Concomitant vagal neurofibroma and aplasia of the internal carotid artery in neurofibromatosis type 1

We report the case of a patient with neurofibromatosis type 1 who had both aplasia of an internal carotid artery (ICA) and a vagal neurofibroma. To our knowledge, this is the first report in the literature of the simultaneous presence of these two rare disorders in a single patient. We believe that this is also the first report of an absence of an ICA in a patient with neurofibromatosis type 1. The patient was a 19-year-old woman who complained of a slowly growing neck mass. The mass occupied the right parapharyngeal space and upper cervical region. The patient had no other masses on physical examination, but widespread café au lait spots were evident. This led us to suspect the presence of a vagal neurofibroma. The tumor was removed, and pathology confirmed the diagnosis. No intracranial aneurysms were detected on cerebral angiography.

[Neurofibroma of the small intestine as a cause of massive bleeding from the gastrointestinal tract]

Two cases of neoplastic tumors of small intestine, operated on because of acute abdominal signs, were described. In both cases, before ultimate surgical treatment, chronic gastro-intestinal bleeding and ileus were observed. None of routine diagnostic procedures (endoscopy and angiography) diagnosed the disease. It was the radiological contrast examination of small bowel, that solved the problem. For the reason, that neoplastic tumors of small intestine are extremely rare and symptoms are not specific, results of treatment were described. Also the mistakes in diagnostic process were analysed. Malignant lesions are very rare and they are not symptomatic, those are the reasons of delayed surgical treatment. Moreover, they are more common in older age (over 60), that makes the invasive diagnostics even more difficult because of general condition and additional loads, e.g. atherosclerosis or circulatory and respiratory failure. Literature survey underlines the fact, that difficulties in the diagnostics process lead to developing of advanced stages of neoplastics disease, which are treated because of massive bleeding ileus. Often patients are hospitalized many times before the ultimate surgery, but are discharged without right diagnosis. Therefore the retrospective analysis of our cases can be useful in future for the proper interpretation of clinical signs.

[Gastric neurofibroma--still a diagnostic problem]

We report a case of gastric neurofibroma encountered in 41-year-old woman who complained of dyspepsia and physical examination revealed palpable mass in her abdomen. It was not possible to determine the nature and origin of the tumor by radiological and endoscopic investigations. At laparotomy the tumor was found to be pendiculated and growing extramurally from the anterior wall of the stomach. Wedge gastric resection, including the mass, was performed. Histological examination revealed a spindle cell gastric tumor, immunohistochemically differentiated as a neurofibroma.

Multicentric reticulohistiocytosis with neurofibroma-like nodules

We describe a patient with multicentric reticulohistiocytosis (MR), who presented with 2 different clinical types of lesions. Some were characteristic for MR in that they were deeply set, small, firm papules. Many others were larger, soft, and even sessile, like neurofibromas. Histopathologic features of both types of lesions revealed MR. To our knowledge, this is the first report of lesions of MR mimicking neurofibromas.

Consequences of neck manipulation performed by a non-professional

Case report. Documentation of complication of neck manipulation by an untrained person. Tertiary care referral teaching hospital at Lucknow, India. Clinical evaluation, plain radiography of cervical spine, spinal MRI.A 30-year-old man who fainted after neck manipulation by a barber and developed spinal cord and brainstem dysfunction. His MRI revealed an extramedullary, intradural dumbbell shaped mass on the right side at C1 and C2 level compressing the spinal cord. Public awareness should be increased about the danger of neck manipulation by an untrained person especially in the communities where it is commonly practiced.

Spinal cord compression due to tumours at Kenyatta National Hospital, Nairobi

OBJECTIVE

To determine the frequency of different types of tumours associated with cord compression, their mode of presentation and treatment outcome.

DESIGN

Retrospective study.

SETTING

Kenyatta National Hospital (KNH), a teaching and referral hospital in Nairobi, Kenya, from January 1985 to December 1994.

SUBJECTS

Thirty eight patients.

RESULTS

There were twenty one males and seventeen females with a male/female ratio of 1.3:1 and a mean age of 36.9 years. Primary spinal cord tumours were more common (65.8%) than metastatic tumours (34.2%). The commonest spinal cord tumour was meningioma (23.7%) followed by neurofibroma (15.8%). Most of the patients (70%) did not show any clinical improvement after surgery.

CONCLUSION

Spinal cord tumours accounted for about 15% of all CNS tumours treated at the Kenyatta National Hospital. Most of the patients had total paralysis of the limbs at the time of presentation. Meningiomas and neurofibromas were the commonest cause of cord compression at KNH. Greater effort is needed to detect these tumours early when the signs and symptoms may be reversible following surgery.

[Spinal neurinomas and neurofibromas in Senegal]

Authors present 13 cases of spinal neurinomas and neurofibromas out of 418 non- pottic, non-traumatic medullary compression operated between 1965 and 1995. All cases were histologically documented. Neurinomas and neurofibromas represent 3.1% of all non pottic, non traumatic medullary compression and 12.8% of tumour medullary compression operated in our service. The illness started with radicular pains (6 cases) and spinal ache (5 cases) and most of the time, the medullary compression diagnosis is completed at the spasmodic paraplegia status. No patient has done any C.T. scan but in the other hand a myelography has been completed in all cases, resulting in the blockage of the contrast product which in 4 cases was of an epidural type, and in 2 cases of intra dural type. All patients were operated through a posterior approach, which ended in 10 cases to a total removal, and in 3 cases to a partial one. 7 extradural localizations were noticed and 3 neurinomas, 3 neurofibromas and 1 neurofibrosarcoma were histologically identified. A post operative follow-up was done on 11 patients and a satisfactory result was obtained on 6 of them. In 2 cases, the neurological status remained unchanged. In 2 cases a deterioration occurred and a patient with neurofibrosarcoma passed away.

Progressive pedal macrodactyly surgical history with 15 year follow-up

Macrodactyly can affect the fingers and/or toes1. Histopathologic examination will distinguish macrodactylia fibrolipomatosis or neural fibrolipoma with macrodactyly, from macrodactylia as a part of neurofibromatosis. Surgical repair is aimed at decreasing the size of the affected foot so it is as near in size and shape to the normal foot as possible. Surgical approaches have included reconstructive surgery (usually staged debulking procedures), epiphyseal plate arrest and amputation. Repeated reconstructive surgical procedures, as illustrated in this report covering patient care over a 15 year period, are usually necessary due to recurring soft tissue and boney enlargement.

Gastric neurofibroma in a patient with von Reklinghausen's disease: a cause of upper gastrointestinal hemorrhage

Gastric neurofibroma associated with von Reklinghausen's disease is a rare clinical entity. We report a case of gastric neurofibroma with gastrointestinal bleeding and severe anaemia. Surgical resection is the treatment of choice. The recommended follow-up is an annual complete cell blood count and stool testing for occult blood.

Neurofibroma of the urinary bladder

BACKGROUND

Neurofibroma of the urinary bladder is rare. Only isolated case reports have appeared. Information regarding the long term follow-up of patients with neurofibroma is limited.

METHODS

The authors studied 4 cases of neurofibroma of the bladder diagnosed at Mayo Clinic from 1965 through 1990. Immunostains for S-100 protein, neurofilament protein, epithelial membrane antigen (EMA), cytokeratin (CAM 5.2; AE 1/3), Type IV collagen, MIB-1, and p53 protein were performed in all cases, as was Alcian blue at pH 2.5. The mean follow-up was 9.6 years (range, 2-18 years).

RESULTS

The mean age at diagnosis was 17 years (range, 7-28 years); the male-to-female ratio was 1:1. All four patients exhibited physical stigmata of neurofibromatosis type 1. Clinical presentations included hematuria (one patient), irritative symptoms (two patients), and pelvic mass (one patient). Long term urinary complications included bladder atony (two patients), neurogenic bladder (one patient), and recurrent urinary tract infection with hematuria (one patient). Subsequently, two patients underwent partial cystectomy and one a complete cystectomy. Involvement of the bladder was generalized in all four cases. Three tumors were transmural, showing a diffuse and plexiform pattern of growth; in the fourth case, a superficial biopsy showed only diffuse submucosal growth with conspicuous pseudo-Meissnerian corpuscle formation. An Alcian blue positive, variably collagenized matrix was present in all cases. Tumor cells displayed immunoreactivity for S-100 protein and Type IV collagen in all cases. Neurofilament protein positive axons were evident in three cases; all other immunostains were negative. The mean MIB-1 labeling index was 3.2% (range, 0.9-7.3%). No malignant transformation was observed during a mean follow-up of 9.6 years.

CONCLUSIONS

Neurofibroma of the bladder presents early in life, is of the plexiform type with a diffuse component, and usually occurs in the setting of generalized neurofibromatosis type 1 rather than as isolated visceral neurofibromatosis. Malignant transformation did not occur in any of these 4 patients during a mean follow-up time of 9.6 years.

p53 and Ki-67 proliferating cell nuclear antigen in benign and malignant peripheral nerve sheath tumors in children

Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon soft tissue tumors. In children with neurofibromatosis 1 (NF1), a MPNST often arises in a pre-existing neurofibroma, or may represent an initial manifestation without other obvious stigmata of the disease. The development of MPNSTs may be associated with instability of the p53 tumor suppressor gene since it is the most frequent genetic abnormality in soft tissue sarcomas. To assess the presence of p53 accumulation in MPNSTs and its correlation with clinical and pathologic features, we studied 12 neurofibromas (NFs), including 4 tumors with cellular features (one congenital) and 10 MPNSTs. Six MPNSTs were associated with NF1, all of which developed within a plexiform neurofibroma. Cell proliferation evaluated with an antibody to Ki-67 and nuclear p53 staining were both detected by immunohistochemistry. We found p53 positivity in 60% of MPNSTs. All NFs except the congenital tumor were p53 immunonegative (P < 0.01). Rare p53-positive nuclei were detected in the transitional zone in two of six MPNSTs arising in plexiform NFs. Ki-67 distinguished the NFs from MPNSTs (P < 0.005). Half of the NF1 patients with p53-positive MPNSTs developed recurrence or metastases or developed a second malignancy within 2 years of diagnosis, whereas patients with p53-positive sporadic MPNSTs were free of disease 1 to 7 years later. We found p53 accumulation more frequently in NF1-associated MPNSTs. p53 mutations may be an additional biologic factor to account for the poor prognosis in these tumors.

[Neurofibroma of the parapharyngeal space: a case report]

Neurofibroma is rarely found arising in the head and neck region. Parapharyngeal space neurofibroma is one of the rare complications of neurofibromatosis type I, occurring in less than 5% of all parapharyngeal space neoplasms. Solitary neurofibroma type II in this location has not been reported so far in literature. In this paper we describe a case of a huge neurofibroma of parapharyngeal space, indicating the main diagnostic procedures (especially CT scan), and report the surgical treatment.

Neurofibroma of the esophagus

Benign esophageal tumors occur infrequently, with leiomyomas accounting for approximately 70% of cases. Benign neural tumors of the esophagus account for 200 cases reported in the literature and rarely require operative resection. The case of a 58-year-old woman with a 4-month history of progressive dysphagia and odynophagia is presented. A large intramural esophageal mass was resected through a right thoracotomy, and the esophagus was primarily repaired. Histologic examination revealed a neurofibroma.

Isolated colonic neurofibroma manifested by massive lower gastrointestinal bleeding and intussusception

We report a case of rare solitary neurofibroma of the transverse colon in a patient without neurofibromatosis. The patient was found to have an intussuscepting tumor prolapsing transanally, with massive lower gastrointestinal bleeding. This case represents only the second documented report of an isolated colonic neurofibroma.

Right outflow tract obstruction by a pedunculated neurofibroma: case report and literature review

Right outflow tract obstruction due to neurofibroma is rare, with only four cases identified in the world literature. Obstruction due to a pedunculated neurofibroma has never been reported. A 36-year-old woman with no known heart disease presenting with dyspnea, palpitations and chest pain was shown on echocardiogram to have a mobile right ventricular mass. Cardiac catheterization revealed normal coronary arteries and right ventricular outflow tract obstruction by a pedunculated mass, which was surgically removed and histologically proven to be a benign neurofibroma. Following surgery the patient's symptoms disappeared, with no recurrence three years postoperatively.