A case of Bednar tumor recurring after 23 years

We reported a patient with a Bednar tumor who developed local recurrence 23 years later. The recurrent Bednar tumor showed the histopathological features dermatofibrosarcoma protuberans (DFSP), and expressed CD34. We favor the term "Bednar tumor" rather than pigmented DFSP and consider that Bednar tumor is an intermediate type between cellular blue nevus and DFSP.

Neurofibroma

Although neurofibroma is a rare orbital tumor, ophthalmic nurses may have the first opportunity to observe patients with this tumor. These patients may first be seen with normal visual acuity, proptosis, or affected ocular motility. An interesting patient who was diagnosed with an orbital neurofibroma is presented.

Intestinal obstruction in an adolescent female

Images

[Multiple radicular tumors in von Recklinghausen disease assessed by magnetic resonance]

We present a case of multiple neurofibromata at lumbar nerve root level in a patient diagnosed as having Von Reckling-hausen's disease or type 1 neurofibromatosis (NF 1), studied using magnetic resonance (MR). We also observed in the same study the presence of dural ectasis, something likewise related to NF 1. We assessed MR possibilities in the study of this type of pathology and its relative advantages with respect to other types of image-forming techniques. MR is nowadays considered as the technique of choice when studying medullar and radicular pathology in patients suffering Von Recklinghausen's disease.

A case of giant bathing trunk naevus with neurofibroma-like change

It is recognized that cells of melanocytic naevi may resemble neuroid structures and the term neurotization has been used to describe this phenomenon. This may result in difficulty in the histological differentiation between naevi and neurofibromas. We report the case of a patient with a giant bathing trunk naevus which has undergone marked neurotization and in whom there had been diagnostic difficulty.

[Superior mesenteric artery syndrome after surgical correction of severe dorso-lumbar deformities. Authors' experience]

The authors report two cases of superior mesenteric artery syndrome observed in 22 operations for severe spinal deformities. Medical, dietary and postural treatment enabled the situation to be resolved in one case; whereas an intestinal derotation according to Strong-Valdoni was successfully performed in the other. The various surgical alternatives are discussed.

Space-occupying lesions as a cause of tarsal tunnel syndrome

In diagnosing the etiology of tarsal tunnel syndrome, the practitioner must be aware of space-occupying lesions as a possibility. These masses, rarely found beneath the laciniate ligament, can occur. Satisfying results have occurred after removal of these lesions. Careful dissection will assure preservation of the nerve and prevent sensory or motor loss.

[Isolated and spontaneously regressive colonic neurofibromatosis]

This case report concerns a man presenting protein losing enteropathy. Multiple polypoid colonic lesions were discovered corresponding to intra and submucosal neurofibromas. No extradigestive sign was noticed, and the diagnosis of isolated colonic neurofibromatosis was upheld. Eight years later, it was observed that both protein losing enteropathy and the colonic neurofibromas had apparently spontaneously disappeared. Isolated digestive neurofibromatosis and spontaneous tumoural regressions are discussed.

MRI of intraspinal nerve sheath tumours presenting with sciatica

The magnetic resonance imaging (MRI) characteristics of 14 intraspinal nerve sheath tumours (NST) presenting with sciatica were reviewed. The group comprised seven schwannomas, six neurofibromas and one perineuroma. The tumours were either iso- or hypointense with respect to spinal cord on T1-weighted (T1W) images; almost all tumours were hyperintense compared with spinal cord on T2-weighted (T2W) images. The tumours were all detectable on unenhanced T1W images. Nine NST were scanned following Gadolinium-Diethylenetriamine penta acetic acid (DTPA) injection and all showed intense enhancement. This aids differentiation from sequestrated disc fragments. Tumours were more likely to show homogeneous enhancement unless they were recurrent tumours. Rim enhancement occurs more commonly in schwannomas and this can be used to differentiate these from neurofibromas. However, on unenhanced images, schwannomas cannot be distinguished from neurofibromas. Four tumours occurred at T11-T12. There was poor correlation of the site of the lesion with the clinical findings. MRI studies in patients with sciatica should include the lower thoracic region especially if no protruded disc was found in the lumbar region.

Relationship between the anatomic and dermatomal levels of spinal cord tumors in the thoracic region

In neurologic examination of patients with a suspected compressive lesion at the thoracic region, the dermatomic level of sensory disturbance is the only index indicating the anatomic level of a lesion. Because spinal cord tumors usually are solitary compressive lesions, the relationship between the anatomic and dermatomic levels is conveniently examined. We examined the relationship between the highest dermatomic level of sensory disturbance and the anatomic level, axial location, and type of spinal cord tumors in the thoracic region in 19 patients (8 men and 11 women aged 27-78 years; 11 neurinomas, 7 meningiomas, 1 neurofibroma). The distribution of sensory disturbance was evaluated with 3-g Frey hair and 1-g pin-prick examinations. The dermatomic distribution of sensory disturbance was diagnosed according to the dermatome chart of Keegan and Garrett. The anatomic level and axial location of the tumor were highly related to the sensory disturbance. Eight of 12 tumors in which the dermatomic level of sensory disturbance was within one vertebral segment of the anatomic level were situated in the middle or lower thoracic region (T6-T10). All five tumors in which the dermatomic level was two or more vertebral segments away from the anatomic level were situated at the conus medullaris (T12) or upper thoracic region (T1-T5); the highest level of sensory disturbance was from 4 to 11 segments below the anatomic level of the tumor. In two patients with no sensory disturbance, the tumor was in the upper thoracic region (T5) and compressed the spinal cord from the dorsal side. When a spinal cord tumor at the thoracic region is suspected, imaging examinations should be performed sufficiently cranially.

Small ileal neurofibroma causing intussusception in a non-neurofibromatosis patient

Neurofibromas in the small intestine are usually accompanied by von Recklinghausen's disease (neurofibromatosis), and usually originate in the intramuscular plexus of Auerbach. We present here a solitary neurofibroma, which caused an ileocolic intussusception, originating in the submucosal plexus of Meissner in a non-neurofibromatosis patient. To our knowledge, there is no previous report of a neurofibroma originating in the plexus of Meissner. This condition was clearly confirmed by macroscopic and microscopic evaluation.

[A case of neurofibromatosis with occlusion of multiple cerebral artery, moyamoya phenomenon and scoliosis]

Cases of cerebrovascular occlusive lesion with neurofibromatosis have rarely been reported. We report here, the case of a 57-year-old woman who twice had sudden onset of brain hemorrhage. She had a family history of neurofibromatosis. Her elder daughter and her niece had a diagnosis of neurofibromatosis and examination showed café au lait spots and neurofibroma over the body, accompanied with scoliosis. CT scans revealed subependymal hemorrhage at the first onset of cerebral bleeding and secondly showed a high-density mass at the left basal ganglia. SPECT(99mTC-HMPAO) showed decreased activity in the left frontal and temporal lobe. Angiogram revealed multiple occlusive lesions of the cerebral arteries, including occlusions of the bilateral anterior cerebral artery and the right middle cerebral artery at the proximal portion and stenosis of the left posterior artery at the proximal portion. Abnormal vascular networks (so called Moyamoya phenomenon) at the base of the brain were also seen bilaterally. Seizinger and others have found a genetic locus of this disease in the use of genetic engineering, and Riccardi showed that mast cell is related to the tumorous growth of neurofibroma and suggested a possibility of medical treatment for growing neurofibroma by stabilizing mast cell function with ketotifen. We anticipate the treatment for this disease will be established in recent years.

Newborn apnea caused by a neurofibroma at the craniocervical junction

The authors report, for the first time, the finding by magnetic resonance imaging of a neurofibroma at the craniocervical junction with upper cervical cord and lower brainstem compression causing complete apnea from birth. Subsequent subtotal resection of the neurofibroma resulted in the successful extubation of a previously ventilator-dependent patient. After a two month period of breathing spontaneously, the newborn developed an upper respiratory tract infection and was reintubated. The patient, unable to be weaned off of the respirator, was extubated and expired shortly thereafter, at the age of five months. The authors suggest that in newborns with unexplained apnea, MRI of the cranio-cervical junction is indicated. Certain patients may be discovered who have less compromised cervico-medullary function and are afflicted by less aggressive forms of neurofibromatosis type 1. These patients may benefit permanently from a surgical decompression.

Spinal dural arteriovenous fistula adjacent to a spinal neurofibroma--a misleading coexistence. Case report

The authors report the case of a patient harbouring a spinal dural arteriovenous fistula adjacent to an intradural neurofibroma. Only the latter could be demonstrated by the diagnostic modalities employed. Such a coexistence proved misleading and two interventions were needed to cure both lesions. Only one report has appeared in the literature dealing with such a condition. The possibility of such a coexistence is stressed and mechanisms are discussed.

[Left ventricular outflow obstruction as a result of external cardiac compression by a mediastinal tumor]

A case of left ventricular outflow tract stenosis resulted from compression of the heart is presented. This symptomatic cardiovascular lesion was produced by extensive growth of mediastinal tumour. Numerous noninvasive methods were necessary to establish this difficult diagnosis. The patient underwent surgery that disclosed a benign process (of neurofibroma). After tumour's resection marked hemodynamic signs subsided.

A controlled multiphase trial of ketotifen to minimize neurofibroma-associated pain and itching

BACKGROUND AND DESIGN

Based on potential contributions of mast cells to neurofibroma-associated itching, pain, and tenderness, the mast cell blocker ketotifen fumarate (Zaditen, Sandoz Pharmaceuticals Corp, Hanover, NJ) has been proposed as a treatment for these symptoms. To test the hypothesis that ketotifen decreases neurofibroma-associated itching, pain, and tenderness, data were accumulated from two protocols. The first was an open-label protocol involving 25 patients with relatively severe symptoms (1170 patient-months), and the second was a double-blind protocol involving 27 patients with either relatively mild or severe neurofibroma-associated symptoms (316 patient-months). All subjects received either oral placebo or 2 to 4 mg of ketotifen fumarate per day. Using a scale of 1 to 10, symptoms were measured before, during, and after treatment.

RESULTS

Itching severity scores (means) were as follows: for all patients receiving ketotifen, 7.8 before, 2.8 during, and 7.2 after treatment; for ketotifen-treated patients in the double-blind protocol, 6.6 before, 3.9 during, and 6.4 after treatment; and for placebo-treated patients, 6.0 before and 6.0 during treatment. Pain and tenderness severity scores (means) were as follows: for all patients treated with ketotifen, 7.6 before, 3.6 during, and 6.6 after treatment; for double-blind ketotifen-treated patients, 6.3 before, 4.6 during, and 6.1 after treatment; and for placebo-treated patients, 7.9 before and 6.7 during treatment.

CONCLUSIONS

Pretreatment, treatment, and posttreatment levels of itching, pain, and tenderness associated with neurofibromas, using both open-label and double-blind protocols, indicate that ketotifen offers a realistic approach to treating these symptoms.

Second cervical root neurofibroma and ipsilateral migraine headache

This is a case history of a 38-year-old woman with a dumbbell-shaped C2 neurofibroma associated with right-sided classic migraine headaches (migraine with aura) and cervical trigeminal signs on the affected side. Surgical removal of the tumor was followed by resolution of the migraine headaches and persistence of the signs of cervico-trigeminal involvement.