Solitary colonic neurofibroma in a patient with transient segmental colitis: Case report

Neurofibromas of the large bowel are very rare and usually are part of the colonic involvement in neurofibromatosis type 1 (Nf1, von Recklinghausen’s disease). Solitary neurofibromas of the colon are extremely rare. We describe a case of an isolated neurofibroma that was found in the large bowel of a patient who suffered from segmental colitis and presented with bloody diarrhea. A review of the literature is also included, concerning the disclosure of isolated neurofibromas in the gut and other body parts and the type of gastrointestinal involvement in von Recklinghausen’s disease.

Poliosis circumscripta associated with neurofibroma

A 32-year-old woman presented at our clinic with a moderately soft, nontender, subcutaneous mass in the left temporal region and white hairs overlying the swelling. The lesion was surgically excised, and there was no recurrence at one year postoperatively. On histological examination, the hair follicles overlying the subcutaneous mass were devoid of pigment and a poorly demarcated fibrocellular process was seen in the subcutaneous mass, which was typical of neurofibroma. To our knowledge, only one case of poliosis associated with neurofibroma has been previously reported.

Extrathecal intraradicular nerve sheath tumor

Object. The purpose of this study was to analyze the clinical profile of patients harboring extrathecal and intraradicular nerve sheath tumors (NSTs), located inside the sleeve of an extrathecal nerve root and very often within the proximal portion of the spinal nerve, and to evaluate the incidence of long-term dysfunction of the tumor-affected roots if resected. These tumors have not received particular attention in the literature.

Methods. A single-institution series of 16 patients who had undergone surgery for intraradicular NSTs during a 50-year period was selected retrospectively. Data pertaining to clinical features, tumor characteristics, and results of surgery were analyzed.

Conclusions. Extrathecal and intraradicular neurofibromas or schwannomas more frequently affect the lumbar and S-1 nerve roots, often producing root pain only. Selective en bloc enucleation sparing at least part of the motor rootlets is possible for small schwannomas of the extrathecal—preganglion segment of the radix, whereas total resection of the affected root is generally required for radical removal of neurofibromas and large schwannomas. In the authors' experience, neither deafferentation pain nor severe radicular weakness occurs after division of the nerve root harboring the tumor.

Subcutaneous neurofibromas are associated with mortality in neurofibromatosis 1: a cohort study of 703 patients

Neurofibromatosis 1 (NF1) is a common genetic disorder with an autosomal dominant mode of inheritance, an increased morbidity and mortality, and a shorter lifespan. Although the disease is fully penetrant by the age of 8, the variability in symptoms and complications is high, even among members of the same family. The aim of this study was to identify easily recognizable clinical features that may be associated with mortality in a cohort of patients affected with NF1. We used prospectively collected data from the Neurofibromatosis Institute Database (NFID) and included in our analysis 703 patients who fulfilled the NIH diagnostic criteria for NF1. Clinical, especially dermatological features were tested as potential factors associated with mortality. Among the patients, 405 (57.6%) were children and 298 (42.4%) were adults. The mean follow-up was 2.4 years (median = 0.98, range: 0-15.3 years). Forty patients died during follow-up, mostly due to tumor development such as sarcoma (n = 18). In the adult population, subcutaneous neurofibromas (odds ratio [OR] = 3.6, 95% confidence interval (CI): [1.2-11.3], P = 0.02) and male gender (OR = 5.6, [1.5-20.9], P = 0.004) were independent predictors of mortality after adjustment for age. Among children, the presence of facial plexiform neurofibromas and pruritus were significantly associated with mortality in univariate analysis. Our study describes independent risk factors of mortality in a large cohort of adult and pediatric patients. Close follow-up should be obtained for patients presenting with subcutaneous neurofibromas.

Neurofibroma of the breast in a boy with neurofibromatosis type 1

Neurofibromas occurring in the breast are very rare. A 10-year-old boy with neurofibromatosis type 1 (NF1) presented with a palpable mass on his left breast. US showed a well-defined and hypoechoic solid mass within the subcutaneous fat tissue in the areolar area. Mass was isointense compared to muscle and hypointense compared to fat tissue on TIW and T2W MR images. Excisional biopsy was applied to the mass. The diagnosis of gynecomastia and neurofibroma was made on the basis of histopathological and immunohistochemical findings.

Severe haemorrhage in neurofibromatoma: a lesson

Neurofibromatosis is a relatively common inherited disease of the nervous system, with a frequency of almost 1 in 3000. It is associated with a wide range of vascular abnormalities. A 62-year-old man with neurofibromatosis presented to us with a sacral haematoma. This was due to spontaneous rupture of a pre-existing neurofibromata. Upon admission the patient was in hypovolaemic shock and required aggressive resuscitation prior to surgery. Haemorrhage following trauma or spontaneous rupture is an uncommon complication of neurofibromatosis. The management is discussed with emphasis on the cause and control of bleeding from these lesions.

[Solitary neurofibroma of the parapharyngeal space]

A 21 year old male patient presented with dysphagia. Clinical examination as well as CT and MRT showed a tumor in the right parapharyngeal space. The tumor was resected completely using a transcervical approach. The pathological examination showed a neurofibroma. In this case report, preoperative diagnosis, therapy and follow-up of this rare tumor are discussed.

Muscle Weakness and Paresthesia Associated with Epidural Analgesia in a Patient with an Intrathecal Neurofibrolipoma as Part of a Tethered Cord Syndrome

We report a case of a 75-yr-old female patient in whom motor deficits and paresthesias occurred after lumbar epidural analgesia. These symptoms were eventually found to be due to a tethered cord syndrome. An epidural catheter was inserted for analgesia after colon surgery. The postoperative course was characterized by fluctuating sensory and motor symptoms. A magnetic resonance imaging scan showed an intraspinal mass, which was removed by laminectomy. The presented complication is of major interest because the intraspinal tumor, which must have been present for years, became acutely symptomatic. Tethered cord syndrome is caused by a limited longitudinal mobility of the cord. It is often seen as a part of spinal closure defects and is also associated with intrathecal tumors. Typically, adult patients complain of weak legs, paresthesias of the legs, and urinary incontinence. However, our patient had denied any muscular or neurological problems or urinary incontinence during the preoperative interview. Postoperative electromyogram and electroneurography ascertained chronic neurogenic lesions of multiple lumbar and sacral nerve roots. Three months after the operation, the patient was able to walk 100 m with a crutch.

Primary endotracheal neurogenic tumors

Benign tumors in the tracheobronchial tree are rare. We report two cases of primary endotracheal neurogenic tumors in patients who presented insidiously. Both patients did not manifest other clinical features of neurofibromatosis (Von Recklinghausen's disease). A single procedure using rigid bronchoscopy and neodymium: yttrium-aluminum-garnet laser resection resulted in excellent resolution of airway patency with good follow-up results in both cases.

Differentially expressed genes in neurofibromatosis 1-associated neurofibromas and malignant peripheral nerve sheath tumors

Neurofibromas represent one of the hallmarks of neurofibromatosis 1 (NF1) patients. Tumor progression of neurofibromas to malignant peripheral nerve sheath tumors (MPNST) is a frequent and life threatening complication. To learn more about processes involved in malignant transformation, we evaluated differential gene expression in plexiform neurofibroma and MPNST from the same NF1 patient. Suppression subtractive hybridization (SSH) yielded 133 differentially expressed genes confirmed by reverse Northern blotting. Virtual Northern blots were employed to validate 23 genes. To independently verify differential expression, immunohistochemical analyses with antibodies to matrix metalloproteinase 13 (MMP13), platelet-derived growth factor receptor alpha (PDGFRA) and fibronectin (FN1) were performed on 9 dermal and 9 plexiform neurofibromas and 16 MPNST from 19 NF1 patients. All three proteins proved to be up-regulated in MPNST. MMP13 expression was observed in 44% of MPNST but was absent in neurofibromas. PDGFRA was expressed in all tumors, but the number of cells expressing it was below 30% in neurofibromas and over 50% in MPNST. Likewise, FN1 was expressed in all tumors, but less than 30% of the cells in neurofibromas and more than 70% of the cells in MPNST exhibited antibody binding. Our data point to several genes not previously recognized to be differentially expressed, and provide a framework for future studies on progression-associated gene expression in low- and high-grade nerve sheath tumors.

Anterior Fusion and Posterior Correction of Severe Cervical Kyphosis Using Pedicle Screw Fixation in a Patient with Neurofibromatosis

We present a 15-year-old boy with severe cervical kyphosis due to neurofibromatosis (NF), who underwent one-stage anterior fusion and posterior correction using pedicle screw fixation. The kyphosis was corrected from 72 degrees to 35 degrees. At the follow-up 16 months postoperatively, anterior fusion and posterior stabilization had been obtained without correction loss. Cervical pedicle screw fixation is a useful method for the correction of severe cervical kyphosis in patients with NF.

Quadriplegia in a 10 year-old boy due to multiple cervical neurofibromas

STUDY DESIGN

A case report of a child with quadriplegia as a result of neurofibromatosis type I who had cervical laminectomy for spinal cord decompression followed by occipitocervical instrumentation is described.

OBJECTIVES

To describe the consequences of severe neurofibromatosis type I and an effective surgical technique of occipitocervical instrumentation.

SUMMARY OF BACKGROUND DATA

Neurofibromatosis type I is one of the most commonly inherited genetic disorders in the human population. Extensive intraspinal involvement by neurofibromas can cause significant distortion of normal spinal structure as well spinal cord compression. Extensive laminectomy (with subsequent risk of postsurgical kyphosis) is often required for adequate decompression of the spinal cord.

METHODS

The clinical and radiographic presentation of a child with severe neurofibromatosis type I resulting in quadriplegia is described. The severe neurologic deficit was caused by compression of the spinal cord by intraspinal neurofibromas. Extensive laminectomy was required to adequately decompress the spinal cord. Occipitocervical fusion from the occiput to C6 was done to stabilize the spine and prevent future kyphosis.

RESULTS

Decompression of the spinal cord led to complete neurologic recovery, and instrumentation of the cervical spine was successful in preventing the development of postlaminectomy kyphosis in this pediatric patient.

CONCLUSIONS

The reported case emphasizes the need for treating acute neurologic symptoms caused by spinal cord compression in neurofibromatosis type I as well as addressing the future risk of spinal deformity following laminectomy.

[Neurinomas and neurofibromas of the jugular foramen: diagnosis and surgical treatment]

The paper analyzes the authors' experience in treating 16 patients with neurinomas and neurofibromas of the jugular foramen. A tumor was located intracranially (Type A) in 1 case, at the level of the base of the skull (Type B) in 7 cases, extracranially (type C) in 3 cases, and extra- and intracranially (Type D) in 5. All the patients were operated on. One-stage removal was performed in 15 patients, in 1 case a tumor was removed in 2 steps. By taking into account differences in the site of the tumors, the authors used the following accesses: retrosigmoid, supracondyllar, extreme lateral transcondylar, retroauricular transtemporal, extended retroauricular transtemporal, lateral cervical. While planning accesses, it is necessary to bear in mind not only the direction of growth of these tumors, but also the pathways of collateral venous blood flow.

Losses in chromosomes 17, 19, and 22q in neurofibromatosis type 1 and sporadic neurofibromas: a comparative genomic hybridization analysis

Neurofibromatosis type 1 (von Recklinghausen's NF1) is an autosomal dominant disease associated with an increased risk of benign and malignant neoplasia including malignant peripheral nerve sheath tumors (MPNSTs). In this study, we employed comparative genomic hybridization (CGH) to determine changes in the relative chromosome copy number in 24 patients with neurofibromas, including 12 NF1-associated and 12 sporadic cases. Differences in the frequency and distribution of chromosomal imbalances were observed in both NF1-asociated and sporadic neurofibromas. Chromosomal imbalances were more common in NF1-associated tumors than in sporadic neurofibromas. In both groups, the number of losses was higher than the number of gains, suggesting a predominant role of tumor suppressor gene in tumorigenesis. A number of new chromosomal imbalances were noted including chromosomes 17, 19, and chromosome arm 22q, which may be related to oncogenes or tumor suppressor genes in neurofibromas. In NF1-associated neurofibromas, the most frequent losses were found in chromosome 17 (the minimal common regions were 17p11.2-->p13 in nine cases and 17q24-->q25 in six cases) and 19p (19p13.2 in nine cases). In addition, both NF1-associated and sporadic neurofibromas often exhibited losses at chromosome arms 19q and 22q (in NF1 tumors, the minimal common regions were 19q13.2-->qter in seven cases).

[Brachial plexus tumors]

The brachial plexus is a primary site of tumours originating from peripheral nervous system, such as neurilemmoma and neurofibroma. Moreover, the brachial plexus is affected by various neoplasms spreading from the neighbouring anatomic structures. Surgical treatment of neoplasms provoking plexopathy is often realised by multidisciplinary teams. The authors present the series of 7 patients operated on for brachial plexus affection between 1993-2000, the pathologic findings were as follows: neurofibroma, neurilemmoma, lymphogranulomatosis, neurofibrosarcoma, lipoma, chordoma, sarcoma neurogenes. The analysis of clinical course includes: main symptoms, diagnostic procedures and results of treatment. Surgical technique is also described.

Thyroid gland neurofibroma in a NF1 patient

Neurofibromas are a hallmark of neurofibromatosis type 1 (NF1). They are usually benign and rarely present in the thyroid gland region. There is a suspected association between NF1 and intramedullary thyroid carcinoma and there is a well-known association between NF1 and pheochromocytoma. Here, we present a 55-year-old man with typical symptoms of NF1, whose course was complicated by a neurofibroma of the thyroid gland. His clinical spectrum of symptoms included bilateral cataract established before the age of 35 years, quadriparesis and an intrathoracic mass. The patient died because of abdominal carcinomatosis of unknown origin. The rarity of thyroid gland neurofibroma is discussed here, emphasizing the importance of early detection of these and other NF1 complications, also including the risk of malignant transformation with lethal outcome.

Neurofibroma in the mastoid segment of the facial canal

Neural tissue-derived facial nerve tumours usually present as neurinomas. We describe the extremely rare occurrence of a histologically verified neurofibroma primarily arising in the mastoid segment of the facial canal in a patient not fulfilling diagnostic criteria for neurofibromatosis. The tumour showed evidence of perineural growth into the jugular foramen, as suggested by cross-sectional imaging and intraoperative findings.

Posthysterectomy vault eversion with a large retroperitoneal mass

A woman with complete vaginal eversion was found to have a large pelvic mass, extending from the rectovaginal septum to the presacral space. This 66-year-old woman with posthysterectomy vaginal eversion complained of pelvic fullness. A pessary provided relief of the prolapse, but the symptom of fullness persisted. Physical examination did not identify a pelvic mass. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a 9 cm tumor of the rectovaginal septum, extending to the presacral space. At laparotomy the patient had a massive neurofibroma arising from the anterior rectal wall. This case is of interest because the complete vaginal prolapse obscured the diagnosis of this large pelvic tumor. CT and MRI were useful in identifying and characterizing the mass. To our knowledge, this is the first reported case of vaginal prolapse with a large pelvic mass.

Parapharyngeal causes of sleep apnea syndrome: two case reports and review of the literature

Most patients with obstructive sleep apnea experience increased pharyngeal collapsibility which predisposes them to upper airway occlusion during sleep. Some patients with or without a higher-than-normal collapsibility may present other causes of sleep apnea syndrome. This article will focus on the parapharyngeal tumors leading to obstructive sleep apnea (OSAS). Two clinical cases will illustrate our review of the literature. The results of surgery will also be discussed.