Involvement of 22q12 in a neurofibrosarcoma in neurofibromatosis type 1

We describe the cytogenetic and molecular genetic findings in a neurofibrosarcoma arising in a patient affected by neurofibromatosis type 1. Multiple chromosomal rearrangements were found but only a few of them were identified as clonal abnormalities, including a deletion of chromosome 22, which at the molecular level proved to be interstitial, mainly involving the 22q12 region. Loss of heterozygosity for markers D22S32 and MB was observed. These findings are in agreement with previous data which suggest a possible involvement of a gene located at 22q11-q13.1 during the neoplastic development of some neurofibromatosis type 1-associated tumors.

Orbital neurofibromatosis with enophthalmos

Two patients with orbital neurofibromatosis associated with enophthalmos are presented. Assessment using 3D-CT scan shows an increase in the size of the orbital cavity and an enlargement of the inferior orbital fissure, which allows orbital fat to prolapse into the infratemporal fossa, causing enophthalmos.

[Duodenal neurofibroma as a cause of chronic bleeding from the gastrointestinal tract]

A rare case of chronic exacerbating gastrointestinal tract bleeding is reported which was caused by duodenal neurofibroma. The patient was successfully treated surgically.

Angiosarcoma arising from malignant schwannoma in a patient with neurofibromatosis

A 20-year-old man with von Recklinghausen disease had a right neck mass. Pathologic examination at excision showed angiosarcoma arising in a malignant schwannoma of the cervical brachial plexus. Comparison with previous reports revealed that angiosarcoma is a rare, highly aggressive sarcomatous element in malignant schwannoma arising in patients with neurofibromatosis (NF).

Neurocutaneous syndromes

Many of the neurocutaneous disorders are more common than once suspected, in part because patients with milder forms of the disorders are now more likely to be recognized. Improved diagnostic studies and increasingly specific medical and surgical therapy allow some previously untreatable complications to be successfully managed. Genetic linkage analysis has localized the abnormal gene for some of the hereditary neurocutaneous disorders onto specific chromosomes, and newly developed clinical diagnostic criteria have improved our ability to establish a definite diagnosis in less obvious patients. Thus, the outlook for these patients is no longer uniformly pessimistic.

Acute paraplegia resulting from haemorrhage into a spinal neurofibroma

Acute paraplegia due to the intratumour haemorrhage of spinal neurofibroma is a rare condition. We describe 2 patients with this unusual presentation. Surgical treatment was successful in both patients. These 2 cases are reported, and the literature is reviewed.

Atypical peripheral neuropathies

Systemic disease and metabolic imbalance may be associated with peripheral nerve focal compressive neuropathies. The nerve may be primarily involved, or symptoms may result from chronic tenosynovitis or synovitis. We review the more commonly occurring compressive neuropathies associated with underlying systemic disorders.

Acute esophageal hemorrhage from a vagal neurilemoma

A man with known systemic neurofibromatosis developed an acute upper gastrointestinal hemorrhage while hospitalized after a neurosurgical procedure. Endoscopic evaluation showed a vascular lesion with an appearance consistent with a Dieulafoy-type lesion in the distal esophagus. Despite multiple endoscopic procedures with attempted coagulation of the bleeding lesion, the patient continued to have life-threatening hemorrhaging. At thoractomy, a tumor was found to arise from the vagus nerve at the site of bleeding. This tumor was resected and histologically determined to be a neurilemoma. Acute bleeding into the esophagus associated with this type of tumor has not been previously reported.

Facial nerve neuromas: MR imaging. Report of four cases

Four cases of facial nerve neuroma were evaluated by computed tomographic (CT) scan and magnetic resonance imaging (MRI). The extension of the tumor in the petrous bone or the parotid gland was well defined by MRI in all cases. CT scan was useful to demonstrate bone erosions and the relation of the tumor to inner ear structures. In cases of progressive facial palsy, CT and MRI should be combined to detect a facial neuroma and to plan the surgical approach for tumor removal and nerve grafting.

Giant pre-sacral neurofibroma

We report a case of pre-sacral neurofibroma diagnosed on a routine medical examination. The pathological features and management criteria of these rare tumours are discussed.

Syndrome of inappropriate antidiuretic hormone secretion in a patient with intrasellar neurofibroma of the sixth nerve

The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been described in a wide range of neurological and other disorders. We wish to add an extremely rare case of a solitary, large, invasive neurofibroma of the sixth cranial nerve extensively destroying the sella turcica in the skull base and causing inappropriate secretion of antidiuretic hormone in a 44-year-old black man in the absence of neurofibromatosis.

Radial nerve paralysis and tumor

This paper presents ten cases of radial nerve paralysis because of tumor and reviews 38 previously reported cases. The tumor distribution was 35 lipomas, four neurofibromas, four ganglions, three neuromas, one fibroma, and one neurilemoma. Malignant tumors are not discussed in this review. Electromyography is of value if diagnostic problems occur. Postoperative results are normally good.

[Gastric neurofibroma. Report of 2 cases]

Two patients consulting for upper gastrointestinal bleeding, associated to impaired gastric emptying in one, were studied with X rays and endoscopy. A gastric neurofibroma was confirmed by histologic study in both patients. One patient was submitted to subtotal gastrectomy. An endoscopic resection of the tumor was performed in the other.

A rare cause of nasal obstruction: a solitary neurofibroma

This case represents a peripheral nerve sheath tumor as a cause of nasal obstruction. Nerve sheath tumors are relatively uncommon; however, most otolaryngologists will encounter them. These tumors develop from cranial and spinal nerve roots and from peripheral nerves. In total, approximately 25% to 44% of nerve sheath tumors occur in the head and neck region. Although the most important are cranial nerve tumors--the majority being acoustic neuromas arising from the vestibular nerve--they may also develop in the nasal cavity.

[Type I neurofibromatosis (von Recklinghausen's disease) associated with abdominal neurofibrosarcoma and pheochromocytoma. Apropos of a case]

Neoplasia and endocrine disorders are common complications of neurofibromatosis 1 (NF1--von Recklinghausen disease). We report here a case of NF1 in a 31-year-old woman presenting simultaneously with an abdominal neurofibrosarcoma and a pheochromocytoma. The prevalence of secondary neoplasia and endocrine tumors in NF1 is also discussed.

[Biliary obstruction in von Recklinghausen disease]

The EVR is an uncommon autosomic dominant hereditary pathology that typically presents neurofibromas in the course of the spinal, cranial and neurovegetative nerves. Occasionally, neurofibromas can be found in the gastrointestinal tract. In this setting, the most frequent locations are jejunum, stomach and ileum. Seldom, they are in duodenum where could become ulcerated determining bleeding and severe pain simulating an acute pancreatitis. There are sympathetic and parasympathetic nerves in the minor epiploon arising from the splanchnic and vagus respectively. It results in a thick network around the extrahepatic biliary system that could be the neurofibromas origin; when they become bigger biliary obstruction can results needing chirurgical treatment. Previously, it is important to discard another probable causes of biliary obstruction (lithiasis, sclerosant cholangitis, biliary or pancreatic neoplasms) with all available proceedings (echosonography, CPRE, TAC, etc).

Unusual haemostasis for an unusual tumour. Catastrophic bleeding from a tactile neurofibroma affecting the thoracic vertebrae. Case report

The symptomatology of a typical acute descending thoracic aorta dissection was imitated by profuse haemorrhage caused by a benign tumour composed almost exclusively of Wagner-Meissner like tactile corpuscles and fatty tissue. The tumour caused extensive destruction of the bodies of the fifth and sixth thoracic vertebrae at the level of the vertebro-costal articulation. Emergency cross clamping of the descending aorta and haemostasis of the bleeding from osteal defects by tamponade with bone polymethyl methacrylate appeared the only way to control the life threatening haemorrhage. It seems that an intrathoracic tactile neurofibroma with a similar case history has not been reported till now.

Dermatopathia pigmentosa reticularis

Dermatopathia pigmentosa reticularis is a rare disorder that presents as reticulate pigmentation distributed widely all over the cutaneous surface. Only nine patients with this disease have been described previously. Our patient had no fingernail and toenail prints, a striking finding also noted in some, but not all, of the other nine patients. Our patient also had a history of a seizure disorder and had two cutaneous neurofibromas, unlike the other patients with this disorder. However, there were no other findings, such as Lisch nodules of the iris, to suggest a diagnosis of von Recklinghausen's disease.