Primary cardiac malignant fibrous histiocytoma with abdominal wall metastasis.

We present a rare case of cardiac malignant fibrous histiocytoma (MFH; undifferentiated pleomorphic sarcoma); to date, fewer than 100 cases of cardiac MFH have been reported. In this case, transthoracic echocardiography revealed cardiac tumors in the left atrium (LA) of a 53-year-old woman with a 3-month history of worsening dyspnea; the largest tumor was found to protrude through the mitral valve in diastole, causing stenosis. Three of the four tumors were resected during emergency surgery; however, the residual tumor extension into the left pulmonary vein could not be removed. Histological findings of the resected tumors, such as organized thrombus and myxomatous tissue changes, indicated that the tumors were benign. After 3 months, the patient underwent total resection for a small mass that developed on her right abdominal wall, which was revealed histologically to be MFH; additionally, the residual mass in the LA had enlarged progressively. After undergoing radiation therapy without further surgery, she died of cerebral bleeding 6 months after cardiac surgery. Postmortem examination revealed that the tumor in the LA was an MFH. Thus, cardiac MFH should be considered as a differential diagnosis for tumors on the posterior wall of the LA. .

[A case of unruptured fusiform aneurysm in a middle cerebral artery branch].

We report a case of a 55-year-old female presenting with headache. Neuroradiological investigations revealed a fusiform aneurysm at the M3 part of the right middle cerebral artery. The aneurysm rapidly developed in the course of one year. She underwent a craniotomy for superficial temporal artery middle cerebral artery bypass (STA-MCA bypass) and resection of the aneurysm. Pathological examination suggested that atherosclerosis was a predisposing factor for aneurysm formation. Although she had developed transient dysarthria and left-hand clumsiness after the operation, she was able to be discharged after 26 days with no neurological deficits. On reviewing the literature, fusiform aneurysms seem to be an important cause of subarachnoid hemorrhage and cerebral infarction of unverified origin. Etiology and treatment of spontaneous fusiform aneurysms in a branch of the middle cerebral artery are also discussed.

[Spontaneous umbilical fistula as a complication of ventriculo-peritoneal shunt: case report].

We report a rare case of a spontaneous umbilical fistula as a complication of ventriculo-peritoneal shunt. A 36 year-old male was admitted our hospital complaining serous discharge from the umbilicus. Two years before admission, he underwent ventriculo-peritoneal shunt for the hydrocephalus due to right hypertensive intracranial hematoma and intraventricular hemorrhage. A shuntgraphy was done and it revealed the cerebrospinal fluid leakage from the umbilicus through an urachal remnant. The abdominal shunt tube was removed at the surgery, and the patient was discharged uneventfully without shunt revision. The possible etiology of this rare complication in this case was supposed to be due to the persistence of the urachus.

Surgically treated aneurysm of the trunk of the persistent primitive trigeminal artery--case report.

A 62-year-old man presented with a very rare cerebral aneurysm arising from the trunk of the persistent primitive trigeminal artery (PPTA) manifesting as subarachnoid hemorrhage. Angiography showed a saccular aneurysm at the curved mid-section of the trunk of the left PPTA of the adult type. The patient underwent surgery via the left subtemporal approach, and the aneurysm was successfully eliminated by clipping without sequelae. Aneurysm formation at this point was probably due to hemodynamic stress. The perforating arteries from the PPTA may be important in supply of the hindbrain, so PPTA patency should be preserved if possible.