Possible toxicity following embolization of congenital giant vertex hemangioma: case report

The authors describe the case of a 3-year-old boy with a giant congenital vertex hemangioma who underwent presurgical embolization with Onyx (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) and Glubran (N-butyl-2-cyanoacrylate). This vascular tumor had no intracranial vascular communication as assessed by pre-embolization MRI and catheter angiography. All embolizations were performed by direct percutaneous injection. One week following the last embolization procedure the child presented with a 24-hour history of ataxia and extrapyramidal tremor. He was diagnosed with a possible immune-mediated reaction to Onyx or Glubran, which was treated with an urgent surgical excision of the hemangioma followed by intravenous administration of immunoglobulin and steroids. To the authors' knowledge, this is the first case of possible immune-mediated toxicity secondary to either Onyx or Glubran administration. This case highlights the need for awareness of potential toxic reactions to these embolic agents in the treatment of hemangiomas in the pediatric patient.

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Intravascular Glomus Tumor of the Forearm Causing Chronic Pain and Focal Tenderness

Case Reports in Orthopedics ◽

10.1155/2014/619490 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sang Ki Lee ◽

Dae Geon Song ◽

Won Sik Choy

Keyword(s):

Chronic Pain ◽

Glomus Tumor ◽

Rare Condition ◽

Surgical Excision ◽

Vascular Tumor ◽

Glomus Tumors ◽

Contrast Magnetic Resonance ◽

History Of ◽

Subcutaneous Layer ◽

Magnetic Resonance Imaging Mri

Introduction. A glomus tumor is a benign vascular tumor derived from glomus cells and occurs mainly in the subcutaneous layer of the subungual or digital pulp. Extradigital glomus tumors have been reported within the palm, wrist, forearm, foot, bone, stomach, colon, cervix, and mesentery. Glomus tumors can originate from the intraosseous, intramuscular, periosteal, intravascular, and intraneural layers. However, a glomus tumor originating from the intravascular layer of the forearm is a rare condition.Case Report. A 44-year-old woman had a 7-year history of chronic pain and focal tenderness of the forearm. No hypersensitivity or sensory alterations were observed. Contrast magnetic resonance imaging (MRI) showed a mass measuring 5 × 3 × 2 mm leading to a vein. Surgical excision was performed, and the tumor was completely resected. Finding of gross examination revealed a dark-red, well-defined soft tissue tumor, and histologic examination confirmed that the mass was a glomus tumor. The patient’s symptoms were completely resolved postoperatively.Conclusion. Intravascular glomus tumors rarely occur in the forearm; therefore, a thorough physical exam, comprehensive medical history, in-depth imaging, and early surgical excision upon clinical suspicion may be helpful to prevent a delayed or incorrect diagnosis.

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Guillain-Barre Syndrome following COVID-19 Infection: First Case Report from Kuwait and Review of the Literature

Dubai Medical Journal ◽

10.1159/000513382 ◽

2021 ◽

pp. 1-5

Author(s):

Walaa A. Kamel ◽

Ismail Ibrahim Ismail ◽

Jasem Yousef Al-Hashel

Keyword(s):

Intravenous Immunoglobulins ◽

Lower Limbs ◽

Guillain Barre Syndrome ◽

Global Pandemic ◽

First Case ◽

Immune Mediated ◽

Guillain Barré Syndrome ◽

Electrophysiological Studies ◽

History Of ◽

Guillain Barré

Objective: Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy that is often related to a previous infectious exposure. GBS emerged as a potentially serious complication of coronavirus disease 2019 (COVID-19) since its declaration as a global pandemic. We report the first case from Kuwait, to the best of our knowledge. Clinical Presentation: A 72-year-old male presented with 3 weeks history of acute progressive and ascending lower limbs weakness. He developed these symptoms 3 weeks after testing positive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electrophysiological studies showed acute demyelinating polyradiculoneuropathy and cerebrospinal fluid showed protein-cell dissociation. He was successfully treated with intravenous immunoglobulins (IVIGs). Conclusion: Neurologists should be aware of GBS as a potentially serious complication associated with COVID-19. Our patient had a favorable outcome with IVIG with no autonomic or respiratory affection.

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Peripheral AVMS pre-operative embolization using plug and push technique with low-density NBCA/LIPIODOL can be used in high-flow feeding arteries at Hue Central Hospital, Vietnam: a case report

Vietnam Journal of Diabetes and Endocrinology ◽

10.47122/vjde.2020.40.6 ◽

2021 ◽

pp. 33-38

Author(s):

Anh Binh Ho ◽

Ngoc Son Nguyen ◽

Vu Huynh Nguyen ◽

Duc Dung Nguyen ◽

Anh Khoa Phan

Keyword(s):

Surgical Excision ◽

High Flow ◽

Low Density ◽

Central Hospital ◽

Technical Success ◽

Case Presentation ◽

Type Iv ◽

Pulsatile Mass ◽

Embolic Agents ◽

Embolization Procedure

Purpose: The aim of this study was to report our experience in one casepre-operative embolization of high-flow peripheral arteriovenous malformations (AVMs) using plug and push technique with low-density NBCA/LIPIODOL. Case presentation: A patient 26 years old man hospitalized at Hue Central Hospital, Vietnam with big pulsatile mass at right femoral above the knee. Doppler ultrasound showed a mass with high systolic and diastolic velocities. Patient felt discomfort and he has a desire to resolve this condition. Angiogram showed a large and high-flow arteriovenous malformation type IV according to Yakes classification. A multidisciplinary discussion was required between surgeon and interventionist because of the high risk of in-operative hemorrhage. Patient was treated with low-density NBCA/LIPIODOL 12.5% embolic agents by transarterial approach using plug and push technique before surgical excision. Results: Technical success was achieved in this patient. Complete devascularization was obtained and surgical excision was performed at 4 days after embolization procedure. Non-target NBCA/LIPIODOL embolization was not observed. Conclusions: Embolization using plug and push technique with low-density NBCA/LIPIODOL is an promising and interesting option for management of peripheral high-flow AVMs either pre-operatively or as a single treatment.

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THOROTRAST-INDUCED PRIMARY CEREBRAL ANGIOSARCOMA

Neurosurgery ◽

10.1227/01.neu.0000348294.05571.d9 ◽

2009 ◽

Vol 65 (1) ◽

pp. E210-E211 ◽

Cited By ~ 16

Author(s):

Gopalakrishnan Balamurali ◽

Daniel G. du Plessis ◽

Moses Wengoy ◽

Nicholas Bryan ◽

Amit Herwadkar ◽

...

Keyword(s):

Latency Period ◽

Vascular Tumor ◽

Cerebral Abscess ◽

Primary Angiosarcoma ◽

First Case ◽

Initial Surgery ◽

History Of ◽

The Central Nervous System ◽

Well Differentiated ◽

The 1960S

Abstract OBJECTIVE Thorotrast was used as a contrast medium in clinical practice until the 1960s for outlining cerebral abscess cavities and ventricular cavities, and for angiography. Gliosarcomas, meningiomas, and schwannomas have been reported previously, as has Thorotrast-associated angiosarcoma, typically in the liver. A unique case of a primary intracerebral well-differentiated angiosarcoma in a 68-year-old man with a history of colocalized exposure to Thorotrast is described. This may be the first case of a primary angiosarcoma in the brain. CLINICAL PRESENTATION The patient presented with a progressive left-sided weakness 62 years after initial surgery for a right parietal cerebral abscess, which included the instillation of Thorotrast into the abscess cavity. Computed tomography showed a right parietal tumor. INTERVENTION An explorative craniotomy showed an intrinsic, infiltrating, very vascular tumor with surrounding calcification. The tumor appeared to arise from a benign cavernous vasoformative lesion intimately associated with a Thorotrast-type granuloma. The patient declined further surgery or radiotherapy. CONCLUSION The histology, confirmation of radioactivity of the material obtained from within the tumor, and latency period of presentation provide compelling support for tumor induction by the Thorotrast. Primary lesions of the central nervous system associated with Thorotrast are very rarely reported, despite its extensive use in cerebral angiography and management of brain abscess between 1930 and 1960.

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Facial palsy after embolization with Squid® 12

BMC Neurology ◽

10.1186/s12883-021-02064-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Santiago Moreno-Paredes ◽

Laura Rodríguez-Alcalá ◽

Juan Martín-Lagos Martínez ◽

Nicolás Müller Locatelli ◽

Cristina Vázquez López ◽

...

Keyword(s):

Facial Paralysis ◽

Facial Palsy ◽

English Literature ◽

Cranial Nerves ◽

Surgical Excision ◽

Vascular Lesions ◽

Ethylene Vinyl Alcohol ◽

Vasa Nervorum ◽

Low Viscosity ◽

Embolic Agents

AbstractEndovascular procedures with liquid embolic agents such as ethylene-vinyl alcohol (EVOH) copolymers are indicated before surgical treatment of cervical paraganglioma. Consequently, these agents are now available as low viscosity formulations, one of which is Squid 12, which are demonstrating superior vascular penetration. Cases of facial paralysis secondary to embolization of cervical vascular lesions with classic embolic agents have been reported in the English literature, however, this complication has not been described with new generation options such as Squid 12.We describe the case of a 43-year-old patient with a left neck carotid paraganglioma. Embolization was performed under general anaesthesia before surgical excision. In the immediate postoperative period, the patient developed total left facial palsy. Since the imaging tests (Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)) and neurological examination showed no involvement of additional cranial nerves (CN), we hypothesise that the main cause of this complication is ischemia of the vasa nervorum of CN VII secondary to embolization. Almost six months later, the patient continues to present total facial paralysis (Grade VI House-Brackmann facial paralysis scale), and palsy of the left CN X and XII as a complication secondary to surgical resection of the paraganglioma.This case is relevant since it is the first clinical case of permanent facial paralysis secondary to embolization with Squid 12.

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Targeting Cerebral Arteriovenous Malformations for Minimally Invasive Therapy

Neurosurgery ◽

10.1227/01.neu.0000238530.44912.01 ◽

2006 ◽

Vol 59 (suppl_5) ◽

pp. S3-178-S3-183 ◽

Cited By ~ 15

Author(s):

Michael J. Alexander ◽

Marshall E. Tolbert

Keyword(s):

Surgical Excision ◽

Arteriovenous Shunting ◽

Embolic Material ◽

Ethylene Vinyl Alcohol ◽

Embolic Agents ◽

Liquid Embolic ◽

Specific Receptors ◽

Physical Limitations ◽

Embolic Materials ◽

Risk Of Hemorrhage

Abstract OBJECTIVE: Cerebral arteriovenous malformation (AVM) embolization has been performed for nearly 40 years to reduce the risk of hemorrhage, to reduce symptomatic arteriovenous shunting, and to pretreat patients for surgical excision or radiosurgery. In some cases, embolization alone may be able to angiographically cure an AVM, although this is a small percentage of all AVMs. METHODS: This report reviews the current limitations of embolic therapy of cerebral AVMs from the standpoint of AVM angioarchitecture and the physical limitations of current embolic materials. In addition, it seeks to identify the areas in which embolization therapy may make advancements both as a pretreatment and as a sole therapy. RESULTS: Currently, liquid embolic agents, ethylene vinyl alcohol, and n-butylcyanoacrylate seem to provide the greatest resistance to recanalization in AVM embolization. These agents, however, elicit only a weak, nonspecific, bioactive inflammatory response by histopathology. CONCLUSION: The further evaluation and understanding of the vascular biology of AVM vessels and the endothelium cell wall biology will help us devise more bioactive material solutions to AVM nidus obliteration. Targeting specific receptors in AVMs with the embolic material delivered may additionally enhance the effects of radiosurgery in these patients.

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Case Report: Rare site for intraoral meningioma

F1000Research ◽

10.12688/f1000research.21999.2 ◽

2020 ◽

Vol 9 ◽

pp. 95

Author(s):

Hatem Wael Amer ◽

Layla Hafed ◽

Sally Ibrahim ◽

Shady Shaker

Keyword(s):

Hard Palate ◽

Surgical Excision ◽

Intracranial Extension ◽

Unusual Site ◽

Immunohistochemical Markers ◽

First Case ◽

History Of ◽

Rare Site ◽

Extracranial Meningioma ◽

The Right

Extracranial meningioma is very rare with few cases reported, especially in the oral cavity. Its diagnosis is considered a challenge owing to the unusual site of occurrence. We report, to the best of our knowledge, the first case of extra-cranial meningioma as a primary tumor in the hard palate with no detected intracranial extension. A 59-year-old Egyptian female patient presented with a 22-year history of a large painless swelling at the right side of the hard palate, which could not be seen on radiographs. An incisional biopsy was taken and, after assessment with a panel of immunohistochemical markers, the lesion was diagnosed as extracranical grade I mengiothelial meningioma. The patient did not show up for surgical excision and follow-up was not performed because of the lose of contact with the patient. Intraoral meningioma is a rare tumor. Immuohistochemical markers are important for confirming this diagnosis.

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Transperitoneal laparoscopic treatment for recurrence of a giant multilocular prostatic cystadenoma: A case report and review of the literature

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.1.66 ◽

2016 ◽

Vol 88 (1) ◽

pp. 66 ◽

Cited By ~ 5

Author(s):

Davide Abed El Rahman ◽

Tiziano Zago ◽

Giuseppe Verduci ◽

Gianpaolo Baroni ◽

Marco Lorenzo Berardinelli ◽

...

Keyword(s):

Abdominal Mass ◽

Laparoscopic Approach ◽

Surgical Excision ◽

Benign Tumors ◽

Pelvic Cavity ◽

Invasive Approach ◽

First Case ◽

Complete Surgical Excision ◽

Adjacent Structures ◽

History Of

Giant multilocular prostatic cystadenomas (GMPC) are very rare benign tumors that originate from the prostate with extensive spread into the pelvis. The lesion may present as large abdominal mass causing obstructive voiding dysfunction and usually not invading adjacent structures. All of the previously reported patients with GMPC underwent open surgery. Although the natural history of prostatic cystadenoma remains unknown, complete surgical excision may not always be necessary. We report the case of a 74-year-old male who presented a retrovesical recurrence of prostatic cystoadenoma after 16 years, treated with a laparoscopic approach. To our knowledge this is the first case of laparoscopic management of GMPC. In this article we review the current literature about this rare tumor and discuss the diagnostic and management dilemmas posed by this rare pathologic condition. We believe that physicians should at least be aware of the existence of this disease in the differential diagnosis of pelvic cavity tumours and, considering the benignity of GMPC, they should propose -as first- a minimally invasive approach.

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Primary Renal Epithelioid Hemangioendothelioma

Case Reports in Pathology ◽

10.1155/2012/802515 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3

Author(s):

S. Roy ◽

A. V. Parwani

Keyword(s):

Surgical Excision ◽

Metastatic Potential ◽

Vascular Tumor ◽

Metastatic Carcinoma ◽

Epithelioid Hemangioendothelioma ◽

High Grade ◽

Clinical Scenario ◽

Rare Tumor ◽

Pathologic Examination ◽

History Of

Epithelioid hemangioendothelioma is a rare vascular tumor with intermediate biologic behavior and metastatic potential. Primary renal epithelioid hemangioendothelioma is extremely rare and we present the second report of this rare tumor in an interesting clinical scenario. A 59-year-old male with established history of widely metastatic high grade esophageal adenocarcinoma was found to have an isolated renal nodule on a followup computed tomography (CT) scan. Surgical excision, with the suspicion of metastatic carcinoma, and subsequent pathologic examination revealed an epithelioid hemangioendothelioma. The various differential diagnoses and use of morphological clues and immunohistochemistry are discussed.

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Case Report: Rare site for intraoral meningioma

F1000Research ◽

10.12688/f1000research.21999.1 ◽

2020 ◽

Vol 9 ◽

pp. 95

Author(s):

Hatem Amer ◽

Layla Hafed ◽

Sally Ibrahim ◽

Shady Shaker

Keyword(s):

Surgical Excision ◽

Intracranial Extension ◽

Unusual Site ◽

Immunohistochemical Markers ◽

First Case ◽

History Of ◽

Rare Site ◽

Extracranial Meningioma ◽

The Right

Extracranial meningioma is very rare with few cases reported, especially in the oral cavity. Its diagnosis considered a challenge owing to the unusual site of occurrence. We report, to our knowledge, the first case of extra-cranial meningioma as a primary tumor in the palate with no detected intracranial extension. A 59-year-old female Egyptian patient presented with a 22-year history of a large painless swelling at the right side of the palate, which could not be seen on radiographs. An incisional biopsy was taken and, after assessment with a panel of immunohistochemical markers, the lesion was diagnosed as extracranical meningioma. The patient did not show up for surgical excision and follow-up was not performed because of loose of contact with the patient. Intraoral meningioma is a rare unsuspected tumor. Immuohistochemical markers are important when confirming this diagnosis.

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