Arachnoid cysts on computed tomography

The appearances of arachnoid cysts on computed tomography are presented. They are well defined lesions with the same density as cerebrospimal fluid and are not contrast enhanced. Superficial lesions are biconvex or semicircular and may have a characteristic straight inner margin. Deep lesions and cysts between the cerebellar hemispheres are spherical and some may be difficult to differentiate from cystic neoplasms. The etiology and clinical manifestations of arachnoid cysts are also briefly discussed.     

Arachnoid cysts associated with post-traumatic and spontaneous rupture into the subdural space

61 children were studied and treated between January 1986 and September 1993 for idiopathic varicocele. The aim of our study was to evaluate the advantages and disadvantages of the different techniques and to show the progression to a greater efficacy. The mean age at the time of therapy was 14 years, ranging from 7 to 16 years. All children presenting with pain or testicular asymmetry were treated. Four asymptomatic children were followed for 2 years before treatment. 36 children were treated by surgical ligature via the inguinal approach; 8 with a resection of the varicose veins as far as the tunica vaginalis. 14 children were treated by percutaneous sclerotherapy including 1 patient following unsuccessful classical surgical treatment. 12 children were treated by surgical inguinal ligature associated with peroperative phlebography and thrombosis. 56 children were reviewed postoperatively over a period which varied from 2 months to 4 years (5 lost to follow-up). For the 36 classical ligatures: 25 good results, but 9 hydroceles (5 out 8 varicose resections): 70% good results. 7 failures and 4 lost to follow-up. For the 14 percutaneous sclerotherapy: 4 technical failures (impossibility to catheterize the spermatic vein): 10 good results. For the 12 ligatures with peroperative phlebography and thrombosis: 11 good results and 1 lost to follow-up. All the above procedures were carried out at our out-patient clinic. The therapeutic choice will therefore have to take into consideration a procedure which produces the lowest morbidity rate and proves to be the most effective. The association of surgical ligature, phlebography and thrombosis meets these requirements.     

Choledochal cysts: a nine-year review

It has been suggested that asbestos might have an important role in the development of p53 mutations in mesotheliomas. The objective of this study was to examine asbestos-associated mesotheliomas and non-asbestos-associated mesotheliomas to establish whether the frequency of p53 immunostaining and, by implication, p53 gene mutation is related to asbestos exposure. Immunopositivity for p53 was found in seven (44%) of the 16 mesotheliomas examined. The frequency was approximately the same in both the asbestos-associated mesotheliomas and the non-asbestos-associated mesotheliomas. It is concluded that the frequency of p53 immunostaining in mesotheliomas and, by implication, the frequency of p53 gene mutation is probably not related to asbestos exposure.     

Euthyroid sick syndrome: recent physiopathologic findings]

OBJECTIVE: To discuss the clinical radiographic findings in a 70-yr-old woman suffering from chondrosarcoma. CLINICAL FEATURES: The patient experienced right SI pain present initially only at night. She later developed morning numbness. An X-ray examination revealed a flocculent calcification in the right buttock region. Computed tomographic scans confirmed the diagnosis. INTERVENTION AND OUTCOME: Initial palliative care continued until surgery was performed to resect the area. CONCLUSION: Chondrosarcoma is a severe disease that must be differentiated from myositis ossificans.     

Aneurysmal bone cysts of the maxilla: a clinicopathologic review

PURPOSE: This study evaluated the significant differences in clinicopathologic features of aneurysmal bone cyst in the maxilla and mandible. MATERIALS AND METHODS: A search of the literature showed 30 recorded maxillary cases, and these together with one previously unrecorded case formed the basis of the study. RESULTS: There were no differences in the age and sex incidence. Only two patients complained of pain, and no patient complained of tenderness. No patient gave a history of trauma. Swelling was present in virtually every patient. In seven cases, there was tooth mobility or migration of teeth. Two patients complained of paresthesia. Four patients presented with proptosis, two of whom complained of diplopia. The radiographic appearance of the aneurysmal bone cyst is suggestive but not diagnostic. CONCLUSION: Although these differences do not enable the clinician to make a definitive diagnosis before biopsy, they have important implications for management.     

Large benign pineal cysts: two case reports with review

Skin biopsies at the plaque regions and adjacent skin obtained from HIV-infected 22-40-year-old patients with Kaposi's sarcoma have been analyzed. Morphological changes revealed depended on the stage of the disease and cell specificity. The alterations were as follows: cell adenoma with degeneration and destruction of cell organelles, changes of the specific granules and microfilaments. Langerhans cells appeared to be most susceptible to HIV and showed all types of changes. In the course of the disease gradual decrease of the activity of the main metabolic enzyme - adenylate cyclase - was recorded.     

Ki-67 and apoptosis in a embryologic model

A 67-year-old man developed slowly progressive muscular weakness in the bilateral upper extremities (C5- 7 regions) without signs of sensory deficit following the cervical radiation therapy (70.5Gy) for right laryngeal cancer 4 years before. These clinical signs resembled those of lower motor neuron disease. MRI with gadolinium-DTPA, however, showed enhancement in the bilateral C5 and C6 anterior roots, suggesting the cervical radiculopathy due to radiotherapy. It is known that radiation to the spinal cord can lead to "selective anterior horn cell injury". This is the first case report of the cervical radiation radiculopathy, which, if without MRI, might be classified into selective anterior horn cell injury. Suggestion is made for the hypothesis that the spinal motoneuron loss in radiation myelopathy would be caused by retrograde degeneration due to anterior root damages.     

Gonadoblastoma: histologic, ultrastructural, and histochemical observations in five cases

In this series of gonadoblastomas it appeared that the germ cells were the motivating force underlying either tumor proliferation or regression. The ultrastructural morphology confirmed the presence of undifferentiated gonadal cells with active steroid synthesis by the interstitial cells. The Call-Exner-like bodies which showed extensive calcification were composed of basement membrane material containing a sulfated mucosubstance. A histochemical comparison with the noncalcifying Call-Exner bodies of a granulosa-cell tumor differed only in their glycoprotein content. The calcium deposits were identified as oriented hydroxyapatite crystals by electron diffraction, and it is proposed that the basement membrane material serves as a nucleation site for calcification. High serum testosterone levels were correlated with the presence solely of interstitial cells in one case. The finding of a gonadoblastoma without the presence of a Y chromosome contradicts earlier proposals concerning the requirement of a Y chromosome for germ cell proliferation.     

Aberrant left pulmonary artery. Clinical and embryologic factors

Uric acid was estimated in the blood plasma, the caecal content, and in the lumen of a caecal pouch in operated rabbits. It was also histochemically detected in the caecal wall. A non negligible excretion of uric acid through the perfused caecal pouch was demonstrated. There was also an accumulation of amorphous uric acid in the enterocytes, probably due to the absence of intestinal transit, and of microorganism's uricase.     

Secretory meningioma: clinical, histologic, and immunohistochemical findings in 31 cases

BACKGROUND: Secretory meningioma is a rare histologic variant characterized by a unique epithelial differentiation of meningothelial cells resulting in the production of hyaline inclusions. Most previous reports have presented single case observations. The authors selected 31 cases for a clinicopathologic study to characterize this type of tumor further. METHODS: Clinical data were compiled and the extent of peritumoral edema was assessed from preoperative computed tomography or magnetic resonance imaging scans. Preparations of surgical specimens of all tumors were studied after both conventional histologic and immunohistochemical preparations were made. Immunostaining was performed by either the avidin-biotin complex method or the alkaline phosphatase-antialkaline phosphatase method using 22 primary antibodies. RESULTS: In the tumor collection used in this study, secretory meningiomas represented 3% of meningiomas. The female-to-male ratio was 9:1. Most tumors were located at the sphenoid ridge or at the frontal convexity, and recurrences were not observed. Eighty-four percent of tumors presented with slight to marked peritumoral edema. The MIB-1 staining index showed a mean of 3.8%. Inclusions and surrounding cells consistently expressed epithelial membrane antigen, cytokeratins, carcinoembryonic antigen, and carbohydrate antigen 19-9. In decreasing frequency, they also contained alpha1-antitrypsin, immunoglobulin (Ig)A, alpha1-antichymotrypsin, IgM, and IgG. Cells positive for vimentin and S-100 did not contain inclusions. All tumors were positive for progesterone receptors. Macrophages were stained with antibodies to factor XIIIa, human leukocyte antigen-DR, and alpha1-antitrypsin. In 64% of cases, tumor vessels lacked expression of glucose transporter protein 1. CONCLUSIONS: The classification of secretory meningioma as a distinct variant has been justified on clinical, histologic, and immunohistochemical grounds. The unique epithelial features call attention to the broad spectrum of differentiation properties found in meningiomas.     

Arachnoid cyst rupture producing subdural hygroma and intracranial hypertension: case reports

OBJECTIVE: To analyze the association between arachnoid cysts and subdural hygromas. METHODS: We reviewed five cases of arachnoid cysts that ruptured, producing acute subdural hygromas. The surgical management and diagnostic methods used are assessed. RESULTS: Five male patients ranging in age from 6 to 25 years sustained the rupture of arachnoid cysts, which produced acute subdural hygromas. Four of the patients had incurred blunt head trauma. All patients presented with symptoms referable to intracranial hypertension. The pathognomonic features of a middle fossa arachnoid cyst (MFAC) were noted on the computed tomographic scans and/or magnetic resonance images of each patient. The hygroma exerted mass effect on the ipsilateral hemisphere and was noted to be under significant pressure at the time of surgical intervention in each case. Two of the five cases are unique in the literature. In one, a coexisting quadrigeminal cyst ruptured, producing a subdural hygroma ipsilateral to the MFAC and dilating the basal cisterns. In the other, the MFAC ruptured into the basal cisterns as well as into the subdural space. The MFAC in each of the remaining three patients ruptured into the subdural space alone. All patients were treated with drainage of the subdural space. In the two patients in whom the basal cisterns were involved, both the hygromas and the MFACs failed to change significantly in size. The hygromas resolved completely and the MFACs decreased in size considerably in the three patients without cisternal involvement. CONCLUSION: The rupture of an arachnoid cyst can produce a subdural hygroma and intracranial hypertension. The latter mandates emergent drainage of the subdural space. In patients in whom the basal cisterns are not dilated by cyst rupture, both the MFACs and hygromas resolve after subdural drainage.     

Testicular epidermoid cysts in prepubertal children: case report and review of the world literature

Epidermoid cysts of the testes are rare, benign lesions that account for approximately 1% of all testicular tumors. They present most often between the second and fourth decade of life, and have been reported in prepubertal children rarely. The authors report the clinical and sonographic findings in a 4 1/2-year-old child with a testicular epidermoid cyst, and they analyze the 22 prepubertal cases found in the world literature. As described below, the clinical and sonographic features of this tumor are not specific for an epidermoid cyst and do not preclude a teratomatous or malignant neoplasm. This case adds to the varied sonographic appearance of prepubertal testicular epidermoid cysts. The lack of either unique clinical or sonographic features would suggest that extreme caution be used if local excision is considered for a patient with presumed epidermoid cyst of the testicle.     

Choledochal cysts in adults: a report of two cases and review of the literature

A choledocal cyst is a dilation of some component of the biliary tract that may include both intra- and extra-hepatic sites. They are classified into six types, all of which are relatively rare. Previously, choledochal cysts were treated with biliary-enteric bypass procedures. The current recommendation is to attempt complete excision to minimize the known risk of malignancy and the development of recurrent cholangitis or pancreatitis that may occur in patients with these cystic lesions. Two cases are discussed in which type I choledochal cysts presented. One was removed from a 31-yr-old man who presented with vague abdominal complaints the other from a 32-yr-old man who presented with pancreatitis. The epidemiology, diagnosis, surgical treatment, and risk of cancer in choledochal cysts is described.     

Lymphangiomatous cysts of the spleen: report of 3 cases and review of the literature

Splenic cysts are very uncommon entities. The majority of these cysts are solitary and asymptomatic. They are mainly seen in children or young adults; and, they are usually seen either as solitary or multiple. For all splenic cysts, surgical intervention is advantageous, as the risk of splenic rupture is very high, even from minor abdominal injury. This report presents a summary of 3 cases with lymphangiomatous splenic cyst that were treated at the Gastroenterology Surgical Center, Mansoura University, Egypt from 1993 to 1996. Lymphangiomatous cyst of the spleen is considered a rare type of cyst that is usually found as a single or multi-cystic lesion.     

Multiple hydatid cysts of the brain: a case report and review of the literature

Multiple hydatid cysts of the brain are uncommon and may be either primary or secondary. We report a 12-year-old child with multiple hydatid cysts of the brain occurring 1 year after surgical rupture of a primary large and infected cerebral hydatid cyst. Surgical removal of hydatid cysts was successfully performed. Albendazole (10 mg/kg twice daily for 12 weeks) was administered to the patient in the postoperative stage.     

Alzheimer disease, markers in the cerebrospinal fluid. Support of physiopathologic hypotheses

CERTAIN DIAGNOSIS: Because the certainty diagnosis of Alzheimer's disease is defined after autopsy or brain biopsy by the presence of neurofibrillar degeneration (NFD), extracellular senile plaques and vascular deposits of amyloid in the hippocampus amygdalus and the cerebral cortex, some authors have searched for biological ante-mortem markers of AD, particularly in the cerebrospinal fluid (CSF) which is essentially derived from brain tissue. SEARCH FOR MARKERS: Studies have investigated the CSF level of neurotransmitters, neuropeptides, amino acids, trace elements, constituents of NFD and senile plaques in a diagnostic and pathogenic perspective. HOPE FOR DIAGNOSIS: Even though ethical, technical and methodological difficulties met by authors are important and even though many clinical and biological parameters must be taken into account, these studies bring important pathogenic evidence and allow hope that markers of AD which are so necessary for early diagnosis and objective study of therapies will be found.     

Hepatic peribiliary cysts: multiple tiny cysts within the larger portal tract, hepatic hilum, or both

PURPOSE: To describe characteristic imaging features of hepatic peribiliary cysts. MATERIALS AND METHODS: Four patients with hepatic cysts in which the radiologic (n = 3) or histologic (n = 1) findings were consistent with peribiliary cysts of the liver (multiple small cysts seen exclusively in the larger portal tract, hepatic hilum, or both at gross examination and dilatations of extramural peribiliary gland at histologic examination) underwent computed tomography (CT) and ultrasound (US). In three patients, CT was performed after drip infusion of cholangiographic contrast material. RESULTS: Contrast material-enhanced CT clearly depicted many tiny cysts along the larger portal veins up to the third- or fourth-order branch (n = 3). US depicted multiple cysts in the echogenic portal tract definitely (n = 2) or equivocally (n = 2). On cholangiographic contrast-enhanced CT scans, cystic areas were located adjacent to or surrounding the bile ducts, and the possibility of biliary dilatation, communication, or both was disproved. CONCLUSION: Hepatic peribiliary cysts can be diagnosed with US and enhanced CT, especially with CT performed after administration of cholangiographic contrast material.     

Kaposi's sarcoma following long-term immunosuppressive therapy: clinical, histologic, and ultrastructural study

Multifocal Kaposi's sarcoma in a patient with chronic myeloid leukemia treated with busulfan, a cytostatic and suppressive drug, is reviewed. After five years of treatment, during which temporary remissions occurred, the patient experienced a relapse of leukemia and a considerable immune deficiency. This was expressed by a decrease in the ratio of CD4/CD8 lymphocytes in the peripheral blood. The relation of Kaposi's sarcoma with leukemia, as well as with the state of immunity in this case, does not evoke any doubts. Verification of oncologic treatment brought about a remission of leukemia, an improvement in the patient's immune state, as well as an inhibition of new foci of the Kaposi's sarcoma in the skin in the course of a few months of follow-up evaluation.