Hypothalamic Lipoma: Outcome of an Intracranial Developmental Lesion

Background. Hypothalamic lipomas are benign developmental lesions that tend to be discovered incidentally. This article describes the radiological features, outcome, and the postulated theories behind hypothalamic lipomas development. Methods. The electronic archive of neurosurgery was retrospectively reviewed. All patients with a neuroradiological diagnosis of hypothalamic lipoma, between 2005 and 2020, were included. Results. Out of 246 patients with intracranial lipomas, a total of six patients with hypothalamic lipomas have been identified. On computed tomography images, one of the hypothalamic lipomas demonstrated calcification. On magnetic resonance imaging, peripheral enhancement after contrast administration was noted in one of the lesions. Considering the benign nature of the lesions, neurosurgical intervention was not indicated. Conclusion. The majority of patients with hypothalamic lipomas are asymptomatic and undergo brain imaging for other indications. Although uncommon, such developmental lesions can be identified in the general population, especially with the advancement of neuroimaging techniques.

Intradural Extramedullary Nerve Sheath Myxoma of the Cervical Spine: A Case Report and Review of Literature

Background: Nerve sheath myxoma is a rare benign soft tissue tumor. Intraspinal nerve sheath myxomas are rare. Only 8 cases of intraspinal nerve sheath myxoma have been reported to date, and no case of nerve sheath myxoma has been reported in the cervical spinal canal. Herein, we reported the first case of intradural extramedullary nerve sheath myxoma in the cervical spinal canal of a 57-year-old man, including its complete clinical course and radiological findings.Case Presentation: A 57-year-old male patient presented with numbness in his left finger without any obvious inducement for 3 years. CT and contrast-enhanced magnetic resonance imaging (MRI) of the spine were performed. Based on the radiological examinations, a diagnosis of schwannoma was initially made. However, nerve sheath myxoma was finally confirmed by histopathological and immunohistochemical examinations. Complete tumor excision at the C1-2 level was performed. Then, the patient recovered well, and the numbness of his left finger disappeared during the later follow-up after the surgery.Conclusion: Nerve sheath myxoma should receive diagnostic consideration for an extramedullary subdural lesion that is a clear boundary mass characterized by isointensity on T1-weighted images, heterogeneous intensity on T2-weighted images, obvious peripheral enhancement, and a growing tendency toward the intervertebral foramen.

Ovarian vein thrombosis: a rare but not to be forgotten cause of abdominal pain

A healthy 38-year-old woman, with no significant medical or surgical history, was referred to the gynaecology emergency department with acute low quadrant abdominal pain and nausea. On examination, painful palpation of right iliac fossa, abdominal guarding and positive Blumberg’s sign were noted. An abdominal-pelvic CT scan showed a hypodense tubular structure with peripheral enhancement to the right of the inferior vena cava, suggestive of thrombosis of the right ovarian vein. The only risk factor identified was the use of the combined contraceptive pill.

Evaluation of peripheral enhancement on contrast-enhanced CT and corresponding pathological findings in colorectal liver metastases after preoperative chemotherapy

Objective: To correlate peripheral enhancement on contrast-enhanced computed tomography (CE-CT) of post-chemotherapy colorectal liver metastases (CRLM) patients with the pathological findings. Methods: Forty-four patients with CRLM who underwent hepatic resection after preoperative chemotherapy between 2008 and 2013 were included. Two radiologists blinded to the histopathology findings performed a consensus categorization of the marginal contrast effects of CRLM on CE-CT as follows: Group 1, smooth margin without enhancement; Group 2, smooth margin with an enhanced rim; and Group 3, fuzzy margin with/without an enhanced rim. The Kruskal-Wallis test was used to compare the imaging findings with the histological findings. Results: The percentage of infarct-like necrosis was significantly higher in CRLM with smooth margins than in those with fuzzy margins (p<0.001, r=0.62). The percentage of viable cells was lowest in CRLM with smooth margins without enhancement (p<0.001, r=0.60). Conclusions: Our findings suggest that the type of necrosis is related to the nature of the margins, and the presence of residual cells are related to peripheral enhancement.

Value of spiral CT multi-parameter combined preoperative evaluation of microvascular invasion in small liver cancer

Objective: To explore the value of multi-slice spiral CT (MSCT) in predicting microvascular invasion in hepatocellular carcinoma (HCC). Methods: The CT and clinical data of 102 patients with HCC were collected for retrospective analysis from January 2018 to December 2020 at Baoji Center Hospital, China. They were divided into two groups based on the pathological results with or without microvascular invasion. The independent sample t-test was used to compare the age, alpha-fetoprotein (AFP) value, tumor size, and tumor enhancement of the two groups. CT value; χ2 test was used to compare gender, hepatitis type, liver function classification, degree of classification, degree of tumor smoothness, envelope, peripheral enhancement, etc. between the two groups. Results: There were 52 cases of non-microvascular invasion and 50 cases of microvascular invasion. The tumor size, grade, degree of margin, capsule, portal vein CT value, and peripheral enhancement were related to microvascular invasion. Conclusion: Microvascular invasion of HCC can be predicted by MSCT manifestations before surgery. doi: https://doi.org/10.12669/pjms.37.6-WIT.4851 How to cite this:Li K, Peng Y, Tian H, He H. Value of spiral CT multi-parameter combined preoperative evaluation of microvascular invasion in small liver cancer. Pak J Med Sci. 2021;37(6):1605-1609. doi: https://doi.org/10.12669/pjms.37.6-WIT.4851 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Imaging findings of human hepatic fascioliasis: a case report and review of the literature

Background Fascioliasis is a food-borne hepatobiliary zoonosis caused by Fasciola hepatica and Fasciola gigantica. Human infestations are predominantly seen in developing countries where the disease is endemic, but, due to the increase in international travel rates, hepatic fascioliasis is also appearing in nonendemic areas including Europe and the USA. The clinical and laboratory findings are usually nonspecific. Cross-sectional imaging can be very helpful in the diagnosis of fascioliasis as well as to differentiate it from other liver diseases with a very similar clinical picture. The objectives of this case report are to discuss imaging findings of hepatic fascioliasis and to review the literature. Case presentation We report the case of a 35-year-old Iranian patient who presented with right upper quadrant pain, low-grade fever, fatigue, and anorexia. The patient had a history of recent travel to the Gilan Province of Iran, almost a month before the onset of symptoms, which is an endemic area of fascioliasis in the country. Laboratory examinations revealed eosinophilia, elevated hepatic enzymes, and slightly raised C-reactive protein. Contrast-enhanced computed tomography of the patient shows clusters of focal ill-defined hypodense lesions with mild peripheral enhancement in the right liver lobe and subcapsular regions. Magnetic resonance imaging of the liver revealed multiple ill-defined lesions of low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image, extending from the liver capsule into deeper parenchyma toward periportal regions, which shows mild peripheral enhancement on post-contrast images. Imaging-based diagnosis of fascioliasis was made depending on the characteristic distribution of subcapsular tracts/lesions on the above-mentioned imaging, which was then confirmed by serologic tests using enzyme-linked immunosorbent assay. The patient was treated with triclabendazole, showing great clinical improvement, and was eventually discharged in good health condition. Conclusion The imaging findings in this case report highlight the importance of cross-sectional imaging for further evaluation of suspected cases of fluke-induced liver disease. The hypothesis of hepatic fascioliasis should be always considered when consistent radiological findings are observed. Clusters of tortuous subcapsular lesions with peripheral contrast enhancement extending into deeper liver parenchyma are characteristic imaging findings that strongly suggest hepatic fascioliasis.

Orbital neuromuscular choristoma of the ophthalmic nerve

Introduction: Neuromuscular choristoma (NC) is a rare tumor composed of striated muscle fibers admixed with nerve fibers that often affects large peripheral nerve trunks in children. To the best of our knowledge, this is the first reported case in the literature of a NC of the ophthalmic nerve in an adult. Case description: A 27-year-old woman presented with a 20-day history of left periorbital headache radiating to the frontotemporal region, with associated tearing, nausea, and vomiting. The examination was normal, except for hypoesthesia in the distribution of the first trigeminal nerve branch (V1). Cranial computerized tomography showed a lesion in the left orbit and cavernous sinus with widening of the superior orbital fissure. On magnetic resonance imaging, the lesion was well-defined with fusiform morphology and showed a central cystic component and peripheral enhancement. An extradural approach was performed with subtotal tumor resection. Biopsy showed proliferation of striated muscle cells admixed with nerve fascicles and Schwann cells. A pathological diagnosis of NC of V1 was determined. Six months after surgery, left hypotropia with limitation of supraduction was observed, as well as hypoesthesia and paralysis of the left forehead with ipsilateral eyebrow ptosis. The rest of the examination remained within normal limits. Conclusion: NC should be considered in the differential diagnosis of a young patient with periorbital headache and hypoesthesia in the V1 region.

A tumor-mimicking parasitic disease: Radiological Findings of Alveolar Echinococcosis

Background: Alveolar echinococcosis(AE) is a tumor-mimicking parasitic disease caused by Echinococcus multilocularis. We have aimed to present the radiological imaging findings of AE characterized by malignant features. Methods: The radiological findings of 20 patients were evaluated retrospectively; who were admitted to our hospital in the Van province in the years between 2014 and 2020 and who were diagnosed with AE. Of these patients, 30% had been operated due to a preliminary diagnosis of a tumor. The study was conducted retrospectively by examining the drawback radiological images of patients from the radiological data archiving system. The diagnosis of AE was confirmed when lesions manifested the following radiological imaging findings: irregular margins, no contrast uptake in dynamic contrast images or late peripheral enhancement, presence of calcifications, and contralateral lobe hypertrophy. Results: The mean age of the patients at the time of diagnosis was 50.95 (12-86) years. Of the patients, 15 (75%) were women and 5 (25%) were men. Typical histopathological and radiological imaging findings were present in 8 (40%) and 17 (85%) patients, respectively. Only 12 (60%) out of 20 patients had seropositivity by ELISA. The remaining 8 (40%) patients were seronegative. Conclusion: Radiological imaging examinations are essential in the diagnosis and the evaluation of the extent of the disease. Different radiological technic can be used to differentiate AE from other diseases. Early diagnosis is important for avoiding unnecessary or inadequate operations due to a misdiagnosis and for preventing potential complications.

WHO Grade III Anaplastic Astrocytoma In A 72 Years Old Male-A Case Report

Glioma is a common type of tumor that originates in the glial cell in brain and is devastating in nature. It can affect all age groups but is more common in adults and has been found more in males than in females with a ratio of 1.3/1. Despite the aggressive treatment it relapsed and can cause mortality because of its infiltrative nature. This WHO type III Anaplastic Astrocytoma is more common in 40-50 years old with a median of 41 years. Here, we report a new case of Glioma occurring in a 72 year old male, who presented with a right sided headache, forgetful, worsening memory, behavioral problem along with increased agitation and irritability. MRI Brain WO/W revealed a mass in the left thalamus and basal ganglia region with a thick rim of peripheral enhancement. Diagnosis of Anaplastic Astrocytoma (WHO Grade III) was confirmed by histology and immunohistochemical analysis of the tumor.Conclusion:It is a case of Left sided WHO GRADE III Anaplastic astrocytoma which is rare in this age group of 72 years. The patient was managed with gamma knife radiosurgery, chemotherapy with Temozolomide (TMZ), and targeted molecular therapy with Bevacizumab. The patient improved with remission of symptoms.

Computed Tomographic Diagnosis of Intracranial Granulomatous Lesions and Clinical Correlation

Background: The evaluation of intracranial granulomatous lesions with emphasis particularly on tuberculoma and neurocysticercosis. Intracranial granulomatous lesions especially tuberculosis and neurocysticercosis are potentially lethal diseases and therefore prompt diagnosis and treatment are imperative. Cysticercosis of the brain is a disease entity that is a easily demonstrable by CT and is confined to the endemic areas in majority of cases. Aim: To identify and the role of computed tomography (CT) in diagnosing intracranial granulomatous lesions and to correlate the findings with clinical health care. Materials and Methods: This study was done at Ganesh Shankar Vidyarthi Medical (GSVM) College, Kanpur, Uttar Pradesh, India during the period 2002 to 2003. The patients admitted with seizures were included after considering the exclusion of metabolic causes and infective causes. 50 cases of documented antecedent history suggestive of raised intracranial tension and seizure (focal or generalized) were evaluated and referred for CT scanning from out patients department and in patients department in Lala Lajpat Rai (LLR) and associated hospitals and GSVM College, Kanpur, India. Results: We prospectively noted in our study that more than half of the patients with chronic granulomatous lesions presented with raised intracranial tensions. Seizure was one of the most commonest presenting complaint in patients with neurocysticercosis diagnosis. Presumptive diagnosis of tuberculoma and neurocysticercosisis was based on clinical and other ancillary criteria. Associated family history and extracerebral tuberculosis are the important criteria for presumptive diagnosis of tuberculoma. Solitary lesions were more frequent CT finding in both tuberculoma and neurocysticercosis. Majority of tuberculomas and neurocysticercosis observed were supratentorial in location, regardless of their clinical presentation. Lesions were isodense or hyperdense on plain CT scan and showed peripheral enhancement with intravenous contrast injection. The lobulated masses represent coalesced small disc and rings forming a large tuberculoma. Conclusion: In our study we have tried to evaluate intracranial granulomatous lesions with emphasis particularly on tuberculoma and neurocysticercosis.