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Goyal-Honavar A, Chacko G, Chacko AG. Supratentorial primary paraganglioma with good long-term outcome following radical excision. Br J Neurosurg 2023; 37:1766-1769. [PMID: 33754919 DOI: 10.1080/02688697.2021.1902476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Paragangliomas are tumours of extra-adrenal paraganglia. They may metastasize to the brain but primary paragangliomas are exceedingly rare in the supratentorial region and long-term outcomes after surgery is largely unknown. This description of an excellent outcome 13 years following surgery in a 40-year-old gentleman with a primary paraganglioma near the falx provides an important perspective on the value of gross total resection in these tumours. We also review the options for adjuvant therapy in tumours that cannot be excised completely. CASE DESCRIPTION We describe a supratentorial paraganglioma in the parasagittal region in a 40-year-old gentleman who presented with clinical and radiological features suggestive of a right parafalcine meningioma. Histopathological examination following gross total excision of the tumour revealed histological and immunochemical features of a paraganglioma. A detailed search for a systemic primary was negative and the patient remains disease-free 13 years after the surgery. CONCLUSIONS Differentiating between tumours arising primarily and those that are metastatic deposits in the central nervous system requires long-term follow-up and monitoring for the appearance of occult primary tumours. Gross total resection is likely to provide good long-term outcomes.
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Affiliation(s)
| | - Geeta Chacko
- Section of Neuropathology, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Ari G Chacko
- Section of Neurosurgery, Christian Medical College, Vellore, India
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Bi WL, Santagata S. Skull Base Tumors: Neuropathology and Clinical Implications. Neurosurgery 2022; 90:243-261. [PMID: 34164689 DOI: 10.1093/neuros/nyab209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Tumors that arise in and around the skull base comprise a wide range of common and rare entities. Recent studies have advanced our understanding of their pathogenesis, which in some cases, have significantly influenced clinical practice. The genotype of meningiomas is strongly associated with their phenotype, including histologic subtype and tumor location, and clinical outcome. A single molecular alteration, NAB2-STAT6 fusion, has redefined the category of solitary fibrous tumors to include the previous entity hemangiopericytomas. Schwannomas, both sporadic and familial, are characterized by near ubiquitous alterations in NF2 , with additional mutations in SMARCB1 or LZTR1 in schwannomatosis. In pituitary adenohypophyseal tumors, cell lineage transcription factors such as SF-1, T-PIT, and PIT-1 are now essential for classification, providing a more rigorous taxonomy for tumors that were previously considered null cell adenomas. The pituicyte lineage transcription factor TTF-1 defines neurohypophyseal tumors, which may represent a single nosological entity with a spectrum of morphologic manifestations (ie, granular cell tumor, pituicytoma, and spindle cell oncocytoma). Likewise, the notochord cell lineage transcription factor brachyury defines chordoma, discriminating them from chondrosarcomas. The identification of nonoverlapping genetic drivers of adamantinomatous craniopharyngiomas and papillary craniopharyngiomas indicates that these are distinct tumor entities and has led to successful targeted treatment of papillary craniopharyngiomas using BRAF and/or mitogen-activated protein kinase inhibitors. Similarly, dramatic therapeutic responses have been achieved in patients with Langerhans cell histiocytosis, both with BRAF -mutant and BRAF -wildtype tumors. Familiarity with the pathology of skull base tumors, their natural history, and molecular features is essential for optimizing patient care.
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Affiliation(s)
- Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
- Laboratory of Systems Pharmacology, Harvard Medical School , Boston , Massachusetts , USA
- Ludwig Center at Harvard, Harvard Medical School , Boston , Massachusetts , USA
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Tuleasca C, Al-Risi AS, David P, Adam C, Aghakhani N, Parker F. Paragangliomas of the spine: a retrospective case series in a national reference French center. Acta Neurochir (Wien) 2020; 162:831-837. [PMID: 31873794 DOI: 10.1007/s00701-019-04186-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Primary paragangliomas (PG) of the spine are extremely rare entities. The present study reviews our experience over a period of 30 years. METHODS This is a retrospective, single center, observational study. Patients surgically treated for a spinal PG with confirmed anatomopathological diagnosis were included. The McCormick classification was used as a reference for clinical evaluation. Follow-up MRI and clinical assessment took place at 6 weeks, 3 months, 6 months, and 1 year after surgery and on yearly basis after. RESULTS Six cases have been operated in our institution. The mean age was 37.8 (median 35.5, 30-53). The mean follow-up period was 9.6 years (median 9.5, 1-23). Preoperative duration of symptoms varied between a few hours to 4 years. Low back pain was most common sign. One presented with hemorrhage and acute onset of paraplegia. All patients underwent single surgery, with the exception of one case, which had two surgeries on the same anatomical site and a third surgery on another location of the same tumor type. Preoperatively, McCormick scale was I in four cases, and II and IV in one case, respectively. Postoperatively, all patients in McCormick I retained the same class; one patient in McCormick II passed to McCormick III; the case in McCormick IV recovered to McCormick II. Five of eight surgeries achieved total resection, while two surgeries accomplished a partial microsurgical excision and one a gross total resection. Three patients had spinal leptomeningeal dissemination. Two of them benefited from extended spine radiotherapy, while the other of a "wait-and-scan" policy. Spinal leptomeningeal dissemination was stable in all patients at last follow-up. CONCLUSION We consider surgery as primary treatment in all PG. In our experience, preoperative diagnosis is difficult and caution must be taken to perioperative course in these cases. We do not routinely perform postoperative radiation if there is a residual tumor. We regularly perform clinical and radiological follow-up, so as to be able to document recurrent cases, which have been reported even up to 30 years after primary surgical excision.
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Affiliation(s)
- Constantin Tuleasca
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, Paris, France.
- Faculté de Médecine, Sorbonne Université, Paris, France.
- Centre Hospitalier Universitaire Vaudois (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland.
- Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland.
| | - Ahmed Salim Al-Risi
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, Paris, France
| | - Philippe David
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, Paris, France
| | - Clovis Adam
- Laboratoire de neuropathologie, GHU Paris-Sud-Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Nozar Aghakhani
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, Paris, France
| | - Fabrice Parker
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, Paris, France
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Laviv Y, Thomas A, Kasper EM. Hypervascular Lesions of the Cerebellopontine Angle: The Relevance of Angiography as a Diagnostic and Therapeutic Tool and the Role of Stereotactic Radiosurgery in Management. A Comprehensive Review. World Neurosurg 2016; 100:100-117. [PMID: 28049034 DOI: 10.1016/j.wneu.2016.12.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The cerebellopontine angle (CPA) is a narrowed skull base area containing important cranial nerves and vessels and bordering with eloquent areas of the posterior fossa. Tumors of the CPA are a heterogeneous group and can have extradural, intradural/extra-axial, or intra-axial origins. Their vascular supply changes depending on their anatomic origin. Symptomatic, large CPA tumors require surgical resection in order to prevent irreversible, severe neurological damages. However, its tight and strategical location make surgery in the CPA very challenging and require appropriate pre-surgical planning. Pre-surgical diagnosis is of great importance as it allows us to choose the optimal management for the particular patient. This is of further significance when encountering high-risk lesions such as hypervascular tumors. Neurosurgeons should utilize every available pre-surgical diagnostic modalities as well as neo-adjuvant treatments in order to reduce such risks. METHODS We review all reported cases of hypervascular lesions of the CPA and discuss the roles of angiography and stereotactic radiosurgery in their management. RESULTS Three lesions of the CPA can be considered as truly hypervascular: hemangioblastomas, hemangiopericytomas and paragangliomas. All lesions share many radiological features. However, each lesion has a different anatomical origin and hence, has a characteristic vascular supply. Pre-surgical angiography can be utilized as a diagnostic tool to narrow down the differential diagnosis of a vascular CPA lesion, based on the predominant supplying vessel. In addition, pre-surgical embolization at time of angiography will narrow the associated surgical risks. CONCLUSIONS Angiography is a crucial diagnostic and therapeutic tool, helping both in narrowing the presurgical differential diagnosis and in controlling intraoperative bleeding. Because of the high surgical risks associated with resection of vascular tumors in the CPA, noninvasive treatments, such as stereotactic radiosurgery, also may have a crucial role.
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Affiliation(s)
- Yosef Laviv
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ajith Thomas
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Vernieri C, Femia D, Pusceddu S, Capella C, Rosai J, Calareso G, Concas L, Prinzi N, Lo Russo G, de Braud F, Buzzoni R. Primary Cerebellar Neuroendocrine Tumors: Chimeras or Real Entities? A Case Report with a 6-Year Follow-Up. Case Rep Oncol 2016; 9:432-439. [PMID: 27721764 PMCID: PMC5043191 DOI: 10.1159/000447771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 38-year-old patient who was diagnosed with a cerebellar well-differentiated neuroendocrine tumor (WDNET) in 2009. At first glance, we believed that it was a metastasis from an unrecognized WDNET arising outside the cerebellum. However, despite a prolonged follow-up of 6 years, an extracranial WDNET has never been found. During this time, the tumor recurred locally twice, and the patient was treated with surgery and radiotherapy. At the moment, he enjoys good general conditions and his tumor is under control. Due to the histopathological characteristics and clinical behavior of the tumor, we believe that this is the first report to date of a primary cerebellar WDNET.
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Affiliation(s)
- Claudio Vernieri
- Istituto Nazionale Tumori, Milan, Italy; IFOM - Istituto FIRC di oncologia molecolare, Milan, Italy
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Said-Al-Naief N, Pourian A, Cure J, Lopez R. Clinicopathologic conference case 3: a 75- year-old man with progressive right-sided hearing loss and dizziness. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:e89-94. [PMID: 25295344 DOI: 10.1016/j.oooo.2014.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Li ZJ, Lan XL, Hao FY, Yao WC, Wang MY, Chen XD, Bo YL, Wang JP, Zhang HD, Sun P. Primary cerebellar paraganglioma: a pediatric case report and review of the literature. Pediatr Neurol 2014; 50:303-6. [PMID: 24485927 DOI: 10.1016/j.pediatrneurol.2013.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 11/14/2013] [Accepted: 11/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Only four cases of primary intracerebellar paragangliomas have been reported in the literature to date. Because of its rarity, primary intracerebellar paraganglioma still presents a diagnostic challenge for both radiologists and neurosurgeons, and the optimal therapeutic modality is still debatable for its hypervascularity and location. PATIENTS We report a 16-year-old boy with pathology-proven primary intracerebellar paraganglioma who presented with dull headache, dizziness, and gait disturbance, and underwent gross total resection. Further, we review all reported cases of primary intracerebellar paraganglioma in the English literature and discuss its clinical profile, neuroradiological features, and treatment modalities. RESULTS His symptoms improved following tumor removal without radiotherapy, and postoperative neuroimaging thirteenth months after surgery showed no recurrence. In the literature, all four patients were stable in the follow-up period including three with complete resection and one with partial resection plus adjuvant radiotherapy. CONCLUSION Surgical resection is the treatment modality most often used for primary intracerebellar paraganglioma; radiation therapy may be used when there is residual tumor or recurrence. Angiography may help to clarify the vessel architecture for reducing intraoperative bleeding when primary intracerebellar paraganglioma is considered.
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Affiliation(s)
- Zhao-Jian Li
- Department of Neurosurgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Xiao-Lei Lan
- Department of Neurosurgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Feng-Yun Hao
- Department of Pathology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Wei-Cheng Yao
- Department of Neurosurgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Ming-Yang Wang
- Department of Neurosurgery, the People's Hospital of Jiaonan City, Qingdao, China
| | - Xiao-Dong Chen
- Department of Neurosurgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Yong-Li Bo
- Department of Neurosurgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Jian-Peng Wang
- Department of Neurosurgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Hong-Di Zhang
- Physics Scientific College, Qingdao University, Qingdao, China
| | - Peng Sun
- Department of Neurosurgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
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8
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Paragangliomes de la queue de cheval : à propos de six cas et revue de la littérature. Neurochirurgie 2012; 58:341-5. [DOI: 10.1016/j.neuchi.2012.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/27/2012] [Accepted: 05/28/2012] [Indexed: 11/23/2022]
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9
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A supratentorial primary parenchymal paraganglioma. J Clin Neurosci 2011; 18:986-8. [DOI: 10.1016/j.jocn.2010.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/09/2010] [Accepted: 11/13/2010] [Indexed: 11/18/2022]
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10
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Primary intraosseous paraganglioma of the sacrum. J Clin Neurosci 2011; 18:1120-2. [PMID: 21665476 DOI: 10.1016/j.jocn.2010.11.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 11/11/2010] [Accepted: 11/21/2010] [Indexed: 11/21/2022]
Abstract
Primary intraosseous sacral paraganglioma is a rare case of location for spinal paragangliomas, which generally manifest as intradural extramedullary tumors of the cauda equina region. The diagnosis can be elusive considering the rarity of sacral paragangliomas. The clinical importance of recognizing this relatively benign tumor cannot be overemphasized as the outcome, extent of surgery and management differs significantly from other common bony sacral tumors which are generally malignant. We report a rare case of sacral paraganglioma that was diagnosed only after histopathological examination, along with a relevant review of the literature.
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En-Nafaa I, Latib R, Fikri M, Cisse A, El Kettani N, Chami I, Boujida N, Jiddane M, Jroundi L. [Frontoparietal paraganglioma: a case report]. JOURNAL DE RADIOLOGIE 2010; 91:1318-1319. [PMID: 21242920 DOI: 10.1016/s0221-0363(10)70202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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12
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Falavigna A, Righesso O, Volquind D, Bueno Salgado K, Teles AR. Intraosseous sacral paraganglioma with extradural extension: case report. Acta Neurochir (Wien) 2010; 152:475-80. [PMID: 19730780 DOI: 10.1007/s00701-009-0362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Paragangliomas are tumors that arise from the paraganglion system, which is a component of the neuroendocrine system. Approximately 10% are located in the extra-adrenal paraganglion system. Paragangliomas of the spine, however, are rare. They usually present as an intradural tumor in the cauda equina. There are only three reports of primary intraosseous paragangliomas of the sacrum. CASE DESCRIPTION A 69-year-old man presented with low back pain and urinary incontinence. Imaging revealed a large intraosseous mass at S2, S3 and S4. Surgical resection was accomplished through a posterior midline incision exposing the spine from L5 to the coccyx. The tumor was located in the extradural space. It was friable, grayish and bleeding. Total tumor removal was performed, with normal bone margins. Follow-up at 2 years showed complete resolution of the preoperative symptoms and no evidence of local recurrence. CONCLUSION Although rare, the possibility of paraganglioma should be included in the differential diagnosis of sacral tumors. The majority of the spinal paragangliomas are benign, slowly growing tumors with low proliferative activity. Despite these characteristics, local recurrence has been reported in cases of both macroscopically total and subtotal resection. Postoperative radiation therapy for patients with incomplete excision may not prevent recurrence, so gross tumor removal should be the goal of surgery.
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Xhumari A, Couvelard A, Redondo A, Kalamarides M. Long-term follow-up of an infratentorial primary paraganglioma: a case report. Br J Neurosurg 2009; 21:531-5. [PMID: 17852107 DOI: 10.1080/02688690701432448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report a case of infratentorial primary paraganglioma for which we have a 10-year incomplete pretreatment clinical and radiological follow-up. Partial surgical removal followed by external radiotherapy resulted in stable disease at 6 years follow-up. We compare our patient's case with similar cases reported in the literature.
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Affiliation(s)
- A Xhumari
- Department of Neurosurgery, Hôpital Beaujon, Université Paris 7, Clichy, France
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Abstract
OBJECTIVE To highlight the importance of a high index of suspicion and meticulous evaluation of a patient with bleeding sinonasal mass in the diagnosis of sinonasal paraganglioma. METHOD Case report of a 39-year-old female who presented with a bleeding lobulated left nasal mass necessitating multiple blood transfusions is presented. RESULT Diagnostic investigations revealed that the patient was HIV-positive (ELISA and Western blot) and a tumour histology of paraganglioma. She had a CD4+ count of 487 cells/mm3. The urinary vanillylmandelic acid assay and echocardiography were normal. Subsequently, she had complete tumour excision through a medial maxillectomy and has remained without a recurrence 12 months after. CONCLUSION To our knowledge, this is the first report in the world literature of sinonasal paraganglioma in a HIV-positive patient and the first reported case of sinonasal paraganglioma in Africa. It is, however, not clear from this report if the patient's HIV status preceded her development of the paraganglioma or not.
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Peltier J, Fichten A, Lefranc M, Grunewald P, Thelu F, Toussaint P, Desenclos C, Le Gars D. Paragangliome du sinus caverneux. À propos d'un cas. Neurochirurgie 2007; 53:391-4. [PMID: 17707867 DOI: 10.1016/j.neuchi.2007.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 06/25/2007] [Indexed: 10/28/2022]
Abstract
A case of paraganglioma arising from the cavernous area is presented. A 51-year-old woman presented with a parasellar mass causing decreased visual acuity, oculomotor nerve paresis and retro-orbital headaches without endocrinological dysfunction. Diagnosis was confirmed by histological appearance and electron microscopy. The patient was treated with surgery followed by radiation therapy consisting of 45 Gy. The clinicopathological features and the possible pathogenesis are discussed.
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Affiliation(s)
- J Peltier
- Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens, Place Victor-Pauchet, 80054 Amiens Cedex 01, France.
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Bonneville F, Savatovsky J, Chiras J. Imaging of cerebellopontine angle lesions: an update. Part 2: intra-axial lesions, skull base lesions that may invade the CPA region, and non-enhancing extra-axial lesions. Eur Radiol 2007; 17:2908-20. [PMID: 17569053 DOI: 10.1007/s00330-007-0680-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 03/11/2007] [Accepted: 04/27/2007] [Indexed: 11/29/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging reliably demonstrate typical features of vestibular schwannomas or meningiomas in the vast majority of mass lesions responsible for cerebellopontine angle (CPA) syndrome. However, a large variety of unusual lesions can also be encountered in the CPA. Covering the entire spectrum of lesions potentially found in the CPA, these articles explain the pertinent neuroimaging features that radiologists need to know to make clinically relevant diagnoses in these cases, including data from diffusion- and perfusion-weighted imaging or MR spectroscopy, when available. A diagnostic algorithm based on the lesion's site of origin, shape and margins, density, signal intensity and contrast material uptake is also proposed. Non-enhancing extra-axial CPA masses are cystic (epidermoid cyst, arachnoid cyst, neurenteric cyst) or contain fat (dermoid cyst, lipoma). Tumours can also extend into the CPA by extension from the skull base (paraganglioma, chondromatous tumours, chordoma, cholesterol granuloma, endolymphatic sac tumour). Finally, brain stem or ventricular tumours can present with a significant exophytic component in the CPA that may be difficult to differentiate from an extra-axial lesion (lymphoma, hemangioblastoma, choroid plexus papilloma, ependymoma, glioma, medulloblastoma, dysembryoplastic neuroepithelial tumour).
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Affiliation(s)
- Fabrice Bonneville
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.
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Unal M, Polat A, Pata YS, Vayisoğlu Y, Yildiz A, Ismi O. Paraganglioma of the skull base: a case report. Auris Nasus Larynx 2007; 34:427-30. [PMID: 17331688 DOI: 10.1016/j.anl.2006.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 11/27/2006] [Accepted: 12/19/2006] [Indexed: 10/23/2022]
Abstract
Paragangliomas are rare benign neuroendocrine tumors derived from the extra-adrenal paraganglia of the autonomic nervous system. Here, we described a new case of a 75-year-old woman with paraganglioma arising in the middle and posterior cranial fossa with extended destruction of the skull base and clivus. She was admitted to our department with the complaint of severe respiratory distress due to vocal cord paralysis. We discussed its clinical, radiological, histopathological features and treatment modalities in the light of the current literature.
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Affiliation(s)
- Murat Unal
- Mersin University School of Medicine, Department of Otolaryngology, Mersin, Turkey.
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