scholarly journals Exceptionally rapid recurrence of malignant meningioma: case report

2022 ◽  
pp. 1-7
Author(s):  
Francisco Arrambide-Garza ◽  
Arnulfo Gómez-Sánchez ◽  
Santos Guzmán-López ◽  
Alejandro Quiroga-Garza ◽  
Rodrigo Enrique Elizondo Omaña
Keyword(s):  
Histological Study ◽  
Occipital Lobe ◽  
Mass Effect ◽  
High Rate ◽  
Incomplete Resection ◽  
Anaplastic Meningioma ◽  
Inter Observer Variability ◽  
Clonic Seizures ◽  
Primary Management ◽  
Adult Female Patient

Anaplastic meningioma represents less than 5% of all meningiomas. It is a neoplasm with a poor prognosis due to aggressiveness and a high rate of recurrence. Patients could remain asymptomatic but clinical characteristics of mass effect are the most common presentation. Although diagnosis is made with histological study, this method is difficult to define, with inter-observer variability. When possible, surgical resection is the primary management. We discuss a case of an adult female patient with tonic-clonic seizures and weakness attributed to an anaplastic meningioma in the occipital lobe. The patient was treated with a parietal craniotomy with complete resection. One month later the patient suffered a recurrence of the tumor with the need for further intervention with incomplete resection. Due to extent of the damage the patient deceased two weeks later.

scholarly journals Extensive Growth of an Anaplastic Meningioma

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Hajrullah Ahmeti ◽  
Homajoun Maslehaty ◽  
Athanasios K. Petridis ◽  
Alexandros Doukas ◽  
Mehran Mahvash ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Tumor Resection ◽  
High Rate ◽  
Complete Tumor Resection ◽  
Calvarial Bone ◽  
Anaplastic Meningioma ◽  
Progressive Ataxia ◽  
Extensive Growth ◽  
Tumor Entity ◽  
Complete Tumor

We present the case of a 30-year-old male patient with an almost complete destruction of the calvarial bone through an anaplastic meningioma diagnosed in line with dizziness. Neuroimaging revealed an extensive growing, contrast enhancing lesion expanding at the supra- and infratentorial convexity, infiltrating and destroying large parts of the skull, and infiltrating the skin. Due to progressive ataxia and dysarthria with proven tumor growth in the posterior fossa in the continuing course, parts of the tumor were resected. A surgical procedure with the aim of complete tumor resection in a curative manner was not possible. Six months after the first operation, due to a new tumor progression, most extensive tumor resection was performed. Due to the aggressive and destructive growth with a high rate of recurrence and tendency of metastases, anaplastic meningiomas can be termed as malignant tumors. The extrinsic growth masks the tumor until they reach a size, which makes these tumors almost unresectable. In the best case scenarios, the five-year survival is about 50%. With the presented case, we would like to show the aggressive behavior of anaplastic meningiomas in a very illustrative way. Chemotherapy, radiotherapy, and surgery reach their limits in this tumor entity.

Nodular enhancement within the internal auditory canal following retrosigmoid vestibular schwannoma resection: a unique radiological pattern

2011 ◽  
Vol 115 (4) ◽  
pp. 835-841 ◽  
Author(s):  
Matthew L. Carlson ◽  
Kathryn M. Van Abel ◽  
William R. Schmitt ◽  
Colin L. W. Driscoll ◽  
Brian A. Neff ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
High Rate ◽  
Preoperative Imaging ◽  
Incomplete Resection ◽  
Tumor Margin ◽  
Tertiary Referral Center ◽  
Original Tumor

Object The authors describe the unique occurrence of nodular enhancement within the fundus of the internal auditory canal (IAC) lateral to the preoperative radiological tumor margin following gross-total vestibular schwannoma (VS) resection. Methods The nature of the study was a retrospective chart review of records. The authors reviewed the cases of all patients who underwent microsurgical resection of a VS between January 2000 and January 2010 at a single tertiary referral center. Patients with incomplete resection, neurofibromatosis Type 2, and those with fewer than 2 postoperative MR images available for review were excluded. Postsurgical patients with IAC enhancement located lateral to the preoperative imaging–delineated tumor margin were identified. Lesion morphology was characterized on serial MR imaging studies. Clinical follow-up and outcomes were recorded. Results Over the past decade, 350 patients underwent microsurgical VS resection. Of these, 16 patients met study criteria and were found to have postsurgical enhancement in the distal aspect of the IAC lateral to the imaging limits of the preoperative tumor margin on the first postoperative MR imaging study (37.5% women, median age 45 years). Initial MR imaging was performed at a mean of 3.1 months following surgery, and the mean radiological follow-up duration was 39.8 months (range 16.4–101.9 months). None of the 16 patients developed recurrence during the follow-up course. Conclusions In contrast to previous publications that have reported a high rate of recurrence in cases involving nodular enhancement within the original tumor bed, postoperative enhancement in the IAC lateral to the original tumor margin appears to carry much less risk for tumor recurrence. These findings may be helpful when counseling patients on the recommended frequency of postoperative follow-up imaging.

High Rate of Incomplete Resection After Primary Excision of Eyelid BCC: Multi-Staged Resection Rarely Needs More Than Two Procedures

Orbit ◽  
2011 ◽  
Vol 30 (6) ◽  
pp. 275-279 ◽  
Author(s):  
Anju Kadyan ◽  
Matthew R. Edmunds ◽  
Kwesi N. Amissah-Arthur ◽  
Omar M. Durrani
Keyword(s):  
High Rate ◽  
Incomplete Resection

Anaplastic Meningioma Arising From a Radiologically Diagnosed Arachnoid Cyst

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. E212-E213 ◽  
Author(s):  
Shelly Lwu ◽  
Yves Pieter Starreveld ◽  
Julie Branson ◽  
Arie Perry
Keyword(s):  
Genetic Markers ◽  
Arachnoid Cyst ◽  
Past History ◽  
Rare Complication ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Wall Thickening ◽  
Repeat Surgery ◽  
Anaplastic Meningioma ◽  
Immunohistochemical Studies

Abstract OBJECTIVE AND IMPORTANCE We report the first example of an anaplastic meningioma arising from an intracranial arachnoid cyst and discuss the diagnostic challenges of this case, including the useful role of genetic markers. CLINICAL PRESENTATION A 72-year-old man presented with transient episodes of expressive dysphasia and focal motor seizures, superimposed on a 6-month history of worsening headaches and dizziness. His past history was significant for a previously drained left-sided chronic subdural hematoma and a radiologically diagnosed left middle fossa arachnoid cyst. Magnetic resonance imaging on admission showed variable wall thickening of the arachnoid cyst with mild mass effect on the left frontotemporal lobes. INTERVENTION The patient underwent decompression of the arachnoid cyst and biopsy of the cyst wall. Histologic and immunohistochemical studies of the thickened portion initially suggested a metastatic carcinosarcoma, but fluorescence in situ hybridization (FISH) studies confirmed the diagnosis of anaplastic meningioma based on characteristic chromosomal deletions. The patient returned 2 months later with progressive disease, leading to his death 6 weeks later despite repeat surgery for tumor debulking. CONCLUSION Malignant transformation of meningothelial elements in arachnoid cysts is an exceptionally rare complication that poses considerable diagnostic challenges. Genetic markers may be particularly helpful in such cases.

scholarly journals Complete endoscopic resection of a pituitary stalk epidermoid cyst using a combined infrasellar interpituitary and suprasellar endonasal approach: case report

2018 ◽  
Vol 128 (2) ◽  
pp. 437-443 ◽  
Author(s):  
Ana C. I. Nakassa ◽  
Joseph D. Chabot ◽  
Carl H. Snyderman ◽  
Eric W. Wang ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Epidermoid Cyst ◽  
Residual Tumor ◽  
Mass Effect ◽  
Visual Disturbance ◽  
Primary Hypothyroidism ◽  
Complete Resection ◽  
High Rate ◽  
Pituitary Stalk ◽  
Endoscopic Endonasal

Intracranial epidermoid cysts are benign lesions of epithelial origin that most frequently present with symptoms of mass effect. Although they are often associated with a high rate of residual tumor and recurrence, maximal safe resection usually leads to good outcomes. The authors report a complete resection of an uncommon pituitary stalk epidermoid cyst with intrasellar extension using a combined suprasellar and infrasellar interpituitary, endoscopic endonasal transsphenoidal approach. The patient, a 54-year-old woman, presented with headache, visual disturbance, and diabetes insipidus. Postoperatively, she reported improvement in her visual symptoms and well-controlled diabetes insipidus using 0.1 mg of desmopressin at bedtime and normal anterior pituitary gland function. One year later, she continues to receive the same dosage of desmopressin and is also taking 50 mcg of levothyroxine daily after developing primary hypothyroidism unrelated to the surgical procedure. A combined infrasellar interpituitary and suprasellar approach to this rare location for an epidermoid cyst can lead to a safe and complete resection with good clinical outcomes.

scholarly journals Epilepsy from Cerebral Arteriovenous Malformations

1983 ◽  
Vol 10 (2) ◽  
pp. 91-95 ◽  
Author(s):  
Richard Leblanc ◽  
William Feindel ◽  
Roméo Ethier
Keyword(s):  
Parietal Lobe ◽  
Epileptiform Activity ◽  
Contrast Material ◽  
Occipital Lobe ◽  
Ct Scanning ◽  
Mass Effect ◽  
Partial Seizures ◽  
Generalized Seizures ◽  
Vascular Enhancement ◽  
Patients With Epilepsy

SUMMARY:Twenty-seven patients with epilepsy as the only manifestation of a cerebral AVM were seen at the MNI/MNH from 1973 to 1981. The nine females and eighteen males between the ages of fourteen and fifty-four years (Mean 25.2 years) had epilepsy for an average of 3.5 years prior to the diagnosis of AVM.Seven patients had primarily generalized seizures, ten patients had partial seizures with complex symptoms, fourteen patients had partial seizures with elementary symptoms, and thirteen patients had secondarily generalized seizures. Although there was no history of intracranial hemorrhage, seven patients had negative hemispheric signs (hemiatrophy, hemianopia, dysphasia, hemiparesis), two had impaired mentation, and two were ataxic. The EEG, normal in ten cases, showed non-epileptiform activity in six cases, and focal epileptiform activity in eleven cases. Angiographic and/or histological examination revealed eight small (less than 2 cm in diameter) and nineteen large lesions. Fifteen AVMs involved the frontal lobe, ten the temporal lobe, five the parietal lobe, and one the occipital lobe. Angiography failed to demonstrate three frontal and three temporal AVMs.Plain CT scanning demonstrated a high or low density lesion without a mass effect in sixteen cases, enlargement of the ipsilateral ventricle or Sylvian fissure in seven cases, and diffuse ventricular enlargement in three cases. CT scanning was performed after the intravenous injection of contrast material in nineteen cases and demonstrated vascular enhancement in fifteen cases and an abnormal blood vessel in six cases. Two angiographically occult AVMs demonstrated vascular enhancement with infusion CT scanning, thereby demonstrating the vascular nature of the lesion where angiography had failed to do so.

scholarly journals Outcome of a novel modified endoscopic papillectomy for duodenal major papilla adenoma

2020 ◽  
Vol 34 (11) ◽  
pp. 5160-5167
Author(s):  
Pin Wang ◽  
Chengfei Jiang ◽  
Yi Wang ◽  
Lin Zhou ◽  
Shu Zhang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Rate ◽  
Conventional Group ◽  
Incomplete Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Endoscopic Papillectomy ◽  
Significant Difference

Abstract Background and aims In recent years, with the development of endoscopic techniques, endoscopic resection is widely used for duodenal papillary adenomas, but conventional endoscopic resection has a high rate of incomplete resection and recurrence. On this basis, we have employed a novel modified endoscopic papillectomy (ESP). In this study, we evaluated the feasibility and advantages of this ESP for the treatment of duodenal major papilla adenoma. Methods A total of 56 patients with duodenal major papilla adenoma confirmed by endoscopic ultrasonography, intraluminal ultrasound and gastroscopic biopsy from October 2007 to June 2017 were collected in the Department of Gastroenterology, Nanjing Drum Tower Hospital. The diameter of the adenoma ranged from 1.41 to 2.02 cm. 16 cases were given the conventional method and 40 cases underwent the modified ESP procedure in which a small incision was made by cutting current when anchoring the snare tip on the distal side of the adenoma. Results En bloc resection rate was significantly higher in the modified group (100%, 40/40) than that in the conventional group (81.3%, 13/16; P = 0.02). However, no significance was seen between the modified group and the conventional group in complete resection rate (92.5%, 37/40 vs 93.8%, 15/16; P = 1.00). There was no significant difference in the number and difficulty of postoperative pancreatic and biliary stents placement between the two groups (P = 0.20). Total bleeding occurrence was much lower in the modified group (37.5%, 15/40 vs 87.5%, 14/16; P = 0.001), and no significant differences were found in other short-term complications and the 3, 6, 12 and 24 months recurrences rate between the conventional and modified ESP groups. Conclusions The modified ESP improves the treatment outcome of duodenal major papilla adenoma with higher en bloc resection rate and lowering bleeding rate.

Primary Dural Lymphoma Masquerading as a Meningioma: A Rare Clinical Entity

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S114-S114
Author(s):  
Sakshi Sakshi ◽  
Ashish Bains
Keyword(s):  
B Cell ◽  
Dura Mater ◽  
Occipital Lobe ◽  
B Cell Lymphoma ◽  
Mass Effect ◽  
Proliferation Index ◽  
Right Visual Field ◽  
Pcr Analysis ◽  
Low Grade ◽  
Ki 67

Abstract Primary dura mater–based lymphomas are extremely uncommon and when detected are often clinically and radiologically misidentified. As per literature search, they account for <0.1% of all non-Hodgkin lymphomas; however, a precise incidence is unknown since only a few cases have been described in the literature. Here we report a case of a 64-year-old female who presented for evaluation of a newly diagnosed left tentorial tumor, diagnosed as “consistent with meningioma” on imaging studies with significant mass effect on the left occipital lobe and left cerebellum with effacement of the fourth ventricle. She had been experiencing disabling headaches, balance dysfunction, and reduced vision. On examination, the patient had right visual field defect with wide-based gait. No evidence of systemic lymphoma or clinically suspicious lymphadenopathy was documented. An intraoperative consultation revealed sheets of lymphocytes, rather highly concerning for lymphoma. H&E sections showed dense fibroconnective tissue heavily infiltrated by mature small- to intermediate-sized lymphocytes with irregular nuclei and condensed chromatin without a discernible architecture. Only sparse and scattered larger lymphocytes were seen. Flow cytometry identified a subset of B cells with lambda-restricted immunophenotype expressing CD19+, CD20+, CD10+, CD5–, and CD23–. On tissue sections, Ki-67 showed an overall proliferation index of 10% to 20%. However, no residual follicular dendritic cell meshwork was detected by CD21 or CD23. PCR analysis detected clonal B-cell IgH and IgKappa gene rearrangements. A diagnosis of low-grade CD10-positive B-cell lymphoma (likely follicle center-cell origin) was made and the patient was discharged after 3 days of surgery for outpatient follow-up and treatment. In conclusion, low-grade dural-based lymphomas are extremely rare and often misdiagnosed as meningiomas clinically and radiologically. Additionally, it is important distinguish lymphomas of the dura mater, which are excluded from the definition of primary CNS lymphomas and may have a different clinical management and outcome.

scholarly journals Non-functioning pituitary adenomas: clinical feature, laboratorial and imaging assessment, therapeutic management and outcome

2009 ◽  
Vol 53 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Maria Licia Calado de Aguiar Ribeiro Cury ◽  
Juliana Coutinho Fernandes ◽  
Hélio Rubens Machado ◽  
Lucila Leico Elias ◽  
Ayrton Custódio Moreira ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Mass Effect ◽  
Visual Disturbance ◽  
Primary Treatment ◽  
Pituitary Hormones ◽  
Therapeutic Management ◽  
Preoperative Imaging ◽  
Clinical Feature ◽  
Incomplete Resection ◽  
Adrenal Hypofunction

OBJECTIVE: This study is an updated review of a Southeast Brazilian experience NFPA, emphasizing clinical features, laboratorial and imaging assessment, therapeutic management and outcome. DESIGN AND METHODS: Retrospective study, in which 104 patients with NFPA were evaluated by the same team of endocrinologists and neurosurgeon. Patients underwent biochemical evaluation, radiological studies and visual field assessment. RESULTS: Hypopituitarism and neuro-ophthalmological defects were observed in 89%. We observed GH deficiency (81.4%), hypogonadism (63.3%), adrenal hypofunction (59.5%), hypothyroidism (20.4%), high (38.5%) and low (16.7%) prolactin levels. Preoperative imaging classified 93% of the tumors as macroadenomas. Extra-sellar expansion was observed in 83.8%. Varying degrees of visual disturbance were observed in 74%. Primary treatment was transsphenoidal surgery (75%). Clinical control was achieved with one surgery in 37.5 % of patients. The majority of patients needed a second therapeutic approach, radiotherapy or other surgeries. Immunohistochemistry resulted negative for pituitary hormones in 43%. Improvement of neuro-ophthalmological symptoms was observed in 61% of the patients after treatment. CONCLUSIONS: Our data confirm elevated prevalence of mass effect and hypopituitarism in patients harboring NFPA. Recurrence due to invasion or incomplete resection of the tumor is quite common, which frequently leads to a second therapeutic option.

scholarly journals Serrated Lesions of the Colon-Rectum: A Focus on New Diagnostic Tools and Current Management

2019 ◽  
Vol 2019 ◽  
pp. 1-14 ◽  
Author(s):  
Gianluca Cassese ◽  
Alfonso Amendola ◽  
Francesco Maione ◽  
Mariano Cesare Giglio ◽  
Gianluca Pagano ◽  
...  
Keyword(s):  
High Rate ◽  
Confocal Laser Endomicroscopy ◽  
Diagnostic Tools ◽  
Confocal Laser ◽  
Incomplete Resection ◽  
Interval Cancers ◽  
Novel Technologies ◽  
Conventional Endoscopy ◽  
Serrated Lesions

Prompt diagnosis and correct management of the so called “serrated lesions” (SLs) of the colon-rectum are generally considered of crucial importance in the past years, mainly due to their histological heterogeneity and peculiar clinical and molecular patterns; sometimes, they are missed at conventional endoscopy and are possibly implicated in the genesis of interval cancers. The aim of this review is to focus on the diagnostic challenges of serrated lesions, underlying the role of both conventional endoscopy and novel technologies. We will show how an accurate and precise diagnosis should immediately prompt the most appropriate therapy other than defining a proper follow-up program. It will be emphasized how novel endoscopic techniques may provide better visualization of mucosal microsurface structures other than enhancing the microvascular architecture, in order to better define and characterize specific patterns of mucosal lesions of the gastrointestinal tract. Standard therapy of SLs of the colon-rectum is still very debated, also due to the relatively lack of studies focusing on treatment issues. The high risk of incomplete resection, together with the high rate of postcolonoscopy interval cancers, suggests the need of an extra care when facing this kind of lesions. Given this background, we will outline useful technical tips and tricks in the resection of SLs, taking aspects such as the size and location of the lesions, as well as novel available techniques and technologies, other than future perspectives, including confocal laser endomicroscopy into consideration. Follow-up of SLs is another hot topic, also considering that their clinical impact has been misunderstood for a long time. The incidence of the so called interval colorectal cancer underlines how some weaknesses exist in current screening and follow-up programs. Considering the lack of wide consensus for the management of some SLs, we will try to summarize and clarify the best strategies for their optimal management.

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