Microsurgical excision of a primary isolated hypothalamic eosinophilic granuloma

1997 ◽  
Vol 87 (5) ◽  
pp. 768-772 ◽  
Author(s):  
Domenico d'Avella ◽  
Maria Giusa ◽  
Alfredo Blandino ◽  
Filippo Flavio Angileri ◽  
Giovanni La Rosa ◽  
...  
Keyword(s):  
Eosinophilic Granuloma ◽  
Brain Lesion ◽  
Surgical Excision ◽  
Residual Tumor ◽  
Treatment Modalities ◽  
Hypothalamic Region ◽  
Peripheral Tissues ◽  
Content Type ◽  
Complete Surgical Excision

✓ Solitary focal eosinophilic granuloma (EG) is one element in the spectrum of diseases associated with Langerhans' cell histiocytosis (LCH). This report documents the occurrence of a primary isolated hypothalamic EG in a man who presented with diabetes insipidus and panhypopituitarism. His treatment consisted of complete microsurgical excision of the lesion. After a 13-month follow-up period, no residual tumor was evident on magnetic resonance imaging and no other lesions were present in peripheral tissues. This case is unique in several respects: 1) it is the third documented case of a primary isolated hypothalamic LCH granuloma diagnosed in a living patient; 2) it is the only known example of complete microsurgical excision of such a lesion in the hypothalamic region; and 3) it demonstrates the efficacy of direct surgery in this scenario, as compared with other treatment modalities such as biopsy and irradiation, suggesting that complete surgical excision may represent the treatment of choice for isolated intracerebral LCH granulomas, being curative in most instances. Also, the literature is reviewed for information about the diagnosis and treatment of this particular type of unifocal brain lesion.

scholarly journals Nasolabial cyst: case report and review of management options

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Abdulhakeem Almutairi ◽  
Abeer Alaglan ◽  
Mazyad Alenezi ◽  
Sultan Alanazy ◽  
Osama Al-Wutayd
Keyword(s):  
Soft Tissue ◽  
Nasal Obstruction ◽  
Surgical Excision ◽  
Mass Effect ◽  
Treatment Modalities ◽  
Open Approach ◽  
Management Options ◽  
Case Presentation ◽  
Complete Surgical Excision

Abstract Background Nasolabial cysts are rare, non-odontogenic, soft-tissue cysts that develop between the upper lip and nasal vestibule with an overall incidence of 0.7% out of all maxillofacial cysts. The predominant presentation of a nasolabial cyst is a painless localized swelling with varying degrees of nasal obstruction. Several treatment modalities have described in the management of the nasolabial cyst. In this paper, we present a case of a nasolabial cyst in a 44 years old man with discussions of the treatment modalities in the lights of the literature. Case presentation We present a case of a nasolabial cyst in a 44-year-old man that slowly increased in size through a period of 3 years, with associated mild pain and nasal obstruction. It had caused a mass effect upon the maxilla, resulting in scalloping. The cyst was excised entirely with no evidence of recurrence at the two months follow up. Conclusions The nasolabial cyst is a rare soft-tissue cyst. Complete surgical excision using an open approach performed to our case, which considered with the complete endoscopic removal of the best treatment for the nasolabial cysts with a rare recurrence rate.

Risk of late stroke and survival following carotid endarterectomy procedures for symptomatic patients

1990 ◽  
Vol 73 (2) ◽  
pp. 193-200 ◽  
Author(s):  
Dennis A. Turner ◽  
Jay Tracy ◽  
Stephen J. Haines
Keyword(s):  
Carotid Endarterectomy ◽  
Life Table ◽  
Stroke Risk ◽  
Neurological Symptoms ◽  
Treatment Modalities ◽  
Control Group ◽  
Content Type ◽  
Postoperative Stroke ◽  
Fine Print

✓ The long-term outcome following carotid endarterectomy for neurological symptoms was analyzed using a retrospective life-table approach in 212 patients who had undergone 243 endarterectomy procedures. The postoperative follow-up period averaged 38.9 ± 2.1 months (mean ± standard error of the mean). The endpoints of stroke and death were evaluated in these patients. Patient groups with the preoperative symptoms of amaurosis fugax, transient ischemic attack, and prior recovered stroke were similar in terms of life-table outcome over the follow-up period. Sixty-two percent of symptomatic patients were alive and free of stroke at 5 years. The late risk of stroke (after 30 days postoperatively) averaged 1.7% per year based on a linear approximation to the hazard at each life-table interval (1.3% per year for ipsilateral stroke). The trend of late stroke risk was clearly downward, however, and could be fitted more accurately by an exponential decay function with a half-life of 33 months. Thus, the risk of stroke following carotid endarterectomy for neurological symptoms was highest in the perioperative period, slowly declined with time, and occurred predominantly ipsilateral to the procedure. The definition of a prospective medical control group remains crucial for a critical analysis of treatment modalities following the onset of premonitory neurological symptoms. In the absence of an adequate control group for this series, the calculated perioperative and postoperative stroke risk from this study was compared to data obtained from the literature on stroke risk in medically treated symptomatic patients. This uncontrolled comparison of treatment modalities suggests the combined perioperative and postoperative stroke risk associated with carotid endarterectomy to be modestly improved over medical treatment alone.

Piloleiomyosarcoma in Seven Ferrets

2001 ◽  
Vol 38 (6) ◽  
pp. 710-711 ◽  
Author(s):  
B. H. Rickman ◽  
L. E. Craig ◽  
M. H. Goldschmidt
Keyword(s):  
Smooth Muscle ◽  
Smooth Muscle Cells ◽  
Immunohistochemical Staining ◽  
Smooth Muscle Actin ◽  
Surgical Excision ◽  
Muscle Actin ◽  
Mustela Putorius ◽  
Nuclear Pleomorphism ◽  
Complete Surgical Excision

In each of seven ferrets ( Mustela putorius furo) with leiomyosarcoma, a single dermal mass was identified and biopsied. Each mass consisted of a well-demarcated but nonencapsulated proliferation of large spindle- to strap-shaped cells arranged in interwoven bundles. The cells resembled the smooth muscle cells of the adjacent arrector pili muscles, but with marked nuclear pleomorphism. Immunohistochemical staining for smooth muscle actin, desmin, and vimentin was positive and staining for myoglobin and cytokeratin was negative. Follow-up on three of the ferrets indicates that the prognosis is good following complete surgical excision.

Topical Therapy for Ocular Surface Squamous Neoplasia

2013 ◽  
Vol 06 (02) ◽  
pp. 154
Author(s):  
Derek Bitner ◽  
Donald U Stone ◽  
◽  
Keyword(s):  
Ocular Surface ◽  
Topical Therapy ◽  
Genetic Defect ◽  
Surgical Excision ◽  
Treatment Modalities ◽  
Ocular Surface Squamous Neoplasia ◽  
Recurrence Rates ◽  
Interferon Alpha 2B ◽  
Complete Surgical Excision ◽  
Treatment Paradigm

Ocular surface squamous neoplasia, or OSSN, is a clinical spectrum often encountered in ophthalmic practice. The incidence varies depending on the population being studied, but is more common among less pigmented males with increased occupational ultraviolet (UV) exposure as well as among those living in closer proximity to the equator. The incidence increases with age; in younger patients, the presence of OSSN is often associated with another underlying disorder, such as the genetic defect in xeroderma pigmentosum, or immunosuppression as is seen in patients infected with HIV. The challenges of complete surgical excision in patients with extensive tumors, in addition to the high recurrence rates in some series, led to a search for nonsurgical treatment modalities. In addition to avoiding surgery, topical agents may offer the additional benefit of treating clinically unapparent disease. Due to the theoretic advantages of topical chemotherapy, multiple agents have been used in both the primary and adjuvant treatment of OSSN. Mitomycin, interferon alpha-2b, and 5-fluorouracil have all been utilized with success; mitomycin may invoke a greater risk for limbal stem cell failure, and interferon is well tolerated and effective but more expensive. Future developments in imaging and chemotherapeutics will likely continue to alter the treatment paradigm for ocular surface tumors.

Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension

2000 ◽  
Vol 122 (2) ◽  
pp. 277-283 ◽  
Author(s):  
Giovanni Danesi ◽  
Benedict Panizza ◽  
Antonio Mazzoni ◽  
Vincenzo Calabrese
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Surgical Excision ◽  
Residual Tumor ◽  
Lateral Approach ◽  
Treatment Modalities ◽  
Intracranial Extension ◽  
Midface Degloving

Although surgery is regarded as the mainstay of treatment for juvenile nasopharyngeal angiofibromas (JNAs), ancillary treatment modalities such as radiotherapy and on rare occasions chemotherapy are still recommended by many for intracranial extension with apparent radiologic involvement of the cavernous sinus and internal carotid artery. Further, most authors undertaking surgical excision of this subgroup of patients would recommend a lateral or combined frontal and lateral approach for its removal. In a series of 49 cases of JNA, 14 were found during surgery to have intracranial extradural extension; the anterior approach was used for their removal. Although in these cases, on radiography the cavernous sinus often looked to be invaded and the internal carotid artery was displaced superolaterally, there was no difficulty in establishing a plane of dissection. Total removal was achieved in 11 of the 14 cases with a single-stage procedure. Of the 3 cases with residual tumor, only 1 occurred intracranially. Removal was achieved by a subtemporal approach in this case. For the extracranial residual tumors 1 required a midface degloving and the other, with a 1-cm residual tumor in the nasopharynx, has been treated conservatively for 6 years with no evidence of growth. No deaths or significant complications have occurred, and radiotherapy has not been required. We conclude that JNAs are tumors with a predilection for spread but that rarely invade dura, acting instead to displace it. We believe that surgery is the method of choice for treating these lesions and that an anterior surgical approach with microsurgical techniques should be used in the first instance. In the last 2 cases we preferred a midface degloving technique to avoid facial scarring and because this approach allows a widening of the surgical field if needed by the performance of bilateral maxillary free bone flaps. On the rare occasion that a lateral approach, with its attendant permanent conductive hearing loss, is found to be necessary for total tumor removal, this can be done as a staged procedure. This may be necessary when the tumor has spread lateral to the horizontal internal carotid artery.

Gliomas of the optic nerve or chiasm

1988 ◽  
Vol 68 (1) ◽  
pp. 85-98 ◽  
Author(s):  
Ellsworth C. Alvord ◽  
Steven Lofton
Keyword(s):  
Optic Nerve ◽  
Growth Rates ◽  
Surgical Excision ◽  
Sufficient Information ◽  
Low Grade ◽  
Complete Excision ◽  
Content Type ◽  
Complete Surgical Excision ◽  
Table Analysis ◽  
Fine Print

✓ A review of the literature revealed 623 cases of optic gliomas with sufficient information to permit actuarial (life-table) analysis concerning the prognosis of this disease by the patients' age, tumor site, treatment, and presence of concomitant neurofibromatosis or extension into the hypothalamus or ventricle. All of these factors are important. The development of mathematical models led to the conclusion that these tumors, generally regarded histologically as low-grade astrocytomas, actually have a very wide but continuous range of growth rates. Some grow rapidly enough to be explained by simple exponential doubling at a constant rate, but most behave as though their growth decelerates. Decelerating growth rates make comparisons of various groups of patients difficult. No support is found for the classical hypothesis that some may be hamartomas. Inadequately treated gliomas of the optic nerve or chiasm bear about the same poor prognosis. However, tumors of the optic nerve (intracranial as well as intraorbital) have an excellent prognosis following complete surgical excision and only a slightly poorer prognosis following irradiation. About 5% of optic nerve gliomas recur in the chiasm following “complete” intraorbital excision. Patients with neurofibromatosis have about twice the recurrence rate following complete excision of an intraorbital glioma. Optic chiasmal gliomas appear to respond to irradiation with doses above 4500 rads. Patients with neurofibromatosis have about the same prognosis as patients without neurofibromatosis following irradiation of a chiasmal glioma.

scholarly journals Spinal osteoid osteoma: Surgical resection and review of literature

2020 ◽  
Vol 11 ◽  
pp. 308
Author(s):  
Abhinandan Reddy Mallepally ◽  
Rajat Mahajan ◽  
Sandesh Pacha ◽  
Tarush Rustagi ◽  
Nandan Marathe ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Osteoid Osteoma ◽  
Surgical Excision ◽  
Presenting Symptoms ◽  
Complete Surgical Excision ◽  
Rare Benign Tumor ◽  
The Common ◽  
Optimal Approach ◽  
Posterior Elements

Background: Osteoid osteoma (OO) is a rare benign tumor of the spine that involves the posterior elements with 75% tumors involving the neural arch. The common presenting symptoms include back pain, deformity like scoliosis, and rarely radiculopathy. Methods: From 2011 to 2017, we evaluated cases of OO managed by posterior surgical resection while also reviewing the appropriate literature. Results: We assessed five patients (three males and two females) averaging 36.60 years of age diagnosed with spinal OOs. Two involved the lumbar posterior elements, two were thoracic, and one was in the C3 lateral mass. All patients underwent histopathological confirmation of OO. They were managed by posterior surgical resection with/without stabilization. No lesions recurred over the minimum follow-up period of 24 months. Conclusion: Surgical excision is the optimal treatment modality for treating spinal OOs. The five patients in this study demonstrated good functional outcomes without recurrences. Further, the literature confirms that the optimal approach to these tumors is complete surgical excision with/without radiofrequency ablation.

scholarly journals Axillary Nodal Metastasis of Operated Gallbladder Carcinoma – First Remote Site of Aggression.

2021 ◽  
Author(s):  
Manu Vats ◽  
Lovenish Bains ◽  
Pawan Lal ◽  
Shramana Mandal
Keyword(s):  
Surgical Excision ◽  
Port Site ◽  
Treatment Modalities ◽  
Axillary Lymph Nodes ◽  
R0 Resection ◽  
Axillary Lymph ◽  
Port Site Metastasis ◽  
Axillary Metastasis ◽  
Complete Surgical Excision ◽  
Axillary Lymphadenectomy

Abstract Background: Gallbladder cancer is a very aggressive type of biliary tract cancer. The only curative treatment is complete surgical excision of the tumour. However, even after surgery, there is still a risk of recurrence of the cancer.Case summary: A 63-year-old gentleman presented with the complaint of a non-healing ulcer at epigastrium for the last 1 month, after having undergone a laparoscopic cholecystectomy at a private centre 4 months ago. Investigations confirmed the diagnosis of epigastric port site metastasis from a primary from gall bladder adenocarcinoma. After undergoing completion radical cholecystectomy with wide local excision of the epigastric ulcer, he received 6 cycles of concurrent chemoradiotherapy. Eighteen months later, he presented to us with bilateral axillary swellings. Investigations confirmed bilateral axillary metastasis. He then underwent bilateral axillary lymphadenectomy (Level 3). However, PET scan after 6 months showed widespread metastasis and the patient succumbed to the illness 1 month later.Conclusion: Axillary metastasis probably occurs due to the presence of microscopic systemic metastasis at the time of development of port site metastasis. An R0 resection of the malignancy is the only viable option for effective therapy. The present case highlights the rare involvement of bilateral axillary lymph nodes as the first distant metastatic site with no evidence of disease in the locoregional site. However, the prognosis after metastasis remains dismal despite multiple treatment modalities.

scholarly journals A Rare Presentation of Schwannoma as a Purely-Cystic Superficial-Intermuscular Extra-Spinal Swelling over Upper Back.

2020 ◽  
Author(s):  
Srinjoy Saha
Keyword(s):  
Surgical Excision ◽  
Thoracic Vertebrae ◽  
Rare Presentation ◽  
Complete Surgical Excision ◽  
Rare Tumours ◽  
S 100 ◽  
One Year ◽  
Atypical Presentations ◽  
Upper Thoracic

Abstract Schwannomas are rare tumours arising from peripheral nerve sheath. Here, a 44-year-old lady came to our clinic with an asymptomatic progressively-enlarging swelling over her upper back. It was fluctuant, with an absence of pain and tenderness. MRI showed a benign, purely-cystic, superficial-intermuscular, extra-spinal swelling nearby upper thoracic vertebrae. Complete surgical excision proceeded smoothly through a well-defined plane between the swelling and the muscles. It was not attached to any identifiable nerve. A 6.5x5.0x2.5 cm ovoid lesion with a glistening whitish-grey capsule was excised and wound reconstructed in layers. Histopathology showed hypercellular areas with nuclear palisading or oval-shaped Verocay bodies. Only S-100 tested positive amongst the five-antigen immunohistochemistry, thus establishing the diagnosis of a schwannoma. Postoperatively, a one-year follow-up period was uneventful. Schwannomas can surprise clinicians by arising anywhere and with atypical presentations. It needs to be in the differential diagnoses of any asymptomatic slowly-growing lesion.

Percutaneous and laparoscopic-assisted cryoablation of small renal cell carcinomas.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 462-462
Author(s):  
Tommy Kjaergaard Nielsen ◽  
Oyvind Ostraat ◽  
Michael Borre ◽  
Truls E Bjerklund Johansen
Keyword(s):  
Complication Rate ◽  
Renal Cell ◽  
Residual Tumor ◽  
Observation Time ◽  
Treatment Modalities ◽  
Minor Bleeding ◽  
Renal Cell Carcinomas ◽  
Cancer Specific Survival ◽  
Co Morbidity

462 Background: To evaluate the complication rate and short term oncological outcome of small renal cell carcinomas treated with cryoablation. Methods: 91 biopsy verified renal cell carcinomas were cryoablated between 2006-11. Patients treated had primarily T1a tumors, but exceptions were made. Patients with tumors not directly accessible percutaneously were selected for laparoscopy. To ensure complete coverage of the tumor, cryoneedle placement and freezing procedure was peroperatively monitored by ultrasound in both modalities. Presice machine with Ice-Seet and Ice-Rod needles from Galil Medical was used. Treatment was considered successful when tumors gradually shrunk and showed no sign of contrast enhancement, assessed by CT or MRI. Results: Mean patient age and tumor size was 65 yr [17 - 83] and 26 mm [10 - 62], respectively [min-max]. Treatment modalities consisted of percutaneous route; n=34 (47%) and laparoscopic guided; n=39 (53%). The mean follow-up time was 19 months [1 - 56]. 18 patients were excluded from follow-up analysis (8 pt. with short observation time, 5 pt. treated despite severe co-morbidity with no planned follow-up, 3 pt. lost to follow-up, 1 pt. emigrated, 1 pt. died as a result of bleeding from perforation of iliac artery by troicar). Residual tumor was diagnosed by imaging in 10 patients (perc n=6 and lap n=4, p>0,05) after a mean follow-up time of 13 months [1 - 31]. Diagnosis was confirmed by biopsy in all but one case, in which the diagnosis was necrosis. Of the 10 patients with residual tumor, 8 patients were reablated and 2 patients were referred to oncological treatment. Cancer specific survival was 100%. Overall survival was 91%. Complications: 8 pt. had minor bleeding in relation to cryoneedle removal, requiring Tachosil. 1 pt. had subcutaneous bleeding, 2 pt. was readmitted due to pain and discharged the following day. No patients required blood transfusion. Conclusions: Although percutaneous and laparoscopic guided cryoablation are minimally invasive procedures and the overall complication rate is low, serious complications may occur. Close follow-up and continuous evaluation of criteria for patient selection and relapse is necessary. An international database is recommended.

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