[Gliosarcomas. A case report]

Gliosarcomas account for 2% of glioblastomas. We report a case of gliosarcoma in a 65-year-old man, which presented as meningioma, and discuss diagnostic, therapeutic and prognostic aspects of this particular entity.

[Intramedullary schwannoma. A case report]

The intramedullary localization of schwannoma is rare, corresponding to 0.3% of all intraspinal tumors. We report a case of intramedullary schwannoma without symptoms suggestive of neurofibromatosis. This patient presented with symptoms of spinal compression. Total removal of the tumor was achieved. The literature is reviewed about of this rare localization of schwannoma.

Les tuberculomes intramédullaires

Tuberculosis of the central nervous system is uncommon. The intramedullary localization is exceptional. We report five cases of intramedullary tuberculosis observed in four women and one man with a mean age of 43 years. Two patients had a prior history of tuberculosis. Spinal cord compression was found clinically in all cases. The spinal MRI visualized the tuberculoma in all patients; two had a double tumor. Complete removal of the tuberculoma was possible in only one patient. Outcome was stationary for four patients.

[Cerebellar schistomiasis. A case report]

Schistomiasis or bilharziosis remains an endemic parasitic disease in many countries world wide. Urogenital, intestinal and hepatic symptoms are common. The brain is exceptionally involved and very few cases have been described in the literature. We report the case of a 35-Year-old male with a history of hematuria and bladder disorders, who developed signs of intracranial hypertension and a cerebellar syndrome over a period of one Month. Brain MRI disclosed a cerebellar lesion and a pelvic CT scan revealed a bladder tumor. Treatment consisted in a ventriculo-peritoneal shunt and corticosteroid therapy. Cystoscopy was performed for total resection of the bladder lesion. Histopathology confirmed the diagnosis of schistomiasis. Surgery was also performed to approach the cerebellar lesion. Histopathology showed the inflammatory nature of the lesion. The patient was given an antiparasitic treatment. Clinical and radiological radiological manifestations regressed.

[Epidermoid cyst of the cerebellopontine angle. A surgical series of 10 cases and review of the literature]

Epidermoid cyst or cholesteastoma is a congenital slow growing lesion. It usually arises in the paramedian cisterns of the posterior fossa. Its incidence varies between 0.2 and 1% of all intracranial tumors. The cerebello-pontine angle (CPA) is the most common localization. Our study reports 10 observations of CPA epidermoid cysts, treated in our department between 1989 and 1999. The age of our patients ranged from 20 to 45 years, with male predominance. The patients were admitted with symptoms of cerebello-pontine angle syndrome or signs of posterior fossa tumor. CT-scan was performed in all cases and MRI was performed in 5 patients. The audiometric explorations only provided an orienting contribution. Treatment was exclusively surgical. The retro-sigmoid approach was used in 6 cases, the sub-occipital in 30% and a subtemporal approach in one case. Total resection of the epidermoid cysts was accomplished in 4 cases, and subtotal resection in 4 cases. Two patients underwent partial resection and underwent a revision procedure. The histological examination showed an epidermoid cyst in all cases. The clinical course was controlled in 6 patients: 4 patients recovered and became symptom free. A persisting neurologic deficit was observed in two cases (hearing loss, dysphonia); 4 patients were lost to follow-up. Epidermoid cyst is a benign tumor. Total resection is the ideal treatment, but we have to be aware, taking into consideration the adherence of the tumor to neurovascular structures, of the risks at attempting total resection.

[Primary malignant melanoma of the cervix]

INTRODUCTION

Primary malignant melanoma of the cervix is an extremely rare histological variety of cervical tumor, with only 54 cases reported.

OBSERVATION

A 70 year-old woman consulted for metrorrhagia and pelvic pain. Clinical examination revealed a tumefaction on the anterior labium of the cervix. The anatomo-pathological examination of the biopsy led to diagnosis of a malignant melanoma of the cervix. Despite enlarged Wertheim-type colpohysterectomy associated with pelvic lymphadenectomy, pulmonary metastases developed and the patient died six months later.

COMMENT

This is a typical case of malignant melanoma of the cervix. All the authors underline the poor prognosis when visceral metastases occur early, as was the case in our patient.

[Calcified cerebral hydatid cyst. Report of a case]

The cerebral localization of the hydatid cyst is still rare (1 to 4% of the cases). The calcified cerebral hydatid cyst is exceptional. We report one case collected in our department. It is about a patient of 28 years old, that the case histories consist in convulsive attacks since the age of 8 years old, hospitalized because of a left hemiparesis with progressive installation. The cerebral computerized tomography showed a right parieto-occipital that is largely calcified. During the operation, a calcified hydatid cyst discovered with various daughter vesicles and a cerebral gliosis, the latter has been extracted entirely. The evolution has been favourable with improvement of the left hemiparesis. The calcified hydatid cyst of brain is still exceptional, its symptomatology is the same as the safe CHC, but it poses some diagnostic and therapeutic problems.

[Sellar hemangiopericytoma. Report of a case]

Authors report spontaneous necrosis of a sellar hemangiopericytoma, in a 44 year old man, revealed by a right cavernous syndrome. The initial CT scan showed a right sellar and parasellar spontaneous hyperdense process, intensely and homogeneously enhanced by contrast-agent. This process invaded the right cavernous sinus and extended to the sphenoid sinus. Magnetic resonance imaging showed a lesion in isointense on T1-weighted sequence and slightly hyperintense on T2-weighted sequence, with an intense and homogenous enhancement. The follow-up CT scan performed 6 months later, showed a total necrosis of the lesion. Angiography showed a slightly vascularised process, with mass effect on the carotid and sylvian vessels. The sellar and parasellar localization of hemangiopericytoma is rare. The spontaneous necrosis is exceptional, but it enabled us to distinguish it from meningioma.

[Sphenotemporal aneurysmal bone cyst. A new case and review of the literature]

Aneurysmal bone cysts (ABC) are benign tumors of the bones, formed by multiple cysts filled with blood and eroding the bone. They are rarely located at the skull. We report a case of a right temporal ABC in a 5-year-old girl. On admission, the physical examination showed a tough and fixed tumor, with no inflammatory signs nor vascular characteristics. The neurological examination was normal. Imaging studies showed an heterogeneous extracerebral mass, eroding the temporal bone and the greater wing of the sphenoid bone. The treatment consisted in an extensive tumor resection, associated with reconstructive surgery. The outcome was uneventful (follow-up 27 months). We underline the pathogenetic, diagnostic and therapeutic features of this condition.

[Malignant schwannoma of the breast. A case report]

Malignant schwannoma is a very rare sarcomatous tumor of unknown etiology. Primary mammary localization is exceptional. Clinically, the tumor manifests as an isolated painless nodule visualized as a benign nodule on standard radiogram. Positive diagnosis is provided by pathology. Treatment is surgical. The risk of local recurrence imposes a radical treatment. We report one case and review the literature, underlining the difficulties encountered in diagnosis and emphasizing the recurrent nature of this tumor after conservative treatment.

[Krukenberg's tumors. 9 cases. Review of the literature]

The authors report a series of nine cases of Krukenberg's tumor, operated at the university clinic of obstetric gynecology (Professor Chaoui) during a period from 1977 to 1990. They underline the metastatic character of this tumor, whose primitive lesion is very often digestive. In most cases, the diagnosis is set late by histological study of the operatory piece, showing the revealing character of this tumor. All the authors agree upon the very dark prognostic of this tumor. The only hope of improvement lies in an extraction as soon as possible of the primitive tumor, followed by a radical treatment of the ovarian tumor. The contribution of complementary treatment is questionable; however, adjuvant chemotherapy keeps a positive efficacy, according to certain authors. The authors deplore one death in keeping with a late diagnosis.