Spinal extramedullary hematopoiesis secondary to hepatocellular carcinoma. Case report and literature review

Herpes simplex virus-1 (HSV-1) infects epidermal cells where it replicates and spreads from cell to cell. While some of the viral factors responsible for cell-to-cell spread are known, the host cell molecules and structures which are utilized by HSV-1 during spread are not well studied. Here we report that a laminin substrate reduced the ability of HSV-1 to spread from cell to cell in cultures of a human keratinocyte cell line (HaCaT). Laminin did not reduce spread of the virus by decreasing the viral replication rate. However, laminin did stimulate the formation of tight junctions between HaCaT cells, suggesting that tight junctions can affect cell-to-cell spread of HSV-1. Since laminin is an abundant component of the basement membrane in vivo, culturing cells on laminin may provide an assay which more accurately reflects the rate and mechanism of HSV-1 cell-to-cell spread in vivo.     

Meningeal carcinomatosis. Case report and review of the literature

Cadaver knee joints were mounted so that life-like forces of weight-bearing were simulated. The patello-femoral contact areas were defined under load throughout the range of movement by the dye method. During movement from extension to 90 degrees of flexion a band of contact sweeps across the patella from inferior to superior pole, but the odd facet makes no contact. At about 135 degrees of flexion separate medial and lateral contact areas form, the medial one limited to the odd facet. From extension to 90 degrees of flexion the patella holds the quadriceps tendon away from the femur, but in further degrees of flexion an extensive "tendo-femoral" contact area forms. Between 90 degrees and 135 degrees of flexion the patella rotates and the ridge between the medial and odd facets engages the femoral condyle. The odd facet is shown to be a habitual non-contact area and the ridge to be subject to high load, observations which correlate with cartilage lesions described in Part 2 of the paper.     

Cytomegalovirus prostatitis. Case report and review of the literature

We report the case of a patient undergoing chemotherapy for multiple myeloma discovered to have cytomegalovirus prostatitis. The findings of a hypoechoic prostatic lesion on ultrasound and a slightly elevated prostatic specific antigen of 4.6 ng/ml prompted a prostate biopsy. Cytopathologic examination and immunohistochemical staining demonstrated cytomegalovirus within the prostate. This virus is a common pathogen in the immunosuppressed patient, but its presence in the male genital tract is relatively rare. No previous reports of biopsy-proven cytomegalovirus prostatitis appear in the literature. The relationship of cytomegalovirus to the prostate is discussed in detail.     

Diffuse craniospinal seeding from a benign fourth ventricle choroid plexus papilloma. Case report

Choroid plexus papillomas can metastasize to the subarachnoid space, but extensive metastasis has only been reported when the tumors are malignant. The authors report a case of diffuse, extensive metastasis to the craniospinal leptomeninges from a benign fourth ventricular choroid plexus papilloma in an adult. This 19-year-old woman presented with a 2-year history of headache, blurred vision, diplopia, and ataxia. Magnetic resonance imaging of the brain and spinal cord revealed obstructive hydrocephalus caused by a 4-cm, partially calcified, inhomogeneously enhancing tumor of the fourth ventricle that was displacing the pons, medulla oblongata, and cerebellum. Innumerable cystic lesions of varying size were also seen in the cranial and spinal leptomeninges. Histological examination of the resected fourth ventricular tumor and of a few of the leptomeningeal lesions revealed a benign choroid plexus papilloma and leptomeningeal choroid plexus cysts. This singular case of diffuse and extensive metastasis to the craniospinal leptomeninges from a histologically benign fourth ventricular papilloma adds to the available information about the biological potential of these tumors and expands the differential diagnosis of posterior fossa lesions with subarachnoid metastasis.     

Spontaneous otogenic pneumocephalus. Case report and review of the literature

Pneumocephalus is commonly seen in clinical neurosurgical practice. Typical causes include trauma, tumor, and infection. Pneumocephalus may also occur iatrogenically at the time of intracranial surgery; it is not pathological and may be seen routinely on postoperative neuroimaging. Pneumocephalus is rarely encountered in the absence of the aforementioned entities. The authors report on an elderly woman in whom spontaneous intraventricular pneumocephalus occurred because of a congenital defect in the left tegmen tympani. Eustachian tube closure and middle ear exclusion were used to obliterate the fistulous connection. This case illustrates both an unusual cause and a unique treatment for spontaneous otogenic pneumocephalus.     

Primary choroid plexus papilloma of the foramen magnum--case report

A 50-year-old male presented with a choroid plexus papilloma in the foramen magnum manifesting as dysesthesia in the right hand and severe headache. Magnetic resonance imaging clearly showed that the tumor was located in the cerebellomedullary cistern, without extension into the fourth ventricle. However, differentiation from hemangioblastoma or foramen magnum tumor was difficult by neuroimaging. Intraoperative observation found the tumor was located extraventricularly and attached to the choroid plexus of the foramen of Magendie. The tumor was grossly totally resected. Histological examination proved the tumor was a choroid plexus papilloma without malignancy. His neurological deficits resolved almost completely.     

Hereditary persistence of alpha-fetoprotein. Case report and review of the literature

BACKGROUND: The issue of performing simultaneous pulmonary resection and cardiac surgery in patients with coexisting lung carcinoma and ischaemic heart disease remains controversial. We report our experience and review the literature. METHODS: Thirteen patients (male ten, female three; mean age 65 years) underwent simultaneous cardiac surgery and pulmonary resection. Lung pathology consisted of primary lung carcinoma (n = 10), benign disease (n = 2) and carcinoid (n = 1). Lung resections included pneumonectomy (n = 3), lobectomy (n = 4), segmentectomy (n = 1) and local excision (n = 5). Cardiac procedures consisted of coronary artery bypass grafting (CABG) in 11, aortic valve replacement in one and mitral valve repair with CABG in one patient. In all but one case the lung resection was performed prior to heparinization and cardiopulmonary bypass (CPB). In two patients, with suitable coronary anatomy, myocardial revascularization without CPB was performed to reduce morbidity. RESULTS: There was no hospital mortality. Postoperative blood loss and ventilation requirements were reduced in the patients who were operated on without CPB. Prolonged ventilatory support was required in two cases. All patients with benign pathology are alive. In the lung cancer group there have been five late deaths: disseminated metastatic disease (n = 3), anticoagulant related haemorrhage (n = 1) and broncho-pleural fistula (n = 1). Of the remaining five patients four are alive and disease free 7-23 months post-operatively; one patient has recurrent disease 40 months post-operatively. CONCLUSIONS: Simultaneous pulmonary resection and cardiac surgery is associated with acceptable operative morbidity and mortality. In patients with lung carcinoma long-term survival was determined by tumour stage. The avoidance of CPB may be advantageous by decreasing blood loss and ventilation requirements.     

Cytogenetics of Askin's tumour. Case report and review of the literature

The eleventh cytogenetically analyzed Askin's tumour, diagnosed in a two-year-old girl, is reported. Chromosomal analysis revealed a pseudodiploid karyotype of tumour cells with translocations of t(11;22)(q24;q12) and der(4)t(2;4)(q24;q35). The observed t(11;22)(q24;q12) is not only a unique characteristic of all cytogenetically analyzed Askin's tumours but it also occurs in 92-100% of peripheral neuroepithelioma and of Ewing's sarcoma, irrespective of its osseous or extraosseous localization. This genetical similarity further supports a nosological concept according to which Askin's tumour, Ewing's sarcoma and peripheral neuroepithelioma represent phenotypic variations of the same tumour, namely the peripheral primitive neuroectodermal tumour.     

Pitfalls of bungee jumping. Case report and review of the literature

A case of cervical spine injury related to bungee jumping is presented. Surgical intervention resulted in resolution of the patient's quadriparesis. The incidence of serious injury connected with this pastime is not inconsiderable, and it is recommended that safer jumping practices be followed. Inspection of bungee equipment and certification of instructors is now voluntary but should be mandated. Jumping heights should be limited and the use of air cushions encouraged.     

Gallbladder volvulus with gangrene. Case report and review of the literature

A total of 126 cases of primary adenocarcinoma of distal (antrum and/or adjacent body) stomach were reviewed. These cases were collected from the histopathology laboratory of Asir Central Hospital, Southwestern Saudi Arabia over an 8 year period (1987-94). Only gastrectomy specimens with non-neoplastic antral mucosa available for histological examination were included. Of 126 cases, 85 (67.5%) were of the intestinal type and 41 (32.5%) were of the diffuse type. Histological examination of the non-neoplastic antral mucosa showed: gastritis in 100% of these cases; Helicobacter pylori in 103/126 cases (81.8%); multifocal atrophic gastritis (MAG) in 53/126 cases (42.1%); intestinal metaplasia (IM) in 62/126 (49.2%); and type III intestinal metaplasia in 30/62 cases (47.7%). None of these non-neoplastic changes of antral mucosa was significantly different when the prevalence of these changes in intestinal and diffuse type gastric adenocarcinoma were compared using the chi 2 test. The prevalence of these non-neoplastic lesions were calculated in a 126 dyspeptic age- and sex-matched control patients and were as follows: H. pylori 91%; gastritis 78%; MAG 7.4%; IM 19% and type III IM 1.6%. The prevalence of H. pylori bacilli and gastritis was not significantly different between the cancer patients and the controls. The prevalence of MAG, IM and type III IM was significantly higher among cancer patients compared with the control group.     

Familial intracranial arteriovenous malformations. Case report and review of the literature

In an earlier study, we found that sexual risk-taking in gay men was reduced by getting them to evaluate the self-justifications for having unsafe sex which they had used on a specific occasion when they 'slipped up' (broke their safe sex rules by having unprotected anal intercourse). This study investigated whether the earlier finding occurred simply because recalling vividly a specific encounter in which a slip-up took place brought the men's risk-taking home to them very strongly and whether the intervention would still work if translated into posters suitable for the mass media. Gay men (n=92) who had slipped up kept diaries of their sexual behaviour for 16 weeks. After 4 weeks, they were allocated to one of 3 conditions: Specific Encounter (detailed reconstruction of a slip-up, but without any questions about self-justifications); Posters (examination of posters, specially designed for the study, that focused on self-justifications); and Control (no intervention). All 3 groups slipped up to the same extent in the post-intervention period. The results for the Specific Encounter group indicate that the earlier finding is not attributable to the alternative explanation above, while those for the Posters group suggest the importance of ensuring personal 'ownership' of the self-justifications presented. Implications for AIDS education are discussed.     

Hydrocephalus and cognitive decline in myotonic dystrophy: case report and literature review

Myotonic dystrophy is a rare genetic neuromuscular disorder with multisystem involvement. Hydrocephalus and cognitive deterioration are not commonly considered part of adult-onset myotonic dystrophy. This report describes a case of progressive distal muscle weakness, cognitive decline, and longstanding ventricular enlargement. Review of the literature suggests that hydrocephalus may be associated with myotonic dystrophy while progressive cognitive decline is rare in the adult form of the disease.     

Recurrent torticollis due to cervical osteochondroma. Case report and review of the literature]

A patient is presented who had bilateral abductor vocal fold paralysis pathologically proven to be due to multiple system atrophy (MSA) in the absence of other neurological features. MSA is a degenerative neurological condition that includes olivopontocerebellar atrophy, Shy-Drager syndrome and striatonigral degeneration. The usual predominant features of MSA are cerebellar ataxia, autonomic dysfunction and Parkinsonism. Stridor is present in over one third of patients and has been reported previously as a presenting symptom in MSA: however previously reported patients have always gone on to develop other neurological symptoms. The usual investigations of bilateral abductor vocal fold paralysis caused by MSA will not reveal the pathological process and we believe that magnetic resonance imaging (MRI) of the medulla and brain stem and autonomic function tests are probably the investigations of choice. It is a worthwhile exercise attempting to identify MSA as the cause of stridor as the prognosis is good in the medium term if appropriate support is offered.     

Solitary plasmacytoma of the mandible. Case report and review of the literature

A case of solitary plasmacytoma of the mandible is presented. Review of the literature disclosed the following characteristics regarding the clinical course and prognosis. The patients ages ranged from 34 to 76 years, with a mean of 53 years; there was a marked preponderance of males. The site of predilection was the posterior portion of the mandible. The common symptom was a non-painful swelling of the mandible of long duration, and radiological features were non-specific. Monoclonal immunoglobulin was initially detected in 42% of the evaluated patients. The majority of patients were treated with radiation therapy with a mean dose of 48Gy with or without surgery. The period of follow-up ranged from 4 months to 12 years, and 17% of the patients progressed to multiple myeloma within 1 year.     

Lipoma of the adrenal gland. Case report and review of the literature

Adrenal lipomas are extremely rarely occurring benign tumors being hormonally inactive. The patient described in this report underwent surgical excision of an adrenal lipoma because of the associated hypertension. The blood pressure decreased postoperatively to normal levels. This case report and the review of the literature consider diagnosis and therapy of the adrenal lipomas.     

Necrotizing fasciitis following laparoscopic surgery. Case report and review of the literature

Necrotizing fasciitis is a rare and potentially fatal infection characterized by rapid and progressive involvement of the fascia and subcutaneous tissues. Early diagnosis, aggressive initial debridement followed by planned redebridements in conjunction with nutritional support and antibiotics remain the mainstay of therapy. We present a case of necrotizing fasciitis of the abdominal wall following a laparoscopically assisted vaginal hysterectomy. Literature is reviewed and discussed with reference to this catastrophic infection in the age of laparoscopic surgery.     

Bilateral calcaneal fracture in childhood. Case report and review of the literature

Malignant rhabdoid tumours (MRT) of the liver are rare. The criteria for pathological diagnosis are clearly defined, but the clinical behaviour of these tumours is still emerging. We report a MRT of the liver with the rare clinical presentation of spontaneous rupture.