Gigantic epidermoid cyst of the skull

One case of an unusually giant epidermoid cyst of the skull is described. The neoformation had been present for 40 years, becoming extremely large in the last 20 years, in a 65-year-old woman. Difficulty in wearing glasses was the sole complaint of the patient, who otherwise concealed the mass by wearing a wig. Preoperative examinations (x-rays, CT scan, MRI) were important to better evaluate the nature of the cyst and to make a differential diagnosis. Dissection of the mass from the surrounding tissues was extremely easy because of its capsule. Sixteen months of follow-up have been pleasant, with no evidence of recurrence.     

Dermoid and epidermoid cyst

The treatment experience of 205 children aged from 1.5 mos to 14 yrs with dermoid or epidermoid cyst was summarized. The external localization was noted in 196 (95.6%) children, internal--in 9 (4.4%). The difficulties most frequently occurred while differential diagnosis conduction of the tumor-like neoplasms, localized in the region of the nose bridge and on the anterior neck surface. The cyst relapse occurred in 2 (1%) children, during the operative intervention conduction the cyst capsule integrity was broken and, may be, all of her membranes were not dissected completely. The cyst malignancy was not noted.     

Primary intracerebellar osteosarcoma arising within an epidermoid cyst

The authors report a case of a primary extraskeletal osteosarcoma arising within an epidermoid cyst in the parenchyma of the cerebellum in a 64-year-old woman. On initial presentation, the tumor involved the midline cerebellum without attachment to the surrounding dura mater or calvarium. Complete medical and radiologic evaluation failed to reveal a primary skeletal or other extraskeletal osteosarcoma. To our knowledge, this is the first reported case of a primary extraskeletal osteosarcoma within the cerebellum. Osteosarcoma as a primary brain tumor is exceedingly rare, and only three cases (all occurring within the cerebral hemispheres) have been reported previously. The histogenesis of primary sarcomas of the brain is not evident. The associated finding of an epidermoid cyst suggests the tumor originated from a teratoma.     

Human papillomavirus 57 identified in a plantar epidermoid cyst

We report a 23-year-old Japanese man who had plantar warts on the right sole, beneath one of which an epidermoid cyst developed. On microscopic examination, an acanthotic epidermis markedly invaginated into the underlying dermis, resulting in an open epidermoid cyst. Not only the polymerase chain reaction but also an in situ hybridization detected HPV 57 DNA in the cyst. HPV 60 is the only type of HPV that has been identified in epidermoid cysts. To our knowledge, this is the first case report of an epidermoid cyst, in which a different type of virus from HPV 60 was identified. Histological features of the cyst were also different those of HPV 60-associated epidermoid cysts.     

Conservative mitral surgery for a tear of the valvular leaflets post-percutaneous mitral commissurotomy

A case of a 32-year-old woman who developed acute mitral insufficiency after percutaneous mitral dilatation is presented. In spite the fact of having torn both leaflets, successful plastic repair of her valve was performed.     

The role of surgery in the treatment of epidermoid cancer of the anal canal

Thirty patients underwent surgery for carcinoma of the anus, a surgical procedure having been planned as all or part of their management in only 18 of them. The other 12 patients required surgery after radiotherapy, either because of progression of their neoplasm, or because of irradiation-related complications. Any tendency to attribute a quasi-exclusive role to radiotherapy in the treatment of carcinoma of the anus should be avoided.     

Conservative surgery for stage I ovarian carcinoma in women of childbearing age

OBJECTIVE: To assess the results of a policy of tailored conservative surgical management for young women with stage I ovarian carcinomas. DESIGN: Retrospective study. PARTICIPANTS: Ninety-nine women aged 40 years or younger who underwent either primary surgery in our department or were referred after primary surgery performed elsewhere. METHODS: Of the 99 women in our study, 56 underwent fertility-sparing surgery and 43 more radical surgery. Minimal requirements for conservative management were adequate staging and complete information about the therapeutic options. Factors important in the choice of the treatment were, age, wish to preserve fertility, histologic type and grade, and the stage of the tumour. RESULTS: Conservative treatment was conducted in 84% of nulliparous and in 33% of parous women; 62% of grade 1 tumours, 48% of grade 2, and 50% of grade 3 were treated conservatively. With a median follow up of seven years, we observed five recurrences (9%) of carcinoma in women treated conservatively and five (12%) in those treated more radically. Two women (one in each treatment arm) were saved after recurrence. Two recurrences after conservative surgery involved the residual ovary (3.6%). Two women developed borderline tumour in the contralateral ovary and both were treated by surgery. CONCLUSION: After adequate staging and accurate information is given to the patient, conservative treatment may be safe in some women with early ovarian cancer. The risk of recurrence in the contralateral ovary is low. Conservative surgery may be also considered in some Stage I grade 3 tumours and in some women with stage JC tumours.     

Escherichia coli meningitis in a 16-month old infant revealing a posterior fossa epidermoid cyst

Surgical management of patients with simultaneous coexisting malignancy of the digestive organs and an abdominal aortic aneurysm (AAA) remains controversial. In the five patients who underwent the aneurysmectomy first, no complications developed after an aneurysmectomy and a resection of malignancy could be performed within 4 weeks, whereas postoperative complications after the resection of malignancy developed in two of them. Two patients underwent a one-stage operation, in which one was unable to tolerate the two procedures, and no postoperative complications were seen; however, one patient with cardiac dysfunction who first underwent an aneurysmectomy died 3 months after operation due to cardiac and renal failure. These results indicate that the aneurysmectomy first is preferred, when such patients do not have absolute indications of malignancy or AAA; however, a one-stage operation should be chosen when the patients show a disturbance of key organs.     

A case of parasellar tumor with double histological texture: chromophobe pituitary adenoma and epidermoid cyst

A rare case of a 42-year-old woman with an intra- and suprasellar tumour with double histological texture (chromophobe pituitary adenoma and epidermoid cyst) is presented. Elevated serum prolactin levels were found on admission. After the surgery symptoms of diabetes insipidus appeared. On the ground of the presented case and review of references it seems that the coexistence of an epidermoid cyst and a pituitary adenoma suggest their common histogenetic origin.     

Epithelial cyst of anterior segment following cataract surgery

A 57-year-old male was evaluated 1 year after cataract extraction for a mass in the anterior segment of the eye. Ultrasonography, transillumination, and fluorescein angiography suggested that the lesion was a melanoma. Histopathologically, it proved to be an epithelial cyst replacing a portion of the iris and ciliary body.     

Laparoscopy for the undescended testis

The authors show their experience in the use of the laparoscopic approach in 18 cases of unilateral exploratory anorchia. They highlight the advantages that this method offers in efficiency, speed, security and minimal aggression compared with conventional exploration of the inguinal channel in the search of the undetectable testis. In the 18 cases studied through the insertion of 5 mm lense in the umbilical area, it was established that a testicular hypoplasia was present in 8 cases. In another 5 cases testicular agenesia was diagnosed, and in the remaining 5, intraabdominal testis were found. In four of these testicles, a laparoscopic approach helped in their correct placement and also in the removal of the fifth in a patient with recurrent leukemia.     

A case of esophageal cyst resected by thoracoscopic surgery

A 59-year-old woman was admitted with back pain and an abnormal chest shadow in the left hilar region. Her chest CT scan showed a posterior mediastinal mass surrounding the descending aorta. By transesophageal ultrasonography, a diagnosis of mediastinal cyst was made. She underwent thoracoscopic resection under general anesthesia with new endoscopic devices including endo-scissors, endoscopic hemoclips and electrocautery. Pathologically, the tumor was an esophageal cyst lined by ciliated columnar and squamous epithelium overlying smooth muscle layers. She made an uneventful recovery. Her back pain subsided following the operation. Thoracoscopic resection is a useful technique for patients with mediastinal cystic tumor.     

Massive orbital cyst of the lateral rectus muscle after retinal detachment surgery

A 73-year-old white man presented with painless proptosis of the right eye 18 years after retinal detachment surgery on the same eye. Computed tomography (CT) showed a mass in the area of the lateral rectus muscle and magnetic resonance imaging (MRI) defined the multiloculated cystic mass to be located within the lateral rectus muscle. At the time of surgery, a large, thin-walled cystic lesion was found within the lateral rectus muscle. Histopathologically, the cystic mass was of nonkeratinizing stratified squamous conjunctival epithelium. Massive orbital cysts after retinal detachment surgery are rare. The authors review the literature and comment on the differential diagnosis and presumed pathogenesis of this lesion.     

Conservative surgery in the environment of a screening program for breast carcinoma: evaluation of the results in terms of local recurrence

This report evaluates the results of conservative surgery plus radiotherapy (QUART) in a group of 123 patients from the screening programme of the District Health Board USSL 41 in Brescia, Italy (over 250 tumours diagnosed in two screening rounds, between 1987 and 1993). To date no recurrence of neoplasms in the operated breast have been diagnosed in either of the two QUART groups (64 patients from the first round, average follow-up 28 months, median 66 months; 59 patients from the second round, average follow-up 28 months, median 30 months). A new carcinoma in the contralateral breast occurred in 3 patients (2 from the first and 1 from the second round), while in 3 cases there was a recurrence in another site (2 from the first and 1 from the second round). These results confirm both the proven effectiveness of conservative treatment in the local control of breast tumours, and the importance of the correct choice of conservative treatment in optimising aesthetic and therapeutic results.     

Upwind Conservative Scheme for the Saint Venant Equations

An upwind conservative scheme with a weighted average water-surface-gradient approach is proposed to compute one-dimensional open channel flows. The numerical scheme is based on the control volume method. The intercell flux is computed by the one-sided upwind method. The water surface gradient is evaluated by the weighted average of both upwind and downwind gradients. The scheme is tested with various examples, including dam-break problems in channels with rectangular and triangular cross-sections, hydraulic jump, partial dam-break problem, overtopping flow, a steady flow over bump with hydraulic jump, and a dam-break flood case in a natural river valley. Comparisons between numerical and exact solutions or experimental data demonstrated that the proposed scheme is capable of accurately reproducing various open channel flows, including subcritical, supercritical, and transcritical flows. The scheme is inherently robust, stable, and monotone. The scheme does not require any special treatment, such as artificial viscosity or front tracking technique, to capture steep gradients or discontinuities in the solution.     

Conservative operation for infective endocarditis of the mitral valve

BACKGROUND: Subvalvular preservation is necessary to maintain left ventricular function, but accidental retention of infected tissue could cause postoperative endocarditis. METHODS: We examined 71 consecutive patients who underwent operation for mitral endocarditis. Endocarditis was uncontrolled and active in 24 patients, partially treated (unfinished antibiotic course) in 17, and healed in 30. RESULTS: Valves were repaired in 17% versus 59% versus 63% and replaced with subvalvular preservation in 25% versus 6% versus 3% of the uncontrolled active, partially treated, and healed groups, respectively. Thirty-day mortality was 29% versus 0% versus 3.3% (p=0.003), total mortality was 46% versus 18% versus 17% (p=0.035), and complications-related mortality was 38% versus 11% versus 13% (p=0.054), respectively. There was a trend toward lower complications-related mortality with subvalvular preservation than without. Postoperative endocarditis occurred in 3 of 30 patients without and 1 of 41 patients with subvalvular preservation. CONCLUSIONS: Postoperative mortality in uncontrolled active mitral endocarditis remains high, but results are good with partially treated or healed endocarditis. Subvalvular preservation improves outcome, does not increase postoperative endocarditis rates, and should be performed whenever feasible.     

Another case of acoustic schwannoma and epidermoid cyst occurring as a single cerebellopontine angle mass: possibly not so rare?

This is the second case of adjacent occurrence of an acoustic schwannoma and epidermoid cyst in the cerebellopontine angle. This case of a 70-year-old woman is presented with a history of her illness, neuroradiologic data, and photographs during the operation. We compare this case with the first of its kind.