Histopathological Investigation of Dura-Like Membrane in Vestibular Schwannomas

The dura-like membrane (DLM) is an outermost membranous structure arising from the dura mater adjacent to the internal auditory meatus (IAM) that envelops some vestibular schwannomas (VSs). Its recognition is important for the preservation of the facial and cochlear nerves during tumor resection. This study analyzes the histopathological characteristics of the DLM. The expression of CD34 and αSMA was histopathologically analyzed in tumor and DLM tissue of 10 primary VSs with and without a DLM. Tumor volume, resection volume percentage, microvessel density (MVD), and vessel diameter were analyzed. Volumetric analysis revealed that the presence of a DLM was significantly associated with lower tumor resection volume (p < 0.05). Intratumoral vessel diameter was significantly larger in the DLM group than the non-DLM group (p < 0.01). Larger VSs showed a higher intratumoral MVD in the DLM group (p < 0.05). Multilayered αSMA-positive vessels were identified in the DLM, tumor, and border; there tended to be more of these vessels within the tumor in the DLM group compared to the non-DLM group (p = 0.08). These arteriogenic characteristics suggest that the DLM is formed as the tumor induces feeding vessels from the dura mater around the IAM.

Robotic excision of interaortocaval paraganglioma: a case report with the literature review

Background Paragangliomas are rare neuroendocrine tumors of extra adrenal origin. The symptomatic paragangliomas require multimodal treatment approach. Case Presentation We report a case of 34-year-old female who presented with complains of headache and blurring of vision. Examination revealed Hypertensive crisis with grade 3 retinopathy. The patient was diagnosed as a case of extra-adrenal paraganglioma during evaluation for secondary hypertension. Magnetic Resonance Imaging of the abdomen revealed 23*28*28 mm mass lesion in the inter-aortocaval region at the level of L3–L4. The patient was started on medical management for hypertension and was managed safely with robot-assisted surgery, owing to enhanced visualization of feeding vessels and avoidance of excessive manipulation of tumor. Conclusions Our case report emphasizes on the robot assisted surgical technique for the removal of tumor in a vulnerable anatomical position and presents a review of the literature.

Parasitic Leiomyoma: A Case Report

ABSTRACT: Parasitic or wandering leiomyoma are rare extra-uterine benign pedunculated sub-serous leiomyoma which after being detached from its primary location thrives in secondary location from blood supply from nearby feeding vessels. This case represents a multiparous woman, with one such parasitic leiomyoma encountered at laparotomy, proven by histopathological examination.

Prenatal Percutaneous Fetoscopic Laser Photocoagulation of Chorioangioma: Report of Two Cases and Review of the Literature

<b><i>Introduction:</i></b> In Doppler flow diagnosis of a large placental chorioangioma with vascularization, there may be fetal consequences as cardiac output failure and polyhydramnios. Prenatal percutaneous fetoscopic laser photocoagulation of chorioangioma is a therapeutic option. First, we present 2 cases of chorioangioma treated by fetoscopic laser photocoagulation. Second, we conducted a narrative review to identify all reported cases of chorioangioma treated by fetoscopic laser photocoagulation. <b><i>Case Presentation:</i></b> Case 1 presented a chorioangioma measuring 48 × 36 × 42 mm, and the Doppler flow study showed vascularization with a high flow rate. The fetus showed dilatation of the right cardiac chambers, moderate tricuspid insufficiency, normal Doppler indices, and polyhydramnios. Case 2 presented a chorioangioma measuring 58 × 36 × 31 mm associated with polyhydramnios and elevated peak systolic velocity of the middle cerebral artery at 49 cm/s, that is, 1.65 MoM. The procedure was performed at 22⁺² and 23⁺⁵ WG for both cases. Photocoagulation of the chorioangioma vessels was performed first on the small superficial vessels (capillaries) and then on the feeding vessels (artery first and then vein), until complete cessation of blood flow on ultrasound. Successful devascularization was achieved when flow within the chorioangioma’s feeding vessels was no longer visualized on intraoperative ultrasound examination using Doppler flow. The ultrasound follow-up showed complete cessation of blood flow in the chorioangioma, normalization of fetal signs, and normal fetal growth in both cases. In case 1, a 2,350-g boy was delivered vaginally after spontaneous labor at 33⁺⁶ WG. In case 2, a 2,700-g boy was delivered vaginally after spontaneous labor at 39⁺² WG. Neonatal findings were normal, and the outcome at 1 year was normal for both children. <b><i>Conclusion:</i></b> Prenatal percutaneous fetoscopic laser photocoagulation improves survival in large chorioangioma, despite a risk of fetal death in utero.

The RAP study, report 4: morphological and topographical characteristics of multifocal macular neovascularization type 3

Purpose To report on the morphological characteristics and regional distribution of multifocal macular neovascularization type 3 (mMNV3). Methods Twenty-two consecutive eyes of 21 patients with mMNV3 were included using multimodal imaging. The count and stage of lesions of all MNV types and the existence of exudate and hemorrhage were determined. Also, we addressed the regional distribution of MNV3 lesions between the superior-inferior and the nasal-temporal halves of the macula, and the range of the distance of the lesions from the central fovea. Furthermore, we explored the number of feeding vessels including the cilioretinal artery. Results We found 51 lesions in 22 eyes of 21 patients. They were bifocal in 16 (73%) eyes, trifocal in 5 (23%), and quadrifocal in one (4%). No lesion of MNV1 or 2 was found. Fifteen (68%), 2 (9%), and 16 (73%) eyes were associated with retinal hard exudate, subretinal pigment epithelium exudate, and intraretinal hemorrhage, respectively. Thirty (59%) lesions were located in the temporal half of the macula, whereas 21 (41%) were located nasally (p = 0.07). One (2%) lesion was closer than 500 µm, 49 (96%) between 500 and 1500 µm, and one (2%) between 1500 and 3000 µm. The lesions were supplied by one arteriole in one (4%) eye, two arterioles in 16 (73%) eyes, and 3 arterioles in 5 (23%) eyes. The CRA contributed as a feeding vessel in 5 (23%) eyes. Conclusion The multifocal variant of MNV3 has specific morphological and topographical characteristics. Multimodal imaging allows the understanding of the pathomorphological condition in more detail.

Possibilities of the indocyanine green dye application for evaluation of peculiarities of lymph outflow and metastasizing of colorectal cancer

Objective. Studying of velocity of prevalence of luminescent dye indocyanine green along lymphatic vessels in the large bowel surgery. Materials and methods. Estimation of procedure for coloring of tumoral substrate and lymphatic vessels while performance of oncological operations was conducted. We performed laparoscopic resection of sigmoid colon in 7 patients, suffering tumors, and anterior rectal resection in 5 patients, having tumors of upper ampullary part of rectum, using indocyanine green dye. Results. In Group I, consisting of 7 patients, surgical technique of no touch manipulations on the tumor before transection of feeding vessels (NTIT–operations) was applied, and in Group II, consisting of 5 patients, the tumor mobilization was done primarily. Application of indocyanine green dye helped a lot to establish localization and prevalence of the process in rectum. Conclusion. Application of fluorescent dye indocyanine green on tumoral substrate before doing ligation of feeding vessels raises possibility of the complication occurrence, consisting of the cancer cells dissemination in abdominal cavity. While performing laparoscopic procedures in resection of the large bowel tumors it is expedient to ligate the feeding vessels primarily, with secondary manipulation– to dissect and mobilize the tumoral substrate.

Intra-Arterial Chemotherapy: New Hope for Adult Retinoblastoma Treatment—A Case Report and Brief Review

Background. Adult retinoblastoma (RB) is a rare intraocular tumor, leading to delayed diagnosis and, eventually, enucleation of the involved eyes. Therefore, this diagnosis should be considered if attributable signs and symptoms occurred. Here, the authors report a case of an adult group D RB, treated successfully with intra-arterial chemotherapy (IAC) as primary treatment followed by cryotherapy. The authors briefly review the literature on the prognosis and management of adult RB. Case Presentation. A 22-year-old man has noticed floaters in his right eye for 2 months. Right eye examination revealed diffuse white spherical calcified vitreous seeds in all quadrants and a large white endophytic mass in the superonasal quadrant with engorged feeding vessels. Based on clinical data, the group D RB tumor was classified and the IAC was started with 2 medications, melphalan (5 mg) and topotecan (1 mg), for 3 cycles. Trans-scleral triple freeze-thaw cryotherapy was used as an adjunctive treatment at the latest hospital visit. Thirteen months after the last treatment, the RB tumor showed type 4 regression (flat chorioretinal scar) and no evidence of recurrence was identified. Conclusion. It seems that IAC, as the first line of treatment, either alone or in conjunction with adjuvant therapies may allow us to salvage the globe of adult patients involved with RB.

Spontaneous bleeding from orbital haemangioma in drug-induced thrombocytopaenia

An 81-year-old woman, a drug-induced thrombocytopaenia (DITP) patient, presented with a case of spontaneous bleeding from an orbital haemangioma manifesting as a sudden onset of ocular pain, proptosis and limited eye movement. Image studies revealed an extraconal, cystic lesion with haemorrhage. The ophthalmopathy was caused by the bleeding of the orbital haemangioma and it was resolved after embolisation of the feeding vessels. Spontaneous bleeding of orbital haemangioma is rare. This case emphasises that DITP may be the cause of spontaneous bleeding of orbital haemangioma by precipitating the inflammatory reactions within the tumour, which further cause the haemodynamic disturbances and ultimate spontaneous bleeding.

Pap, gruel, and panada

This chapter collects information on artificial infant feeding published before 1860, the date when commercial formula became available. There is extensive artefactual evidence from thousands of feeding vessels since the Bronze Age. Literature on the use of animal milk for infant feeding begins with Soranus in the 2nd century c.e. Literature evidence from the very first printed books in the 15th century proves that physicians, surgeons, midwives, and the laity were aware of the opportunities and risks of artificial infant feeding. Most 17th- to 19th-century books on infant care contained detailed recipes for one or several of the following infant foods: pap, a semi-solid food made of flour or breadcrumbs cooked in water with or without milk; gruel, a thin porridge resulting from boiling cereal in water or milk; and panada, a preparation of various cereals or bread cooked in broth. During the 18th century, the published opinion on artificial feeding evolved from health concern to moral ideology. This view ignored the social and economic pressures which forced many mothers to forego or shorten breastfeeding. Bottle feeding was common practice throughout history.

Diagnosis and endovascular management of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVM) are abnormal communication of a branch of the pulmonary artery and pulmonary vein circumventing the intervening pulmonary capillaries. This results in a right-to-left (R-L) shunt and its related manifestations, which include hampered gas exchange leading to hypoxaemia, dyspnoea, paradoxical emboli leading to stroke, cerebral abscess, myocardial infarction and pulmonary haemorrhage due to rupture of the PAVM. Endovascular transcatheter embolization of the feeding vessels with coils or occlusion devices is the current standard care of treatment and preferred treatment modality. The articles aim to provide insights into the current trends in diagnosis, the current recommendations, approach and management options for patients with PAVM.