Intraosseous Schwannoma of the Frontal Bone: A Case Report and Review of the Literature.

Intraosseous schwannoma is a rare diagnosis, particularly so in the skull. Accordingly, little data exists to unify common features of this disease. Here, we present the fourth known case of a primary intraosseous schwannoma of the frontal bone: a 46-year-old male with severe, progressive headache and an osteolytic frontal bone lesion. Gross total resection of the lesion was performed with excellent clinical outcome. Histological analysis confirmed the diagnosis. The limited existing literature on this topic was reviewed to identify emerging trends surrounding presenting symptoms and treatment. Early literature suggests symptoms are often nonspecific, except for lesions of the petrous apex. No cases of recurrence have been demonstrated after gross total resection, though incomplete resection has been associated with recurrence. This diagnosis appears to be becoming a more often-considered differential for osteolytic, expansile skull lesions.

Recurrent anaplastic transformation of a Vermian region rosette forming glioneuronal tumour - A rare entity. Case report and review of literature.

INTRODUCTION AND IMPORTANCE: Rosette forming Glioneuronal tumours (RGNT) are rare WHO grade I tumours. They have been recognised as a sole entity in the WHO classification since 2007. They are typically described as having a favourable prognosis. Since their description as a distinct entity, there have been only four reports of malignant or anaplastic transformation of RGNT. We report a case of recurrent RGNT with new anaplastic histopathological features. CASE PRESENTATION: We present the case of a 48-year-old female who presented with a vermian region RGNT. The tumour recurred six years after initial surgical resection with new anaplastic transformation. Despite further surgery, chemotherapy, and radiation, the lesion continued to recur with high grade features. CLINICAL DISCUSSION: RGNT is a rare variant of a mixed glial-neuronal tumour. It has been defined as a WHO grade I lesion with a favourable prognostic course. There is growing evidence that this neoplasm can demonstrate malignant transformation with aggressive behaviour. CONCLUSION: Recurrent RGNT is a rare entity. There is a growing bank of literature surrounding this relatively new entity to aid patients and clinicians alike in management decisions. To our knowledge, we report one of only few cases of anaplastic transformation of a RGNT. A high degree of suspicion should be maintained for patients with recurrent RGNT and in suitable cases, surgical resection with adjuvant chemo-irradiation should be pursued.

Clinical and radiomics prediction of complete response in rectal cancer pre-chemoradiotherapy.

Background and purpose: Patients with rectal cancer could avoid major surgery if they achieve clinical complete response (cCR) post neoadjuvant treatment. Therefore, prediction of treatment outcomes before treatment has become necessary to select the best neo-adjuvant treatment option. This study investigates clinical and radiomics variables' ability to predict cCR in patients pre chemoradiotherapy. Materials and methods: Using the OnCoRe database, we recruited a matched cohort of 304 patients (152 with cCR; 152 without cCR) deriving training (N = 200) and validation (N = 104) sets. We collected pre-treatment MR (magnetic resonance) images, demographics and blood parameters (haemoglobin, neutrophil, lymphocyte, alkaline phosphate and albumin). We segmented the gross tumour volume on T2 Weighted MR Images and extracted 1430 stable radiomics features per patient. We used principal component analysis (PCA) and receiver operating characteristic area under the curve (ROC AUC) to reduce dimensionality and evaluate the models produced. Results: Using Logistic regression analysis, PCA-derived combined model (radiomics plus clinical variables) gave a ROC AUC of 0.76 (95% CI: 0.69-0.83) in the training set and 0.68 (95% CI 0.57-0.79) in the validation set. The clinical only model achieved an AUC of 0.73 (95% CI 0.66-0.80) and 0.62 (95% CI 0.51-0.74) in the training and validation set, respectively. The radiomics model had an AUC of 0.68 (95% CI 0.61-0.75) and 0.66 (95% CI 0.56-0.77) in the training and validation sets. Conclusion: The predictive characteristics of both clinical and radiomics variables for clinical complete response remain modest but radiomics predictability is improved with addition of clinical variables.

Large frontal osseous hemangioma with dural sinus involvement in a patient with Klippel-Trenaunay syndrome: A rare case report.

BACKGROUND: We present one of the first documented cases in the literature of an adult with Klippel-Trenaunay syndrome (KTS) with a large frontal osseous hemangioma. CASE DESCRIPTION: A 30-year-old male presented with a rapidly enlarging frontal skull lesion that had developed in only 3 months. Radiological investigation revealed a highly vascular lesion attached to the frontal bone. The lesion was surgically resected with the patient making complete recovery. Histopathology was consistent with an osseous hemangioma. CONCLUSION: We report the clinical presentation and surgical management of a rare presentation of osseous hemangioma in a patient with KTS.

Minimally invasive resection of lumbosacral pseudojoint resulting in complete resolution of a lower back pain - A case report and review of Bertolotti syndrome.

Bertolotti syndrome describes lower back pain secondary to an anatomical lumbosacral transitional vertebrae. We present the case of a 37 year old female with chronic lower back pain with radiological evidence of an anatomical lumbosacral pseudojoint. The patient underwent minimally invasive resection of her pseudojoint with complete resolution of symptoms postoperatively. We, as the authors would like to highlight that in patients with pain secondary to an aberrant lumbosacral articulation, consideration should be given to treatment via a minimally invasive technique.

Bilateral vocal cord palsy causing stridor as the only symptom of syringomyelia and Chiari I malformation, a case report.

INTRODUCTION: Bilateral vocal cord palsy is a condition which has many causes (Gupta et al., 2012) [1]. Syringomyelia is an uncommon condition which describes the formation of fluid filled cavity, occupying the spinal cord (Chang, 2003) [2]. It rarely manifests itself as subacute onset of stridor. PRESENTATION OF CASE: We present the case of a three year old female who presented for evaluation of her speech and language delay, when incidentally it was made note of her loud breathing which had previously been managed as bronchiolitis by her general practitioner. In hospital she was found to have a bilateral vocal cord palsy. Further investigation revealed a large syrinx as well as an associated Arnold Chiari 1 malformation, for which she required neurosurgical decompression. CONCLUSION: Although uncommon, formation of a syrinx should be considered for patients who present with stridor and reiterates the importance of MRI as an important investigative tool of bilateral vocal cord palsy.

Internal jugular vein cannulation complications and elimination of the muscular triangle of the neck due to aberrant infrahyoid muscles.

We report on a rare case of anatomical variations of the infrahyoid muscles with prominent clinical significance. The aberrant anatomy was on the right side of the neck and involved the omohyoid and sternohyoid muscles. The superior belly of the omohyoid was duplicated in width due to an aberrant belly anteriorly and merged with fibers of the inferior belly inferiorly and the sternohyoid muscle medially. An additional aberrant muscle slip extended between the inferior third of the sternohyoid muscle and united with the inferior belly of the omohyoid. The intermediate tendon between the two bellies of the omohyoid was absent, whereas the so-called muscular triangle of the neck was diminished. Due to the arrangement and fusion of myofibers the muscle could be termed as omo-sternohyoid muscle. A profound hematoma was noted in the aberrant muscle at the area overlying the internal jugular vein indicating difficulty in obtaining jugular venous access for catheter placement. Clinicians and surgeons should be aware of muscular anatomic variations when intervening in the lateral neck area as the classical anatomical landmarks might be misinterpreted and confuse.

The perils of high carbohydrate drinks in the undiagnosed diabetic patient.

Diabetes mellitus is increasing in its incidence and prevalence. Reduction in refined carbohydrate (sugar) intake is an important part of nutritional advice to patients with known diabetes. Sugar is available in a variety of confectionary products. It is also available in especially packaged 'convenience foods' as high energy drinks. Among people without diabetes, such food can have its own health risks. A significant group of patients with diabetes remain undiagnosed. This group are at especially high risk from all the negative metabolic effects of high sugar intake available as high calorie drinks. The authors report two patients without previously known diabetes who presented similarly with marked hyperglycaemic states, leading to severe metabolic disturbances. Both were obese, had common precipitating factors and consumed large quantities of sugary soft drinks ('lucozade'). Both patients recovered well. They were followed up for over 7 years. One is not diabetic and the second is diabetic requiring a small dose of metformin.