Malignant teratoid medulloepithelioma: a case report

We report the histopathological findings of the anterior cornea from a patient with skin biopsy-proven epidermolysis bullosa simplex. As seen with light microscopy, the cornea had a fibrocellular pannus deep to a thickened epithelial basement membrane. Transmission electron microscopy of the anterior cornea demonstrated a nonhomogeneous basal epithelial layer with abnormal attachment complexes to an irregular, multilaminar basement membrane. The findings of transmission electron microscopy of the bulbar conjunctiva were normal.     

Localized amyloid tumour of the duodenum : a case report

Amyloid tumours in the gastrointestinal tract are rare. A case is presented of a localized amyloid tumour in the duodenum, which was removed by loop resection during ERCP.     

Phyllodes tumour in pregnancy: a case report

An 18 1/2-year-old castrated male donkey with progressively worsening right forelimb lameness presented with a mass on the distal dorsal aspect of its P3 bone. Grossly, the firm, gritty mass was infiltrative, disrupted the contours of the overlying hoof wall, and had mottled and cavitated areas on cut surface. Histologically, the growth was composed of densely cellular sheets of mildly pleomorphic mesenchymal cells forming irregularly shaped islands of poorly mineralized osteoid. The neoplastic mass had patchy areas of necrosis. The diagnostic possibilities considered for this donkey's mass include osteosarcoma, osteoma, ossifying fibroma, and fibrous dysplasia. Careful consideration of the gross and histological characteristics of this donkey's mass support a diagnosis of osteosarcoma.     

Giant-cell tumour of the lumbar spine. Case report

Giant-cell tumours of the spine are very rare. They occur mainly in long bones. We report a patient with a giant-cell tumour of the lumbar spine which had been operated on at another hospital 5 months previously as a protruded lumbar intervertebral disc.     

Malignant gastric teratoma: case report

Gastric teratomas are rare and usually benign. A 4 month old boy presented with an abdominal mass and computed tomographic and ultrasound examination demonstrated a large multi-loculated tumour which was totally excised. The pathological diagnosis was of a malignant gastric teratoma and 12-month follow-up was uneventful.     

Ivory osteoma of the cervical spine: case report

OBJECTIVE AND IMPORTANCE: We report a unique case of ivory osteoma of the cervical spine. CLINICAL PRESENTATION: The clinical presentation was one of polyradicular deficit without myelopathy after trauma. The imaging characteristics and histology of the lesion were those of a classic ivory osteoma. INTERVENTION: A complete surgical excision of the lesion was accomplished. CONCLUSION: We think we have recorded the only well-documented case of ivory osteoma affecting the spine.     

Malignant glomus tumor: a case report and review of the literature

This report concerns a malignant glomus tumor, a rare soft tissue tumor that was examined immunohistochemically and ultrastructurally. It occurred in a 44-year-old male patient who had suffered from dull pain and stiffness in the right thigh for 10 months. Radiographic examination revealed a well-defined osteolytic lesion in the diaphysis of the right femur. Hypervascularity of the tumor was observed angiographically. Computed tomographic and magnetic resonance examinations showed an intramuscular mass invading the marrow space of the femur. Wide resection was performed after open biopsy. Histologically, round to polygonal tumor cells revealed a uniform appearance of round to ovoid nuclei with single large nucleoli and slightly eosinophilic cytoplasm, forming solid sheets of cells interrupted by vessels of varying size. A few mitotic figures and vascular invasion were observed. Immunohistochemically, vimentin and alpha-smooth muscle actin were stained intensely, and muscle actin was positive for tumor cells of the perivascular area. Tumor cells were negative for desmin, factor VIII-related antigen, S-100 protein, neurofilament, cytokeratin, and epithelial membrane antigen. Ultrastructurally, tumor cells were characterized by many cytoplasmic processes, pinocytotic vesicles, plasmalemmal dense plaques, and scattered microfilaments in the cytoplasm. Few cell junctions and focal basement membrane-like structures were observed. No recurrence or metastasis was noted 57 months after operation. This case was considered to be a malignant glomus tumor, that is, a glomangiosarcoma arising de novo.     

Malignant phyllodes tumor of the breast with hypoglycemia: report of a case

A surgically resected case of giant malignant phyllodes tumor of the breast associated with a hypoglycemic attack is reported. A 54-year-old woman was referred to our hospital with loss of consciousness and a huge chest wall tumor. She was diagnosed as having a malignant phyllodes tumor by core needle biopsy and underwent palliative simple mastectomy because lung metastasis was detected on computed tomography and by other imaging modalities on admission. The preoperative laboratory data revealed a very low fasting blood sugar level of 37 mg/dl. After removal of the tumor, the blood sugar level gradually normalized (90-100 mg/dl) and the plasma insulin-like growth factor-II (IGF-II) level promptly decreased. The IGF-II level of tumor extracts was high (2500 ng/g wet weight) and the majority of atypical cells stained positively for IGF-II immunohistochemically. These findings suggested that the patient's hypoglycemia was associated with IGF-II produced by a giant malignant phyllodes tumor that consumed glucose.     

Extradural ecchordosis physaliphora of the thoracic spine: case report

OBJECTIVE AND IMPORTANCE: We report an unusual case of ecchordosis physaliphora of the thoracic spine. CLINICAL PRESENTATION: The clinical presentation was one of disabling thoracic radicular pain without objective neurological deficit. The imaging characteristics of the lesion were those of a cyst containing aqueous fluid. There was no bone destruction. INTERVENTION: Gross total removal of the lesion was accomplished. CONCLUSION: We present the only well-documented case of thoracic extradural ecchordosis physaliphora and discuss the relationship between the notochord, ecchordosis physaliphora, and chordoma. We provide a comprehensive list of lesions exhibiting physaliphorous cells.     

Malignant prolactinoma: case report and review of the literature

BACKGROUND: Malignant prolactinomas are rare events. To date, only 14 patients with metastases in- or outside the central nervous system have been reported. CASE DESCRIPTION: We present a patient who developed a metastasis to the cauda equina, which is the first case documented with MRI. A giant prolactinoma in this 51-year-old man was partially removed by a transcranial approach. After radiotherapy and treatment with bromocriptine, the patient had a remission for 3 years. Thereafter, a sacral intraspinal tumor was diagnosed. Because of increasing prolactin levels not responding to bromocriptine and a radiologically suspected intrasellar tumor, we operated transsphenoidally first and found only fibrous tissue. We performed a sacral laminectomy and almost totally removed an intradural tumor. Histopathology and immunohistochemistry confirmed the diagnosis of a prolactinoma metastasis. The patient received radiotherapy and bromocriptine and has no evidence of recurrent tumor or metastases after a follow-up of 38 months, thus being the second reported patient with long-term remission of the disease. DISCUSSION: We review the literature on this topic and try to establish common features of the course of this rare malignant disease and the efficacy of therapy in the cases reported hitherto.     

Infection of a Charcot spine. A case report

Charcot spine is an unusual neuropathic arthropathy that may be found in patients with complete neurologic lesions of the spinal cord. The case presented represents a progressive destructive lesion of a Charcot spine, which, on extensive investigation and subsequent surgical arthrodesis, demonstrated an infectious process. Infection must be considered as a possible etiology in a destructive lesion of a Charcot spine.     

Ganglioneuroma of the thoracic spine presenting as adolescent idiopathic scoliosis: a case report

Total coumarins of Fructus Cnidii (TCFC), 5 g.kg-1 by intragastric gavage, 6 d/wk, x 7 wk, was effective for prevention of bone loss in ovariectomized (OVX) rats. In comparison to aging control rats, the proximal tibia of placebo-treated OVX rats were characterized by an increase in eroded perimeter (+298%), label perimeter (+77%), osteoid perimeter (+47%), mineral apposition rate (+32%) and bone formation rate (+130%). These changes indicated a high bone turnover in OVX rats leading to a rapid bone loss (-44%) in proximal tibial metaphysis. In contrast, the TCFC-treated OVX rats showed an increase of cancellous bone area (+41%) compared with placebo-treated OVX rats and decrease in all the above indices of bone turnover to near aging control levels except that of the osteoid area (+88%) which was higher than that in aging control, but mineralization lag time did not show significant changes. The results suggested that the TCFC inhibited the high bone turnover and reversed the bone loss at early menopausal stage.     

Malignant granular cell tumor: report of a case and review of the literature

The histological, immunohistochemical and electron microscopic features of a rare malignant granular cell tumor (GCT) arising in the left radial nerve of a 54-year-old man are reported. Despite a lack of local recurrence following extirpation, the tumor metastasized to the skull five years later. Light-microscopically, both primary and metastatic tumors consisted of markedly atypical or pleomorphic neoplastic cells with abundant cytoplasm containing diastase-resistant periodic acid Schiff reaction-positive granules. These tumor cells were arranged in a sheet-like pattern with mitotic figures including atypical ones, and were frequently immunopositive for proliferating cell nuclear antigen and c-MET, the c-met proto-oncogene product. These findings reflect high-grade malignancy of the present tumor. In addition, the tumor cells were positive for S-100 protein and neuron-specific enolase. Ultrastructurally, a large number of intracytoplasmic granules featuring secondary lysosomes as well as long interdigitating cytoplasmic processes, intercellular intermediate junctions, discontinuous basal lamina-like structures, and stromal long-spacing collagen were observed. These findings indicated schwannian differentiation of the present tumor. In addition, based on a review of previously reported cases, the overall clinicopathological characteristics of malignant GCT were summarized.     

Gouty arthropathy of the lumbar spine: a case report and review of the literature

STUDY DESIGN: A patient with hyperuricemia developed symptoms from lateral recess stenosis attributed to gouty arthropathy of a lumbar facet joint. OBJECTIVE: To present the diagnosis and management of gouty arthropathy of the lumbar spine in one individual. SUMMARY OF BACKGROUND DATA: The symptoms and treatment of a patient with intra-articular gout of a lumbar facet are presented and contrasted with other cases of spinal extra-articular gout found in the literature. METHODS: A patient with hyperuricemia reported back pain and symptoms consistent with lateral recess stenosis. Conservative treatment failed, and, after further evaluation, a successful decompressive laminectomy was performed. Pathology revealed intra-articular urate crystal deposition. RESULTS: This patient's unilateral S1 radiculopathy corresponded with magnetic resonance and computed tomography studies documenting unilateral lateral L5-S1 lateral recess stenosis secondary to intra-articular gouty arthropathy. As anticipated, the serum uric acid also was elevated. Since surgical decompression with unilateral laminotomy was performed, the patient has been symptom-free for 2 years. CONCLUSION: Although rare, gouty arthropathy of the lumbar facet joint should be considered in all patients with neurologic symptoms and known or suspected gout. Optimization of pharmacologic treatment is indicated for patients suspected of having gouty neuropathy. Surgical decompression is indicated if conservative management with Indocin, nonsteroidal anti-inflammatory agents, and allopurinol fails to reverse neurologic dysfunction.     

Acquired dural arteriovenous malformations of the lumbar spine: case report

OBJECTIVE AND IMPORTANCE: Although dural arteriovenous malformations (AVMs) are considered to be acquired, no conclusive evidence has been obtained. The first case of dural AVMs of the lumbar spine that showed evidence supporting their being acquired lesions is described. CLINICAL PRESENTATION: A 27-year-old man was admitted to our hospital in November 1994, presenting with increasing pain and numbness in the left buttock to the left lower limb. Myelography and arteriography showed dural AVMs of the lumbar spine. However, the myelogram obtained before surgery for lumbar disc herniation in 1987 provided no findings suggestive of intradural vascular anomalies. INTERVENTION: Embolization procedures via the left iliolumbar arteries were performed. However, there was no improvement of the symptoms, and the patient underwent surgical treatment. CONCLUSION: The present report documents a case of dural AVMs of the lumbar spine that showed evidence supporting their being acquired lesions.     

Repeated hepatectomies for recurrent follicular dendritic cell tumour of liver: a case report

Follicular dendritic cell tumour is a very rare tumour of unknown aetiology. We report a case of follicular dendritic cell tumour of liver which was treated with extended right hemihepatectomy but recurred twice in the remaining left lobe within 3 years. The recurrent tumours were removed by further liver resection. The mainstay of treatment for this rare tumour is surgical resection.     

Neurinoma of the facial nerve mimicking a parotid tumour. A case report

A case of a facial neurinoma localized in the right parotid gland is presented. Neurinomas derived from the facial nerve are very rare especially when extracranially located. Despite imaging and other investigations, extirpation of the tumour and histopathological examination are the only way to establish the diagnosis. Neurinomas are encapsulated and can be dissected without interruption of nerve branches.     

Malignant mesenchymoma in the scrotum. A case report

A 67-year-old man visited our hospital with the chief complaint of painless swelling of the left scrotal content. An elastic hard mass was palpable in the left scrotum. Resection of the tumor, including the left scrotal skin, was performed. The tumor originated from the scrotal wall and did not communicate with the testis, the epididymis or spermatic cord. Histologically, the tumor was diagnosed as a malignant mesenchymoma composed of liposarcoma, chondrosacoma and osteosarcoma. Malignant mesenchymoma is very rare, especially in the scrotum. Our case that originated from the scrotal wall is the first one reported in Japan.     

Malignant change in a solitary hamartoma of the lung. A case report

Three cases of biliary tract perforation are presented. They had in common an anomalous arrangement of the pancreatico-biliary system, a cylindrical dilatation of the biliary tree, and an inflammatory thickening of the wall of the bile duct. The etiological importance of the anomalies is discussed. Bypass procedures are necessary at the final operation.     

Sclerosing stromal tumour of the ovary. A case report

The results of a national survey of Advanced Practice Psychiatric Nurses (APPN) are presented. Results are based on the Society for Education and Research in Psychiatric/Mental Health Nursing's (SERPN) Primary Mental Health and Advanced Practice Psychiatric Nursing monograph. Characteristics of the nurses, the clients they serve, and their practice patterns are described. Documenting the cost-effectiveness of these practitioners and increasing the number of younger APPNs is recommended.