A rare case of primary sellar melanoma

2004 ◽  
Vol 100 (5) ◽  
pp. 931-934 ◽  
Author(s):  
Jochen Tüttenberg ◽  
Wolfram Fink ◽  
Walter Back ◽  
Frederik Wenz ◽  
Dirk Schadendorf ◽  
...  
Keyword(s):  
Mr Imaging ◽  
S100 Protein ◽  
Sella Turcica ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Optic Chiasm ◽  
Pituitary Macroadenoma ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ The authors report on the case of a 37-year-old woman in whom a primary sellar malignant melanoma mimicking a hemorrhagic pituitary macroadenoma was treated. This entity is exceedingly rare; only five cases are described in the literature. The patient presented with rapid deterioration of vision within a 2-week period. After an ophthalmological diagnosis of chiasmal syndrome was made, magnetic resonance (MR) imaging of the head revealed an intra- and suprasellar mass that was elevating and compressing the optic chiasm. Because of the signal heterogeneity of the lesion a hemorrhagic pituitary macroadenoma was assumed; the lesion was transsphenoidally resected. Histological examination of the specimen showed a malignant melanocytic tumor with immunopositivity for S100 protein and HMB-45. Despite extensive staging no other primary melanotic tumor was found. Thus, a primary sellar melanoma was diagnosed. Postoperative MR images demonstrated no residual tumor. For adjuvant therapy the region around the sella turcica received 40.4 Gy stereotactically guided radiation. A 24-month follow-up examination revealed no tumor recurrence. This represents the sixth case of such a lesion reported in the literature, the third case evaluated using MR imaging, and the first case with a progression-free survival of 24 months. Thus, the authors advocate that management of primary sellar melanoma should include gross-total removal and postoperative stereotactic radiotherapy.

Pilocytic astrocytoma of a spinal nerve root

2002 ◽  
Vol 97 (1) ◽  
pp. 110-112 ◽  
Author(s):  
Mark Robert Philipson ◽  
Jake Timothy ◽  
Aruna Chakrobarthy ◽  
Gerry Towns
Keyword(s):  
Mr Imaging ◽  
Pilocytic Astrocytoma ◽  
Nerve Root ◽  
Residual Tumor ◽  
Conus Medullaris ◽  
Spinal Nerve ◽  
Spinal Nerve Root ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ A case of pilocytic astrocytoma involving a spinal nerve root is reported. A 39-year-old woman presented with a 1-year history of progressive pain and numbness, predominantly in the S-1 dermatome. Magnetic resonance (MR) imaging revealed an intradural lesion at the tip of the conus medullaris. The intradural tumor was excised as was the sacrificed nerve root. Histological examination showed a pilocytic astrocytoma in which there were unusual features of calcification and ossification. At 3-year follow-up review MR imaging demonstrated no residual tumor. To the best of the authors' knowledge, this is the first case of a primary pilocytic astrocytoma, a tumor typically of central nervous system origin, arising from a spinal nerve root.

Intrasellar persistent trigeminal artery associated with a pituitary adenoma

1989 ◽  
Vol 70 (2) ◽  
pp. 271-273 ◽  
Author(s):  
K. Stuart Lee ◽  
David L. Kelly
Keyword(s):  
Pituitary Adenoma ◽  
Sella Turcica ◽  
Preoperative Imaging ◽  
Persistent Trigeminal Artery ◽  
Pituitary Macroadenoma ◽  
Trigeminal Artery ◽  
Imaging Studies ◽  
Content Type ◽  
Fine Print ◽  
Transsphenoidal Resection

✓ The case of a patient with Cushing's disease and a pituitary macroadenoma, who also had a persistent trigeminal artery coursing through the sella turcica on preoperative imaging studies, is presented. The patient was treated by transsphenoidal resection of the tumor.

Intracranial Rosai—Dorfman disease treated with microsurgical resection and stereotactic radiosurgery

2003 ◽  
Vol 98 (1) ◽  
pp. 165-168 ◽  
Author(s):  
Constantinos G. Hadjipanayis ◽  
Ghassan Bejjani ◽  
Clayton Wiley ◽  
Toshinori Hasegawa ◽  
Melissa Maddock ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cervical Lymphadenopathy ◽  
Residual Tumor ◽  
Content Type ◽  
First Case ◽  
Excess Morbidity ◽  
Rosai Dorfman Disease ◽  
Microsurgical Resection ◽  
Partial Labyrinthectomy ◽  
Fine Print

✓ Sinus histiocytosis or Rosai—Dorfman disease (RDD) is a rare idiopathic histioproliferative disorder typically characterized by painless cervical lymphadenopathy, fever, and weight loss. Extranodal, intracranial disease is uncommon. In this report the authors describe the first case of intracranial RDD treated with stereotactic radiosurgery after resection. This 52-year-old man with known RDD presented with a 7-day course of fever, headache, diplopia, left facial paresthesias, and difficulty swallowing. No cranial nerve deficits were evident on examination, but right submandibular and inguinal node enlargements were noted. On neuroimaging, the patient was found to have a homogeneously contrast-enhancing petroclival lesion with extension into the left cavernous sinus. The patient underwent a combined left petrosal craniotomy and partial labyrinthectomy with duraplasty for biopsy sampling and partial microsurgical resection of the lesion. Microscopic examination of the biopsy specimen revealed the presence of a mixed cellular population with predominant mature histiocytes consistent with RDD. The residual tumor was treated with stereotactic radiosurgery 2 months after resection. On follow-up imaging the lesion had regressed significantly, with only slight dural enhancement remaining. Microsurgical resection for histological diagnosis, followed by stereotactic radiosurgery for residual tumor represents one treatment alternative in the management of intracranial RDD in which a complete resection carries the potential for excess morbidity.

Volume of residual disease as a predictor of outcome in adult patients with recurrent supratentorial glioblastomas multiforme who are undergoing chemotherapy

2004 ◽  
Vol 100 (1) ◽  
pp. 41-46 ◽  
Author(s):  
G. Evren Keles ◽  
Kathleen R. Lamborn ◽  
Susan M. Chang ◽  
Michael D. Prados ◽  
Mitchel S. Berger
Keyword(s):  
Survival Rate ◽  
Residual Disease ◽  
Prognostic Significance ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Adult Patients ◽  
Content Type ◽  
Response To Chemotherapy ◽  
Fine Print

Object. For patients with recurrent glioblastomas multiforme (GBMs) the prognosis is poor. Although chemotherapy may provide a survival advantage, the role of the extent of tumor resection, or the volume of the residual tumor at the time of recurrence, before instituting chemotherapy, is unclear. This study was designed to assess the response to chemotherapy based on the volume of residual disease (VRD) at the start of treatment in patients with recurrent GBMs. To accomplish this, the authors evaluated a homogeneous group of patients with recurrent GBMs who received the same chemotherapeutic agent. Methods. One hundred nineteen adult patients with recurrent supratentorial GBMs received temozolomide chemotherapy at the time of tumor recurrence. In this cohort the authors analyzed the prognostic significance of volumetrically assessed tumor mass on time to tumor progression (TTP) and survival time (ST). Multivariate analysis demonstrated that the VRD at the beginning of chemotherapy was a statistically significant predictor of both TTP (p < 0.0001) and ST (p < 0.006) when adjusted for the patient's age, performance score, and time from the initial diagnosis. Patients in whom the VRD was less than 10 cm3 at the start of chemotherapy had a 6-month progression-free survival rate of 32% compared with 8% for patients with a VRD between 10 and 15 cm3 and 3% for patients with a VRD larger than 15 cm3. Patients in whom the VRD was smaller than 10 cm3 had a 1-year survival rate of 37% compared with 9% for patients with a VRD between 10 and 15 cm3 and 18% for patients with a VRD larger than 15 cm3. Conclusions. These data indicate that patients with recurrent GBMs who start chemotherapy with a smaller volume (< 10 cm3) of residual disease may have a more favorable response to chemotherapy and a more favorable outcome.

En bloc removal of the lower lumbar vertebral body for chordoma

2001 ◽  
Vol 94 (2) ◽  
pp. 284-291 ◽  
Author(s):  
Jark J. D. Bosma ◽  
Timothy J. D. Pigott ◽  
Bruce H. Pennie ◽  
David C. Jaffray
Keyword(s):  
Mr Imaging ◽  
En Bloc Resection ◽  
Retroperitoneal Approach ◽  
En Bloc ◽  
Content Type ◽  
First Case ◽  
Lumbar Vertebral Body ◽  
Anterior Retroperitoneal Approach ◽  
Lower Lumbar ◽  
Fine Print

✓ En bloc removal of the lower lumbar vertebral bodies (VBs) is a major surgical challenge. The authors describe the surgical technique used in two patients who presented with chordoma confined to the L-5 and L-4 VB, respectively. These tumors were diagnosed using magnetic resonance (MR) imaging during investigation for back pain. Both patients underwent a combined (two-stage) anterior—posterior approach. In the first case the posterior stage of the procedure was followed by an anterior retroperitoneal approach, and in the second case a lateral retroperitoneal approach was used. Complete en bloc excision of the tumor was achieved in each case, even though in the second case the VB fractured when it was mobilized. The correlation between the MR imaging findings and surgical specimens was remarkable. The authors conclude that en bloc resection is feasible in these cases. Because mobilization of the VB is more difficult in the lateral approach, the authors favor the anterior retroperitoneal approach. The authors anticipate the need for such procedures to increase with the widespread use of MR imaging, which demonstrates the extent of these tumors with remarkable accuracy.

Pathophysiology of long-standing overt ventriculomegaly in adults

2000 ◽  
Vol 92 (6) ◽  
pp. 933-940 ◽  
Author(s):  
Shizuo Oi ◽  
Masami Shimoda ◽  
Masayoshi Shibata ◽  
Yumie Honda ◽  
Kouji Togo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Third Ventricle ◽  
Three Dimensional ◽  
Sella Turcica ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Patients Âgés ◽  
Cine Mr ◽  
Programmable Valve ◽  
Fine Print

Object. Long-standing overt ventriculomegaly in adults (LOVA) is a unique form of hydrocephalus that develops during childhood and manifests symptoms during adulthood. The aim of the present study was to analyze the specific pathophysiological characteristics of LOVA.Methods. The specific diagnostic criteria for LOVA include severe ventriculomegaly in adults that is associated with macrocephalus measuring more than two standard deviations in head circumference and/or neuroradiological evidence of a significantly expanded or destroyed sella turcica. Twenty patients who fulfilled these criteria, 14 males and six females, were retrospectively studied. These patients' ages at diagnosis ranged from 15 to 61 years (mean 39.4 years). All had symptoms and/or signs indicating that hydrocephalus first occurred at birth or during infancy in the absence of any known underlying disease. The authors performed a pathophysiological study that included specific variations of magnetic resonance (MR) imaging, such as fluid-attenuated inversion recovery and cardiac-gated cine-mode imaging; intracranial pressure (ICP) monitoring; three-dimensional computerized tomography (CT) scanning; and other techniques.Hydrocephalus was caused by aqueductal stenosis in all patients. Severe ventriculomegaly involving the lateral and third ventricles was associated with a marked expansion or destruction of the sella turcica in 17 cases. Cardiac-gated cine-MR imaging did not reveal any significant movements of cerebrospinal fluid in the aqueduct. Three-dimensional CT ventriculography confirmed that the expanded third ventricle protruded into the sella and, sometimes, extended a diverticulum. Fourteen patients revealed symptoms and signs that indicated increased ICP with prominent pressure waves. Dementia or mental retardation was seen in 11 patients, gait disturbance in 12, and urinary incontinence in eight; all three of these symptoms were observed in seven patients. Thirteen patients experienced visual disturbance. Nine patients underwent ventriculoperitoneal shunt implantation as the initial treatment, leading to postoperative subdural hematoma in all seven cases in which a differential pressure valve was used. Nine patients, three of whom were initially treated by shunt placement, underwent a neuroendoscopic procedure, mainly for third ventriculostomy. Postoperatively, ICP returned to normal, and marked to-and-fro pulsatile movements at the site of ventriculostomy were recognized on cine-MR imaging in patients treated endoscopically. However, the ventriculomegaly was little improved. Consequently, all patients eventually demonstrated improvement in response to either a shunt equipped with a pressure-programmable valve or an endoscopic procedure; however, depression appeared in six patients, who required psychiatric consultation or medication.Conclusions. Such remarkably decreased intracranial compliance but relatively high ICP dynamics are the pathophysiological characteristics of LOVA. The therapeutic regimen should be determined based on the individual's specific pathophysiological makeup.

Intramedullary plasma cell granuloma in the cervicothoracic spine

2002 ◽  
Vol 97 (2) ◽  
pp. 235-238 ◽  
Author(s):  
Toshimi Aizawa ◽  
Tetsuro Sato ◽  
Yasuhisa Tanaka ◽  
Koshi Kishimoto ◽  
Mika Watanabe ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Plasma Cell ◽  
Bladder Dysfunction ◽  
Imaging Modality ◽  
Plasma Cell Granuloma ◽  
Mr Images ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ Intraspinal plasma cell granuloma, which is a nonneoplastic entity, is extremely rare. To date, only four cases have been documented in the spinal meninges. The authors report the first case of a C7—T1 intramedullary plasma cell granuloma. After excision of the lesion, the patient's gait and bladder dysfunction improved. This plasma cell granuloma initially showed no delineated mass on T1-weighted magnetic resonance (MR) images, low signal intensity on T2-weighted images, and was well enhanced after administration of gadolinium diethylenetriamine pentaacetic acid. The latter MR imaging modality should help to detect this tumorous lesion. Histologically, the granuloma needs to be distinguished from lymphoplasmacyte-rich meningioma and plasmacytoma.

Transsphenoidal surgery and adjuvant gamma knife treatment for growth hormone—secreting pituitary adenoma

2001 ◽  
Vol 95 (2) ◽  
pp. 285-291 ◽  
Author(s):  
Hidetoshi Ikeda ◽  
Hidefumi Jokura ◽  
Takashi Yoshimoto
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Mr Imaging ◽  
Transsphenoidal Surgery ◽  
Residual Tumor ◽  
Cure Rate ◽  
Content Type ◽  
Transsphenoidal Microsurgery ◽  
Biochemical Cure ◽  
Fine Print

Object. The results of combined transsphenoidal surgery and adjuvant gamma knife surgery (GKS) for growth hormone (GH)—secreting adenoma were investigated using biochemical cure criteria for surgery and biological cure criteria for adjuvant GKS. Methods. Ninety patients (42 male and 48 female patients), ranging from 11 to 75 years of age, underwent transsphenoidal surgery for GH-secreting pituitary adenoma. Preoperative and postoperative GH and insulin-like growth factor-I levels were measured, as was the postoperative GH level after the oral glucose tolerance test. Tumor size, cavernous sinus (CS) invasion, and residual tumor were evaluated using magnetic resonance (MR) imaging. Transsphenoidal microsurgery was performed, followed by adjuvant GKS when there was persistent biochemical evidence of GH hypersecretion with residual tumor detectable in the CS on MR imaging. Patients in whom GKS was contraindicated were treated with conventional radiotherapy or by medical means. Conclusions. The overall surgical cure rate was 57% based on recently accepted biochemical cure criteria. Patients with no CS invasion achieved a 100% cure rate, whereas patients with CS invasion achieved an 82% cure rate (14 of 17 patients) after adjuvant GKS. The combination of transsphenoidal microsurgery and adjuvant GKS is the optimal therapy for patients with GH-secreting adenoma.

Osteosarcoma and fibrosarcoma caused by postoperative radiotherapy for a pituitary adenoma

2002 ◽  
Vol 96 (5) ◽  
pp. 960-963 ◽  
Author(s):  
Kanna K. Gnanalingham ◽  
Aabir Chakraborty ◽  
Malcolm Galloway ◽  
Tamas Revesz ◽  
Michael Powell
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Rare Complication ◽  
Postoperative Radiotherapy ◽  
Pituitary Macroadenoma ◽  
Content Type ◽  
Sarcomatous Change ◽  
First Case ◽  
Fine Print

✓ Sarcomatous change is a rare complication of postoperative radiotherapy for pituitary adenomas. The authors report on what they believe to be the first case in which fibrosarcoma and, later, osteosarcoma developed during a 14-year period following surgery and radiotherapy for a nonsecreting pituitary macroadenoma.

Radiation therapy for juvenile pilocytic astrocytoma of the pituitary stalk

1992 ◽  
Vol 77 (1) ◽  
pp. 139-142 ◽  
Author(s):  
Juji Takeuchi ◽  
Kiyoshi Kikuchi ◽  
Yuta Shibamoto ◽  
Ichiro Fujisawa
Keyword(s):  
Radiation Therapy ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Growth Retardation ◽  
Pilocytic Astrocytoma ◽  
Residual Tumor ◽  
Pituitary Stalk ◽  
Content Type ◽  
Juvenile Pilocytic Astrocytoma ◽  
Fine Print

✓ A case of juvenile pilocytic astrocytoma of the pituitary stalk is reported. The patient presented with diabetes insipidus and growth retardation. Magnetic resonance (MR) imaging was useful in diagnosing the lesion. Although the tumor could not be completely removed by surgery, radiotherapy was effective and the residual tumor disappeared 6 months after irradiation. The patient's condition has remained stable and no recurrence has been observed by MR imaging in the 4 years since radiation therapy.

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