L3 rootlet recurrent melanocytic schwannoma &ndash; case report and literature review

First described by Miller in 1932, melanocytic schwannoma (MS) (melanotic schwannoma, pigmented schwannoma) is a rare variation of peripheral nerve sheet tumours with ectodermal origin occurring predominantly in somatic, but also in the autonomic peripheral system with around two hundred cases in the literature. Predominantly benign tumours, MS are still imaging and pathological challenge and can be easily misdiagnosed with more aggressive peripheral nerve tumours. We report a case of melanocytic schwannoma on L3 sensory rootlet with systematic literature review of nearly 200 cases presented in intracranial, paraspinal region, thoracic, abdominal or pelvic cavities and skin. Two-thirds of cases are part of Carney complex. We present a case of a 61-year-old male with a 3-month history of low back pain, progressive numbness and stiffness in the right thigh, shin and knee, tibial and peroneal paresis causing gait disturbance and neurological claudication. MRI findings present “sand clock” type intradural extramedullary tumour formation with extension to the L3 rootlet through right L3-L4 foramen, hypointense on T2 and hyperintense on T1. Pathological diagnosis of sporadic type melanocytic schwannoma was made via immunohistological and ultrastructural analysis. Thirteen months after total resection there was clinical and MRI evidence of recurrence of the tumour. Total resection and radiosurgery was performed with a recurrence free period of 14 months.A gold standard for melanocytic schwannoma treatment is gross total surgical resection. Despite being considered benign tumours, MS have a local or metastatic recurrence of around 13%. MRI imaging in most of the cases is insufficient and only exhaustive pathological and immunohistological examination is the key to diagnosis. Need of postoperative radiation therapy is still controversial. For the first time, a criterion for postoperative adjuvant therapy was established.

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Lipomatous, vascular, and chondromatous benign tumors of the peripheral nerves

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.6.19 ◽

2007 ◽

Vol 22 (6) ◽

pp. 1-8 ◽

Cited By ~ 19

Author(s):

Claude-Edouard Châtillon ◽

Marie-Christine Guiot ◽

Line Jacques

Keyword(s):

Peripheral Nerve ◽

Peripheral Nerves ◽

Postoperative Radiotherapy ◽

Symptomatic Relief ◽

Gross Total Resection ◽

Benign Tumors ◽

Preoperative Embolization ◽

Total Resection ◽

Peripheral Nerve Lesions ◽

The Right

Benign peripheral nerve lesions of lipomatous, vascular, and chondromatous origin are very rare. Only one previous case of brachial plexus involvement by such a tumor has been reported. The authors report on their experience with peripheral nerve tumors in three patients and review the available literature on these topics. The three cases discussed include a 44-year-old woman with an intraneural lipoma of the right middle trunk, a 40-year-old woman with an intraneural hemangioma infiltrating the right posterior cord, and a newborn male with a predominantly cartilaginous hamartoma originating from the right C-5 nerve root. The literature review yielded six previous cases of intraneural lipoma, approximately 50 cases of lipofibromatous hamartoma, 13 cases of intraneural hemangioma, and no previous case of cartilaginous hamartoma originating from a nerve. Intraneural lipomas are well encapsulated, and gross-total resection can be achieved. Lipofibromatous hamartomas are diffusely infiltrative; decompressive debulking and neurolysis is often the most appropriate initial approach for patients with symptomatic lesions. Resection of intraneural hemangiomas can be achieved but may require nerve resection and repair in some cases. Debulking has been reported to provide prolonged symptomatic relief in these lesions, and preoperative embolization and postoperative radiotherapy were beneficial in the case presented here. To the authors' knowledge, this is the first reported case of a cartilaginous hamartoma infiltrating a peripheral nerve. Gross-total resection of symptomatic intraneural lipomas is feasible and apparently curative. The optimal treatment for lipofibromatous hamartomas and vascular and chondromatous lesions of the peripheral nerves is uncertain and should be guided by the severity of symptoms.

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Brainstem intraparenchymal schwannoma: A case report and literature review

Surgical Neurology International ◽

10.25259/sni_621_2021 ◽

2021 ◽

Vol 12 ◽

pp. 508

Author(s):

Anselmi Kovalainen ◽

Roel Haeren ◽

Anders Paetau ◽

Martin Lehecka

Keyword(s):

Literature Review ◽

Histopathological Examination ◽

Case Reports ◽

Young Patients ◽

Postoperative Recovery ◽

Gross Total Resection ◽

Benign Tumors ◽

Mri Imaging ◽

Total Resection ◽

Radiological Features

Background: Intracranial intraparenchymal schwannomas (IS) are rare tumors that have mainly been described in case reports. Here, we report on a case of a brainstem IS and included a comprehensive literature review. Case Description: A 74-year-old man presented with progressive gait disturbances. CT- and MRI-imaging revealed a contrast-enhancing mass accompanied by a cyst in the dorsolateral pons. Hemangioblastoma was suspected and surgery was advised. During surgery, gross total resection of a non-invasive tumor was performed. Postoperative recovery was uneventful. Based on histopathological examination, the intraparenchymal brainstem tumor was diagnosed as schwannoma. Conclusion: Our extensive review illustrates that ISs are benign tumors that most often present in relatively young patients. Malignant cases have been described but form an extremely rare entity. Preoperative diagnosis based on radiological features is difficult but should be considered when peritumoral edema, calcifications, and cysts are noted. In benign cases, gross total resection of the lesion is curative. To adequately select this treatment and adjust the surgical strategy accordingly, it is important to include IS in the preoperative differential diagnosis when the abovementioned radiological features are present.

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Tumours of the heart

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0361 ◽

2020 ◽

pp. 3544-3550

Author(s):

Thomas A. Traill

Keyword(s):

Mitral Stenosis ◽

Metastatic Cancer ◽

Clinical Importance ◽

Carney Complex ◽

Papillary Fibroelastoma ◽

Clinical Clue ◽

Benign Tumours ◽

Cardiac Myxomas ◽

The Right ◽

Symptoms And Signs

Cardiac myxomas are rare benign tumours that grow in the lumen of the atria, usually the left. Most are sporadic, but they can be associated with the Carney complex, where unusual freckling is typically the most obvious clinical clue. Symptoms and signs most commonly mimic those of mitral stenosis. Systemic emboli occur in about 40% of cases. However, the most common tumour seen in adult patients is the benign papillary fibroelastoma, which should be surgically removed only if it has been discovered in the search for a source of otherwise unexplained embolism. Primary cardiac sarcomas are found more often in the right heart than in the left. Microscopic secondary deposits within the myocardium can often be found in patients who die of metastatic cancer, but these are rarely of clinical importance.

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Abstract WMP59: Multiple Scattered Tiny Cerebral Infarctions Are Unlikely Cardiogenic

Stroke ◽

10.1161/str.47.suppl_1.wmp59 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Yi Dong ◽

Yuan Gao ◽

Deepak S Nair ◽

Sarah Parker ◽

Jan L Jahnel ◽

...

Keyword(s):

Oral Anticoagulants ◽

Previous History ◽

B Cell Lymphoma ◽

Median Number ◽

Mri Imaging ◽

Mri Findings ◽

Presenting Symptoms ◽

Recurrent Strokes ◽

Moderate Chronic Kidney Disease ◽

The Right

Background: Embolic ischemic strokes are commonly considered to be cardiogenic. In clinical practice, however,patients with a pattern of multiple tiny ischemic foci on MRI often have no cardiac source. To identifying its etiology may help selecting the right therapy to treat or prevent recurrent strokes. Methods: From 1/2010 to 12/2013, records and MRI imaging of 2984 consecutive stroke patients were reviewed. Patients with the following DWI MRI findings were included: 1) ≥3 high intensity lesions in three different arterial territories, 2) each ≤15mm in size and ≤2 sections in thickness. Other data reviewed include general demographics, clinical features and lab results. Patients with known cardiac embolism, aortic arch plaques or aneurysms and recent surgery were excluded. Images of follow-up MRI were reviewed. Results: Among 2984 cases reviewed, 71 patients had multiple tiny DWI lesions. In order to rule out artery to artery emboli, patients with lesions from the same artery territory or watershed region were excluded. Only 43 met all criteria. Their median age was 65 and 23(53.5%) were male. Extremity weakness and slurred speech were the most common presenting symptoms. The median number of DWI lesions in each brain was 13. Common disorders identified include: infection (81.4%), hyperlipidemia(58.1%), moderate chronic kidney disease(39.5%), previous history of stroke (48.8%). Four (9.3%) had large B cell lymphoma and 2 had lung cancer. The quantity of DWI lesions was related to hyperglycemia, hyperlipidemia and impaired GFR. Patients with primary hypercoagulable state more likely had multiple lesions (median 39). On discharge, 5 (11.6%) patients were prescribed dual antiplatelet therapy and 11 (25.6%) were given oral anticoagulants. Conclusions: To our knowledge, this was the first review of this type of specific DWI findings with clinical correlation. Multiple tiny or ‘Star-like’ type of lesions on DWI MRI were likely caused by infection, hyperlipidemia CKD and leukemia. They are unlikely cardiogenic and its recurrent rate was high. Recognizing the pattern of these tiny lesions will help clinicians refocus on the work up of stroke, strategies of treatment and stroke prevention strategy.

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Liponeurocytoma of Cerebellum: rare entity, case based study

Romanian Neurosurgery ◽

10.1515/romneu-2015-0026 ◽

2015 ◽

Vol 29 (2) ◽

pp. 183-187 ◽

Cited By ~ 1

Author(s):

Guru Dutta Satyarthee ◽

A.K. Mahapatra

Keyword(s):

Case Reports ◽

Interesting Case ◽

Rare Entity ◽

Mri Imaging ◽

Mri Findings ◽

Pertinent Literature ◽

Total Resection ◽

Cerebellar Liponeurocytoma ◽

High Index Of Suspicion

Abstract Cerebellar liponeurocytoma (LNC) is a very rare neuroepithelial tumor. About thirty eight cases have been reported, in literature till date, mostly in the form of isolated case reports due to rarity of the occurrence. Authors report interesting case in 27-year old male presented with headache and cerebellar signs. MRI imaging revealed posterior fossa mass. He underwent sub occipital ctraniectomy with gross total resection of lesion. Histopathological report of specimen was consistent with liponeurocytoma with range of MIb index less than three. He is under regular follow-up. However he was not advised any adjuvant therapy. Diagnosis of LNC requires high index of suspicion and neuroimaging with typical MRI findings may be help to confirm the diagnosis. The tumor needs to be differentiated from medulloblastoma, which is far more common and aggressive and requires post-operative chemo-radiation and carries poor prognosis Management and pertinent literature will be reviewed

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Metodologi Pengeluaran Fatwa di Jawatankuasa Fatwa Negeri Johor

Journal of Fatwa Management and Research ◽

10.33102/jfatwa.vol13no1.132 ◽

2018 ◽

Vol 13 (1) ◽

pp. 70-88

Author(s):

Mohd Faez Mohd Shah ◽

Norhidayah Pauzi

Keyword(s):

Literature Review ◽

Research Methods ◽

Research Methodology ◽

Research Method ◽

Islamic Law ◽

Field Research ◽

The State ◽

Original Source ◽

Interview Methods ◽

The Right

In the discipline of Islamic law research, strong proofing and clear Istinbat method are key pillars in the construction of Islamic law based on the application of the science of usul al-fiqh and maqasid al-shari'ah. However, what happens at the state of Johor’s fatwa institution is the opposite. The fatwa research methods applied by the Fatwa Committee of Johor in resolving current fatwa issues is not based on the right and true discipline of Islamic law research. In fact, current inputs related to fatwa issues are not explicitly stated in the method of determining the law either in the form of reality or scientifically verified. Therefore, this paper will discuss the fatwa procedures undertaken by the Fatwa Committee of Johor based on the methods applied in resolving current issues. The research methodology adopted is library and interview methods. This study shows that fatwa management and production in the state of Johor is placed under the jurisdiction of the Mufti of Johor’s Department. The methods adopted by the Fatwa Committee of Johor covers two methods, namely: internal research methods including literature review through the application of original source and proofs based on syarak. Second: field research method that includes an external review or going to the location of study such as conducting observation, questionnaires and interviews including referrals to specialists of different fields. Maslahah and mafsdah consideration are also implemented by the Fatwa Committee in every fatwa decision based on the standard that meets the interests of maqasid al-shari'ah. Keywords: Metode, fatwa, istinbat, usul al-fiqh, maqasid al-shari’ah ABSTRAK Dalam disiplin penyelidikan hukum Islam, kekuatan pendalilan dan kaedah istinbat yang jelas merupakan tunggak utama dalam pembinaan hukum Islam berasaskan kepada aplikasi ilmu usul al-fiqh dan maqasid al-shari’ah. Namun begitu, apa yang berlaku di institusi fatwa negeri Johor adalah sebaliknya. Kaedah penyelidikan fatwa yang diaplikasi oleh Jawatankuasa Fatwa Negeri Johor dalam menyelesaikan isu fatwa semasa tidak berasaskan kepada disiplin penyelidikan hukum Islam yang tepat dan sebenar. Malahan input-input semasa yang berkaitan dengan isu fatwa juga tidak dinyatakan secara jelas dalam kaedah penentuan hukum sama ada dalam bentuk realiti yang berlaku atau pembuktian secara saintifik. Justeru, kertas kerja ini akan membincangkan prosedur fatwa Jawatankuasa Fatwa Negeri Johor berdasarkan metode-metode yang diaplikasi dalam menyelesaikan isu-isu yang bersifat semasa. Metodologi kajian yang digunakan dalam kajian ini adalah melalui metode perpustakaan dan metode lapangan. Hasil kajian menunjukkan bahawa pengurusan dan pengeluaran fatwa di negeri Johor hanya terletak di bawah bidang kuasa Jabatan Mufti Johor. Metode fatwa yang diamalkan oleh Jawatankuasa Fatwa Negeri Johor merangkumi dua metode iaitu pertama, kaedah penyelidikan dalaman yang merangkumi kajian kepustakaan menerusi pengaplikasian dari sumber asas dan dalil-dalil syarak. Kedua, kaedah penyelidikan lapangan yang meliputi kajian luaran atau turun ke lokasi kajian seperti observasi, soal selidik dan temubual dan rujukan kepada pakar dalam bidang yang berlainan. Pertimbangan maslahah dan mafsdah juga dimplementasikan oleh Jawatankuasa Fatwa dalam setiap keputusan fatwanya berasaskan standard yang menepati kepentingan maqasid al-shari’ah. Kata kunci: Metode, fatwa, istinbat, usul al-fiqh, maqasid al-shari’ah

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Popliteal nodal metastasis from squamous cell cancer of the foot. Case report and literature review

Journal of Clinical Case reports and reviews ◽

10.36879/jccrr.19.000140 ◽

2019 ◽

pp. 1-2

Keyword(s):

Case Report ◽

Lymph Node ◽

Literature Review ◽

Squamous Cell ◽

Rare Case ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Nodal Metastasis ◽

Regional Disease ◽

The Right

We report a very rare case of squamous cell cancer of the right foot which had metastasize to the ipsilateral popliteal lymph node after initial diagnosis and treatment for the loco-regional disease.

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Neuroimaging of Children With Takayasu Arteritis

Journal of Child Neurology ◽

10.1177/0883073821991287 ◽

2021 ◽

pp. 088307382199128

Author(s):

Hafize Emine Sönmez ◽

Ferhat Demir ◽

Semanur Özdel ◽

Şerife Gül Karadağ ◽

Esra Bağlan ◽

...

Keyword(s):

Takayasu Arteritis ◽

Internal Carotid ◽

Laboratory Data ◽

Left Middle Cerebral Artery ◽

Mri Findings ◽

Cranial Mri ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

And Diffusion ◽

Left Middle

Objective: Takayasu arteritis is a rare granulomatous chronic vasculitis that affects the aorta and its main branches. Neurologic manifestations can accompany the disease; however, there is no study on neuroimaging in children with Takayasu arteritis. Therefore, we aimed to evaluate cranial magnetic resonance imaging (MRI) in pediatric Takayasu arteritis patients. Materials and Methods: Demographic, clinical, and laboratory data were obtained retrospectively. Results: The study included 15 pediatric Takayasu arteritis patients. All patients presented with constitutional symptoms. Additionally, 6 patients suffered from headache, 2 had syncope, 1 had loss of consciousness, and 1 had convulsion. All patients underwent cranial and diffusion MRI a median 12 months after diagnosis. Cranial MRI findings were normal in 12 patients, whereas 3 patients had abnormal findings, as follows: stenosis in the M1 and M2 segments of the left middle cerebral artery (n = 1); diffuse thinning of the right internal carotid, middle cerebral, and right vertebral and basilar artery (n = 1); as a sequela, areas of focal gliosis in both the lateral ventricular and posterior periventricular regions (n = 1). Among these 3 patients, 1 had no neurologic complaints. Conclusion: Abnormal MRI findings can be observed in pediatric Takayasu arteritis patients, even those that are asymptomatic; therefore, clinicians should carefully evaluate neurologic involvement in all pediatric Takayasu arteritis patients.

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Levator palpabrae superioris myositis as an unusual cause of unilateral ptosis—case report

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00469-2 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Ahmed M. Abdrabou

Keyword(s):

Previous History ◽

Good Prognosis ◽

Oculomotor Nerve Palsy ◽

Ophthalmological Examination ◽

Bilateral Ptosis ◽

Mri Findings ◽

Upper Eyelid ◽

Unilateral Disease ◽

The Right ◽

Mri Study

Abstract Background Ptosis can be a manifestation of a more serious situation. Hence, the analysis of the complaint and the search for etiology are crucial in such cases. Ptosis has many causes; some of them lead to unilateral ptosis while others cause bilateral ptosis. For instance, myasthenia gravis is a cause of bilateral ptosis while oculomotor nerve palsy induces unilateral disease. Proper evaluation of the patient and identification of the cause are important to achieve accurate management and good prognosis. Case presentation A 47-year-old male patient attended the ER complaining of dropping the right eye lid of 2 days’ duration. There was no associated pain or diplopia. On examination, the extraocular muscles’ (EOM) motility was intact, normal pupil and corneal reflexes, and there was swelling of the upper eyelid. Ophthalmological examination revealed normal anterior and posterior chambers as well as the vitreous and retina. The patient had a previous history of traumatic intracranial hemorrhage that was resolved without surgical intervention. He also had diabetes mellitus and hypertension. The patient was transferred to the MRI unit to perform MRI study of the brain and orbit with MRA and IV contrast administration. MRI findings confirmed the diagnosis of LPS myositis, and the patient received medical treatment and improved. Conclusion Proper radiological diagnosis leads to accurate management and achieves rapid recovery and optimal patient care.

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