RESUMO
Las células envolventes olfatorias son células gliales que se encuentran en el bulbo y el nervio olfatorios. Las células de Schwann y las células envolventes del olfatorio presentan características morfológicas e inmunohistoquímicas similares. Sin embargo, las células de Schwann son positivas en la tinción con Leu-7(CD-57) mientras que las células envolventes lo son negativas. Presentamos el caso de un varón de 49 años con pérdida de agudeza visual e hiposmia. Los estudios de TC y RM craneal muestran una lesión extraaxial subfrontal quística, que erosiona la lámina cribosa derecha y capta contraste heterogéneamente. Con resección completa mediante craneotomía bifrontal, el estudio histológico inicial sugería schwannoma, con inmunorreactividad positiva para S100 y negativa para EMA. Sin embargo, la tinción con Leu-7 negativa y el diagnóstico definitivo fue de tumor de las células envolventes del olfatorio. Describimos el sexto caso de tumor de las células envolventes del olfatorio intracraneal subrayando la importancia de las técnicas inmunohistoquímicas en su diagnóstico (AU)
Olfactory ensheathing cells are glial cells located in the olfactory bulb and nerve. Microscopically, both olfactory ensheathing cells and Schwann cells have similar morphological and immunohistochemical features. However, olfactory ensheathing cells are negative for Leu-7(CD-57), whereas Schwann cells are positive. We present the case of a 49 year-old male with a history of visual impairment and hyposmia. Radiological CT and MRI studies showed a subfrontal cystic extra-axial mass, which eroded the right cribriform plate, with heterogeneous contrast enhancement. Total excision of the tumour was performed by bifrontal craniotomy. Histological examination initially suggested a schwannoma, with immunohistochemical staining being positive for S-100 protein and negative for epithelial membrane antigen (EMA). However, the tumour was negative for Leu-7. Accordingly, the final diagnosis was olfactory ensheathing cell tumour. Herein, we describe the sixth case of intracranial olfactory ensheathing cell tumour and stress the important role of immunohistochemical techniques in obtaining a definitive diagnosis
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Bulbo Olfatório/patologia , Neoplasias Encefálicas/patologia , Glioma/patologia , Neurilemoma/patologia , Neoplasias de Bainha Neural/patologia , Proteínas S100/análise , Diagnóstico Diferencial , Transtornos da Visão/etiologiaRESUMO
Olfactory ensheathing cells are glial cells located in the olfactory bulb and nerve. Microscopically, both olfactory ensheathing cells and Schwann cells have similar morphological and immunohistochemical features. However, olfactory ensheathing cells are negative for Leu-7(CD-57), whereas Schwann cells are positive. We present the case of a 49 year-old male with a history of visual impairment and hyposmia. Radiological CT and MRI studies showed a subfrontal cystic extra-axial mass, which eroded the right cribriform plate, with heterogeneous contrast enhancement. Total excision of the tumour was performed by bifrontal craniotomy. Histological examination initially suggested a schwannoma, with immunohistochemical staining being positive for S-100 protein and negative for epithelial membrane antigen (EMA). However, the tumour was negative for Leu-7. Accordingly, the final diagnosis was olfactory ensheathing cell tumour. Herein, we describe the sixth case of intracranial olfactory ensheathing cell tumour and stress the important role of immunohistochemical techniques in obtaining a definitive diagnosis.
Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias de Bainha Neural/diagnóstico , Doenças do Nervo Olfatório/diagnóstico , Nervo Olfatório/patologia , Adulto , Antígenos de Neoplasias/análise , Biomarcadores Tumorais/análise , Antígenos CD57/análise , Neoplasias dos Nervos Cranianos/química , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Craniotomia , Humanos , Masculino , Pessoa de Meia-Idade , Mucina-1/análise , Neoplasias de Bainha Neural/química , Neoplasias de Bainha Neural/complicações , Neoplasias de Bainha Neural/patologia , Neoplasias de Bainha Neural/cirurgia , Neurilemoma/química , Neurilemoma/patologia , Transtornos do Olfato/etiologia , Nervo Olfatório/química , Doenças do Nervo Olfatório/complicações , Doenças do Nervo Olfatório/metabolismo , Doenças do Nervo Olfatório/patologia , Doenças do Nervo Olfatório/cirurgia , Proteínas S100/análise , Transtornos da Visão/etiologiaRESUMO
El absceso epidural espinal tras anestesia epidural es una complicación rara. Se describe un caso de absceso epidural y de psoas tras anestesia epidural para un parto sin complicaciones. Su diagnóstico requiere un alto índice de sospecha clínica y un estudio de resonancia magnética. La descompresión quirúrgica precoz y antibioterapia prolongada son los elementos clave en el tratamiento del absceso epidural, mientras el absceso de psoas precisa drenaje percutáneo con control radiológico y cobertura antibiótica. El absceso epidural tras anestesia epidural puede suponer una complicación catastrófica. Un diagnóstico precoz es esencial para prevenir daños neurológicos permanentes (AU)
Epidural abscess is a rare but serious complication of epidural anesthesia. We present the case of a healthy parturient who developed spinal epidural and psoas muscle abscesses following spinal analgesia for uneventful labor and delivery. Diagnosis requires a high index of suspicion and magnetic resonance imaging. Early surgical decompression and prolonged antibiotic therapy are the mainstays of epidural abscess treatment, while percutaneous drainage under imaging guidance with antibiotic coverage is an effective front-line treatment of psoas muscle abscess. Epidural abscess can be a catastrophic consequence of epidural anesthesia. Early diagnosis is essential to prevent permanent neurological damage (AU)
