESULTS: Forty-four of 69 lymph nodes were found to be malignant histopathologically. In color Doppler analysis, most malign metastatic lymphadenopathies showed peripheral (76.4%), and the rest of them (23.6%) showed peripheral and hilar (mix) vascularization. Most benign lymphadenopathies (88%) and lymphomatous lymphadenopathies (85%) had hilar vascularization. In tuberculous lymphadenopathies, 50% of them showed avascular pattern and the rest of them had variable type of vascularization. A resistive index = or > 0.7 indicated a malignant metastatic lymphadenopathy and a resistive index <0.5 was consistent with benign lesions. In lymphomatous and tuberculous lymphadenopathies resistive index values were between 0.6-0.7. The sensitivity of the resistive index for distinguishing inflammatory from neoplastic lymphadenopathies was 84.6%, the specificity 100% and the diagnostic accuracy 95.7% (p<0.001). CONCLUSION: In addition to B-mode ultrasonography findings, vascularity pattern assessment and spectral analytical measurements with color and power Doppler ultrasonography has an important contribution for the differential diagnosis of cervical lympadenopathies.

Nasal-subfrontal giant schwannoma.

Subfrontal schwannomas are rare lesions. They can be misdiagnosed as olfactory meningiomas or neuroblastomas. We report a case of giant schwannoma involving the anterior cranial fossa; the frontal and ethmoid sinuses and nasal cavities. The patient presented with a year-long history of increasingly severe headache associated with insomnia. Examination revealed no neurological deficit except for the anosmia. Magnetic Resonance Imaging revealed a 9x5x3 cm intranasal-subfrontal extraaxial mass. Nasal biopsy indicated the presence of a schwannoma. The lesion was totally removed through a bifrontal craniotomy and the skull base was repaired with periosteal flap, fibrin glue and a split craniotomy graft. In addition to the cosmetic advantages over standard transfacial approaches, the extended subfrontal approach also provides early dissection of neural tissues, avoiding an inadvertent cerebrospinal fluid leak.