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Du H, Xu D, Zhang S, Zhang X, Fang M, Li M. Adenocarcinoma arising in an ectopic enterogenous cyst: A rare case report and review of literature. Front Oncol 2022; 12:942449. [PMID: 36561532 PMCID: PMC9763888 DOI: 10.3389/fonc.2022.942449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
Enterogenous cyst (EC) is a rare congenital lesion generally located in the central nervous system, such as in the cerebral hemispheres, posterior fossa, or spinal canal. They are usually benign lesions, and malignant transformation is rare. A 42-year-old woman felt an obvious pain in the lump and went to a local hospital for local lumpectomy. After 7 months, she again felt pain in the buttocks and difficulty in urinating and defecation. The computed tomography (CT) scan showed a mass in the pelvis. Sacrococcygeal cyst excision was performed 10 days later, and postoperative pathology showed epidermoid cyst. Shortly after, the patient recovered and was discharged from the hospital; the pain in the buttocks continued to recur. Puncture and drainage were performed five times. Later, the patient went to our hospital for treatment, and pelvic MRI showed multiple abnormal signal shadows in the presacral and sacrococcygeal regions, some of which were considered abscesses, and some were cystic lesions. She underwent tumor resection and was diagnosed with EC with locally moderately differentiated adenocarcinoma. Four months later, the patient's symptoms of swelling and pain recurred. MRI examination showed multiple high-signal T2 shadows in the anterior sacral and subcutaneous tissues of the buttocks, and enhanced scan showed partial marginal enhancement. After assessment, the patient was given a radiation dose of 60 Gy/25F. ECs in the anterior sacral and soft tissue of the buttocks are very rare, and the case of carcinomatous transformation has never been reported. Therefore, we discussed the clinicopathological features of ectopic ECs and reviewed the literature.
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Affiliation(s)
- Haina Du
- Department of Oncology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Dachao Xu
- Department of Anorectal, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuhui Zhang
- Department of Anorectal, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinliang Zhang
- Department of Oncology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Mingzhi Fang
- Department of Oncology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Min Li
- Department of Oncology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China,*Correspondence: Min Li,
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2
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Saito S, Natsumeda M, Sainouchi M, Takino T, Shibuya K, On J, Kanemaru Y, Ogura R, Okada M, Oishi M, Shimada Y, Wakai T, Okuda S, Ajioka Y, Kakita A, Fujii Y. Elucidating the multiple genetic alterations involved in the malignant transformation of a KRAS mutant neurenteric cyst. A case report. Neuropathology 2022; 42:519-525. [PMID: 36146951 DOI: 10.1111/neup.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022]
Abstract
Neurenteric cyst (NC) shows benign histopathology and rarely demonstrate malignant transformation. We herein describe a case of NC that exhibited malignant transformation. A 65-year-old female presented with gait disturbance due to compression by a cystic mass on the dorsal surface of the medulla oblongata. Partial resection was performed twice, leading to improvement of her symptoms. Two years after the second surgery, gadolinium-perfused T1-weighted magnetic resonance imaging revealed an invasive lesion with contrast enhancement at the trigone of the left lateral ventricle for which partial resection followed by radiotherapy was performed. However, mass regrowth was observed, with the patient eventually succumbing to her disease 11 months after her third surgery. Histopathological analyses of the first and second surgical specimens identified pseudostratified cuboidal epithelial cells, with no nuclear or cellular atypia resembling gastrointestinal mucosa, lining the inner surface of the cystic wall. Based on these findings the lesion was diagnosed as NC. The third surgical specimen exhibited apparent malignant features of the epithelial cells with elongated and hyperchromatic nuclei, several mitotic figures, small necrotic foci, and a patternless or sheet-like arrangement. Based on these findings, the lesion was diagnosed as NC with malignant transformation. Next-generation sequencing revealed KRAS p.G12D mutation in all specimens. Additionally, the third surgical specimen harbored the following 12 de novo gene alterations: ARID1A loss, BAP1 p.F170L, CDKN1B loss, CDKN2A loss, CDKN2B loss, FLCN loss, PTCH1 loss, PTEN loss, PTPRD loss, SUFU loss, TP53 loss, and TSC1 loss. The aforementioned results suggest that KRAS mutation is associated with the development of the NC, and that the additional gene alterations contribute to malignant transformation of the NC.
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Affiliation(s)
- Shoji Saito
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan.,Department of Pathology, Niigata University Brain Research Institute, Niigata, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Makoto Sainouchi
- Department of Pathology, Niigata University Brain Research Institute, Niigata, Japan
| | - Toru Takino
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Kohei Shibuya
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Jotaro On
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan.,Department of Pathology, Niigata University Brain Research Institute, Niigata, Japan
| | - Yu Kanemaru
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Ryosuke Ogura
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Masayasu Okada
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shujiro Okuda
- Division of Bioinformatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Medical AI Center, Niigata University School of Medicine, Niigata, Japan
| | - Yoichi Ajioka
- Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Niigata University Brain Research Institute, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Niigata University Brain Research Institute, Niigata, Japan
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3
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Poyuran R, Kalaparti VSVG, Thomas B, Kesavapisharady K, Narasimhaiah D. Nonneoplastic and noninfective cysts of the central nervous system: A histopathological study. Neuropathology 2022. [PMID: 36210745 DOI: 10.1111/neup.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
Nonneoplastic epithelial cysts involving the central nervous system are diverse and are predominantly developmental in origin. This study represents a surgical series describing the histopathological features of 507 such epithelial cysts with clinical and imaging correlation. Age at surgery ranged from 7 months to 72 years (mean: 33 years) affecting 246 male and 261 female patients. Colloid cyst was the most frequently resected cyst, followed by epidermoid cyst, arachnoid cyst, Rathke cleft cyst, dermoid cyst, neurenteric cyst, Tarlov cyst, and choroid plexus cyst. Diagnosis was based on the location of the cysts and the nature of the lining epithelium. Rathke cleft cyst showed the highest propensity for squamous metaplasia, significant inflammation, and xanthogranulomatous reaction. Ulceration of lining epithelium and calcification were most frequent in dermoid cyst. Radiopathological concordance was maximal for colloid cyst, followed by epidermoid and arachnoid cysts. Epidermoid and dermoid cysts exhibited the highest propensity for local tumor progression, followed by Rathke cleft cyst.
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Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | | | - Bejoy Thomas
- Department of Imaging Sciences & Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
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Pediatric intracranial neurenteric cyst of the oculomotor nerve: a case-based review. Childs Nerv Syst 2021; 37:3681-3693. [PMID: 34401938 DOI: 10.1007/s00381-021-05308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neurenteric cysts (NECs) of the central nervous system (CNS) are uncommon congenital entities arising from embryonal elements. Intracranial NECs in the pediatric population are rare. METHODS The authors describe the presentation, radiographic imaging, and pathologic findings of an 11-year-old boy with a right oculomotor nerve NEC. A literature review was performed to identify additional cases of pediatric intracranial NECs published in the English language, over the past 30 years (1990-2020). The authors discuss the presentation, investigations, management, and prognosis of this interesting entity. RESULTS We describe an 11-year-old boy who presented to neurosurgical attention with disconjugate gaze, anisocoria, and ptosis. Magnetic resonance imaging (MRI) demonstrated a lobulated, cystic, and peripherally enhancing mass involving the right oculomotor nerve. The patient underwent pterional craniotomy for drainage of the cyst and subtotal resection of the cyst wall. The tan-colored mass was displacing the basilar artery, compressing the cerebral peduncle, and adherent to the inferior surface of the tentorium. The lesion was within the oculomotor nerve and splitting the fibers, and the cystic contents were thick and mucinous. Histopathological examination of the specimen demonstrated a thin fibrous cyst wall with scattered inflammatory cells and lined by simple columnar epithelium containing mucin. The lining cells were immunoreactive with epithelial membrane antigen (EMA) and pan-keratin AE1/AE3. The diagnosis of a NEC was rendered. A comprehensive literature review of pediatric intracranial NECs yielded 46 additional lesions published in the literature, involving the skull base, posterior fossa, cerebral convexity, and cranial nerves. NECs present with local mass effect and less commonly, with aseptic meningitis or intracystic hemorrhage. Maximal safe GTR remains the mainstay management, although cyst drainage and marsupialization, cyst shunting, and fenestration of cystic contents into the ventricle or basal cisterns have been reported with variable success. CONCLUSION CNS NECs are rare congenital entities; although they occur less frequently in the intracranial components compared to the spine, their diagnosis and management should be considered for intracranial cystic lesions. Maximal safe GTR is the mainstay treatment and frequently yields favorable outcomes.
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Kalfas F, Scudieri C. Endodermal Cysts of the Central Nervous System: Review of the Literature and a Case Report. Asian J Neurosurg 2020; 15:989-996. [PMID: 33708675 PMCID: PMC7869303 DOI: 10.4103/ajns.ajns_322_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/30/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022] Open
Abstract
Context Endodermal cysts are rare benign developmental cysts lined by mucin-secreting and/or ciliated, cuboidal, or columnar epithelium of probably endodermal origin. Aims Endodermal cysts are rarely intracranial, frequently located in the posterior fossa. Supratentorial location is the most infrequent and only few cases are reported in the literature, included our case. Settings and Design The authors report a case of intracranial supratentorial endodermal cyst with a review of the literature. Subjects and Methods A 40-year-old woman was admitted to our department because of progressive gait disorder for 3 months due to right brachial and crural motor deficit associated to right crural sensory disorder (tactile hypesthesia) and right Babinski response at neurological examination due to an endodermal cyst located in the left frontoparietal convexity. Discussion Total resection of endodermal cysts is recommended, despite their location and adhesion to the surrounding structures, due to its high risk of recurrence. Fenestration of the cystic content into the subarachnoid cistern may cause obstructive hydrocephalus or chemical meningism. Results Although rare, surgeons should be aware that these lesions must be differentiated clinically, radiologically, and histologically from other supratentorial cystic lesions.
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Affiliation(s)
- Fotios Kalfas
- Department of Neurosurgery Padua University Hospital, Padua, Italy
| | - Claudia Scudieri
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
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Weng JC, Zhang ZF, Li D, Wang JM, Li GL, Xu YL, Yang J, Zhang JT, Jia WQ. Therapeutic Strategies and Prognostic Factors Based on 121 Spinal Neurenteric Cysts. Neurosurgery 2020; 86:548-556. [PMID: 31081882 DOI: 10.1093/neuros/nyz143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/25/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited data existed to guide the management of intraspinal neurenteric cysts (ISNECs). OBJECTIVE To evaluate the risk factors for progression-free survival (PFS), elucidate the radiological features of ISNECs, and propose a treatment protocol. METHODS From 2003 to 2015, 121 patients with pathologically confirmed ISNECs treated at our institute were included in this study. Pertinent risk factors were evaluated. RESULTS Gross total resection (GTR) was achieved in 55 (44.6%) patients; 106 (87.6%), 12 (9.9%), and 3 (2.5%) ISNECs were classified as Wilkins A, B, and C, respectively. After a median follow-up duration of 64.2 mo, recurrence occurred in 25 (22.7%) patients, with a median PFS time of 43.1 mo. The actuarial PFS rates at 5 and 10 yr were 73.2% and 66.2%, respectively. The actuarial overall survival rates at 5 and 10 yr were 100% and 97.6%, respectively. Non-GTR (hazard ratio [HR], 5.836; 95% confidence interval [CI], 1.698-20.058; P = .005), Wilkins B/C (HR, 3.129; 95% CI, 1.009-9.702; P = .048), and a history of surgical resection (HR, 3.690; 95% CI, 1.536-8.864; P = .004) were adverse factors. CONCLUSION GTR and Wilkins A were favorable factors for PFS. If tolerable, GTR alone was advocated as an optimal treatment. Because of the benign nature and favorable prognosis, non-GTR was an alternative if GTR failed. Close follow-up was needed because of the recurrent tendency of ISNEC. Future study with a large cohort is necessary to verify our findings.
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Affiliation(s)
- Jian-Cong Weng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhi-Feng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurosurgery, The Second Hospital of Hebei Medical University, Hebei, People's republic of china
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun-Mei Wang
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, People's Republic of China
| | - Gui-Lin Li
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, People's Republic of China
| | - Yu-Lun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wen-Qing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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7
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Singhal A, Hackney JR, Chapman PR. Rare cause of cystic cerebellopontine angle lesion: Answer. J Clin Neurosci 2020. [DOI: 10.1016/j.jocn.2019.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Supratentorial neurenteric cyst: Analysis of 45 cases in the literature. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2017.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wang X, Song G, Chen G, Guo H, Li M, Liang J, Bao Y. Single-Center Clinical Characteristics and Treatment Experience of Foramen Magnum Neurenteric Cyst: Report of 6 Cases and Brief Review of the Literature. World Neurosurg 2018; 112:e608-e616. [PMID: 29374608 DOI: 10.1016/j.wneu.2018.01.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To retrospectively analyze the clinical data of 6 patients with foramen magnum (FM) neurenteric (NE) cysts, and summarize the clinical characteristics and treatment experience for this rare disease in our single center. METHODS Between January 2011 and December 2015, 6 patients with FM NE cyst were surgically treated at Xuan Wu Hospital of Capital Medical University. We summarize the treatment experience of these patients through a retrospective review of the clinical information, imaging features, surgical details, and follow-up outcomes. RESULTS All 6 patients were female, ranging in age from 15 to 54 years (mean age, 36.8 ± 12.9 years). Occipital headache along with cranial nerve injury were the most common symptoms. Preoperative brain magnetic resonance imaging identified all lesions in the FM region, with an oblong or lobulated shape. The surgical approach was far lateral in 4 patients and suboccipital midline in 2 patients. Total lesion removal was completed in 4 patients, and subtotal excision was performed in the other 2 patients, in whom the cyst wall was intensely adherent to surrounding structures. In all 6 patients, the preoperative symptoms were significantly relieved after surgery. No recurrence was seen after a mean follow-up of 27.3 months (range, 3-70 months). CONCLUSIONS Our present study identified a female predominance among patients with intracranial FM NE cyst. Surgical excision is the optimum treatment strategy for this rare disease. Our findings indicate that subtotal removal of an FM NE cyst may be associated with favorable outcomes, but strict long-term follow up is needed.
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Affiliation(s)
- Xu Wang
- Skull Base Surgery Center, Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Gang Song
- Skull Base Surgery Center, Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Ge Chen
- Skull Base Surgery Center, Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Guo
- Skull Base Surgery Center, Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Mingchu Li
- Skull Base Surgery Center, Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Jiantao Liang
- Skull Base Surgery Center, Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yuhai Bao
- Skull Base Surgery Center, Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
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Fomichev D, Kalinin P, Gavrushin A. Endoscopic Transnasal Transclival Resection of Endodermal Cyst on Ventral Surface of Brainstem. World Neurosurg 2017; 97:756.e7-756.e11. [DOI: 10.1016/j.wneu.2016.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
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11
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Rim HT, Song JH, Kim ES, Kwon MJ. Mucinous adenocarcinoma arising from a residual supratentorial neurenteric cyst and expressing mutated KRAS: a case report. Hum Pathol 2016; 58:146-151. [PMID: 27569299 DOI: 10.1016/j.humpath.2016.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/03/2016] [Accepted: 05/12/2016] [Indexed: 11/16/2022]
Abstract
Malignant transformation of intracranial neurenteric cysts (NCs) has been reported in only 7 cases, but the molecular characteristics leading to malignant transformation remain unclear. A 61-year-old woman presented with headache and dizziness. Imaging revealed a 10-cm, extra-axial cystic mass in both middle fossae. A partial resection was performed, and the residual mass size gradually decreased. She had repeated ventriculoperitoneal shunts to relieve symptoms of hydrocephalus. Eight years later, follow-up images revealed marked enlargement of the mass and a newly developed lesion. After a second partial resection, a mucinous adenocarcinoma infiltrating the brain was identified. Transitions from benign-looking cuboidal cells to dysplastic cells were observed. A KRAS mutation, which might be associated with malignant NC transformation and was not present in the initial specimen, was identified in the adenocarcinoma. In conclusion, KRAS-mutant mucinous adenocarcinoma may arise in a longstanding residual NC after partial resection.
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Affiliation(s)
- Hyun Taek Rim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, Republic of Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, Republic of Korea
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, Republic of Korea.
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 431-070, Republic of Korea.
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Yang Y, Fang J, Li DA, Wang L, Ji N, Zhang J. Recurrent intracranial neurenteric cyst with malignant transformation: A case report and literature review. Oncol Lett 2016; 11:3395-3402. [PMID: 27123123 DOI: 10.3892/ol.2016.4386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 01/06/2016] [Indexed: 11/06/2022] Open
Abstract
Neurenteric cysts (NCs) are uncommon congenital cystic lesions. Malignantly transformed NCs are extremely rare. The present study reports the case of a recurrent foramen magnum NC with a malignant transformation and reviews 8 previously reported cases. A 58-year-old woman with a 5-month history of occasional headaches, dizziness and vomiting presented to the Beijing Tiantan Hospital (Beijing, China) with palsy of the left cranial IX and X nerves, decreased sensation in the limbs on the right side and an ataxic gait. Magnetic resonance imaging (MRI) scans revealed a cystic mass in the left side of the foramen magnum, positioned anteriolaterally to the medulla oblongata. Surgery using a left suboccipital retrosigmoid approach was performed. The lesion was partially resected and was histopathologically diagnosed as an NC with focal hyperplasia of the epithelial cells. Additional MRI scans that were performed 25 months later revealed a solid lesion posterior to the medullar oblongata. Therefore, surgery using a suboccipital midline approach was performed. The solid lesion was sub-totally removed and was histopathologically diagnosed as a well-differentiated papillary adenocarcinoma. At 1 month post-surgery, the patient's condition worsened, eventually resulting in mortality due to respiratory failure. Based on the findings of the present case and previous literature, strict criteria for malignant-transformed NCs were created. The location distribution of malignant-transformed NCs does not coincide with the location distribution of all NCs, and malignantly transformed NCs usually occur in adult patients and present as atypical radiological features. Surgery is the optimal treatment for malignantly transformed NCs, and the effectiveness of adjuvant therapy requires additional studies.
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Affiliation(s)
- Yang Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jingyi Fang
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
| | - D A Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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13
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Matsumoto H, Minami H, Tominaga S, Yamaura I, Yoshida Y, Yoshida K. Cerebellar Enterogenous Cyst with Atypical Appearance and Pathological Findings. World Neurosurg 2015; 86:510.e19-28. [PMID: 26485416 DOI: 10.1016/j.wneu.2015.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intracranial enterogenous cysts are rare and occur mainly in the posterior fossa. These cysts are usually extra-axial, midline, anterior to the brainstem, or at the cerebellopontine angle. Intracranial intra-axial enterogenous cysts are extremely rare. We report a case of an intra-axial cerebellar enterogenous cyst in which diagnosis was difficult because the lesion resembled an arachnoid cyst in appearance and showed atypical pathologic findings. CASE DESCRIPTION A 69-year-old woman had a 2-year history of progressive headache, giddiness, and unsteadiness of gait. Magnetic resonance imaging showed a cystic lesion with isointensity to cerebrospinal fluid in the left cerebellar hemisphere, reaching into the fourth ventricle. The patient underwent fenestration of the cyst and creation of a communication between the fourth ventricle and cyst because the tight attachment of the cyst wall to the cerebellum prevented total removal of the cyst. Although pathologic examinations did not show findings typical of enterogenous cyst, the diagnosis was finally made based on the presence of basement membrane and immunohistochemical results. CONCLUSION The diagnosis of enterogenous cyst is based mainly on histologic findings, because characteristic findings on neuroimaging have not been defined. Although total resection of enterogenous cysts is recommended in general, partial resection while ensuring the cyst communicates adequately with the surrounding cerebrospinal fluid space with or without a shunt procedure may be useful if the cyst is adherent to surrounding neurovascular structures.
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Affiliation(s)
| | - Hiroaki Minami
- Department of Neurosurgery, Eisyokai Yoshida Hospital, Kobe, Japan
| | - Shogo Tominaga
- Department of Neurosurgery, Eisyokai Yoshida Hospital, Kobe, Japan
| | - Ikuya Yamaura
- Department of Neurosurgery, Eisyokai Yoshida Hospital, Kobe, Japan
| | - Yasuhisa Yoshida
- Department of Neurosurgery, Eisyokai Yoshida Hospital, Kobe, Japan
| | - Kozo Yoshida
- Department of Neurosurgery, Eisyokai Yoshida Hospital, Kobe, Japan
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14
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Fujisawa N, Oya S, Higashi M, Matsui T. Malignant Transformation of a Neurenteric Cyst in the Posterior Fossa Presenting with Intracranial Metastasis: A Case Report and Literature Review. NMC Case Rep J 2015; 2:123-127. [PMID: 28663981 PMCID: PMC5364880 DOI: 10.2176/nmccrj.2014-0416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/24/2015] [Indexed: 11/29/2022] Open
Abstract
Intracranial neurenteric cysts are relatively rare and almost exclusively benign. Here we present a case of an intracranial neurenteric cyst that was histologically benign in the first surgery and later demonstrated significant growth and intracranial metastasis with malignant transformation. A 47-year-old woman presented with a headache, which had gradually worsened over 1 year. Initial magnetic resonance (MR) images revealed a solitary cystic lesion in the left cerebellopontine angle with significant mass effect. Subtotal resection leaving a small mass strongly adhered to the brainstem was achieved. Histopathological diagnosis was neurenteric cyst with no malignant features. This lesion recurred 4 years after the first surgery in the form of a cystic mass adjacent to the brainstem. In addition, histopathological examination of a specimen from the second surgery revealed malignant transformation. The patient declined to undergo radiation therapy and was conservatively managed. Three years after the second surgery, MR imaging showed recurrence of the solid mass. Although the patient had been treated with subtotal resection and radiation therapy, she died with metastatic masses in the right frontal lobe and cervical cord. A specimen from the third surgery revealed diffuse malignant features similar to mucinous adenocarcinoma. Our case and literature review indicate that, although rare, malignant transformation can occur particularly among intracranial neurentreric cysts. This finding suggests the importance of long-term follow-up for subtotally or partially resected intracranial neurenteric cysts.
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Affiliation(s)
- Naoaki Fujisawa
- Department of Neurosurgery, Saitama Medical Center/University, Saitama
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center/University, Saitama
| | - Morihiro Higashi
- Department of Pathology, Saitama Medical Center/University, Saitama
| | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center/University, Saitama
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Fujisawa N, Oya S, Higashi M, Matsui T. Malignant Transformation of a Neurenteric Cyst in the Posterior Fossa Presenting with Intracranial Metastasis: A Case Report and Literature Review. NMC Case Rep J 2015. [DOI: 10.2176/nmccrj.cr.2014-0416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Naoaki Fujisawa
- Department of Neurosurgery, Saitama Medical Center/University
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center/University
| | | | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center/University
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Okabe H, Katsura K, Yamano T, Tenjin H, Nakahara Y, Ishida M, Kato T. Mucinous adenocarcinoma arising from supratentorial intramedullary neuroenteric cyst with broncho-pulmonary differentiation. Neuropathology 2014; 34:420-4. [PMID: 24673460 DOI: 10.1111/neup.12118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 11/29/2022]
Abstract
Neuroenteric cysts are benign intradural endoderm cysts lined by gastrointestinal (GI) or tracheobronchial epithelial cells. Their malignant transformation is extremely rare and only six cases have been reported. In these cases, tissue lineage of the cystic endoderm cells giving rise to carcinoma was not clearly identified either as respiratory or as GI type. Herein, we report a case of mucinous adenocarcinoma arising from the neuroenteric cyst with broncho-pulmonary differentiation in the right cerebral hemisphere of a Japanese woman in her late 50s. The cyst wall was entirely lined by the following respiratory epithelial components: stratified bronchial ciliated columnar epithelium with basal cells positive for CK5 and p63, terminal bronchiolar Clara cells positive for thyroid transcription factor (TTF)-1, surfactant B and negative for surfactant C, type I pneumocytes positive for TTF-1, negative for surfactant B and C, and type II pneumocytes positive for TTF-1 and surfactant B and C. In addition, nests of hyperplastic single layered mucinous epithelial cells with bronchial goblet cell phenotype were also demonstrated, and histologic features were almost the same as the pulmonary type I congenital adenomatoid malformation (CCAM) with mucinous epithelial proliferation. The mucinous epithelial nests of type I CCAM are liable to develop mucinous adenocarcinoma and frequently accompany K-ras mutation and expression of p16. However, K-ras mutation and p-16 expression were not detected in this case.
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Affiliation(s)
- Hidetoshi Okabe
- Division of Diagnostic Pathology, Department of Laboratory Medicine, Shiga University of Medical Science, Otsu, Japan; Department of Pathology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
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Arabi M, Ibrahim M, Camelo-Piragua S, Shah G. Supratentorial neurenteric cyst mimicking hydatid cyst: A case report and literature review. Avicenna J Med 2013; 3:73-80. [PMID: 24251235 PMCID: PMC3818783 DOI: 10.4103/2231-0770.118463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurenteric (NE) cysts are uncommon congenital cysts of endodermal origin. These cysts are commonly encountered in the posterior fossa surrounding the brain stem structures. We present a case of pathologically proven supratentorial NE cyst that mimicked a hydatid cyst in its clinical presentation and imaging appearance. Including this pathology in the differential diagnosis of supratentorial cystic lesions is important due to the differences in medical and surgical management.
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Affiliation(s)
- Mohammad Arabi
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
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18
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Gauden AJ, Khurana VG, Tsui AE, Kaye AH. Intracranial neuroenteric cysts: A concise review including an illustrative patient. J Clin Neurosci 2012; 19:352-9. [DOI: 10.1016/j.jocn.2011.10.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/09/2011] [Indexed: 10/14/2022]
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Shi W, Cui DM, Shi JL, Gu ZK, Ju SQ, Chen J. Microsurgical excision of the craniocervical neurenteric cysts by the far-lateral transcondylar approach: case report and review of the literature. Skull Base 2011; 20:435-42. [PMID: 21772801 DOI: 10.1055/s-0030-1265823] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Neurenteric cysts in the anterior craniocervical junction (CCJ) region can be found in extremely rare cases. We report one case with craniocervical neurenteric cyst that was excised by the far-lateral transcondylar (FLT) approach. A 43-year-old man presented with a history of recurrent episodes of mild neck pain and dysesthesia in his bilateral hands of 2 years' duration with rapid deterioration 3 weeks prior to admission. Magnetic resonance imaging (MRI) of the CCJ region revealed a well-defined intradural cystic lesion located ventral from the pontomedullary junction to C1 vertebra with medulla and C1 cord compression. This patient underwent total excision of the lesion via the FLT approach without any postoperative neurological deficits, and the histopathologic diagnosis was neurenteric cyst. Follow-up MRI has revealed no evidence of recurrence. The clinical features, imaging studies, and surgical approach options involved in resecting craniocervical neurenteric cysts are discussed, along with a review of the literature.
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Lara M, Pascual D, Aparicio MA, Ruiz L, Miranda D, Gomez-Moreta JA, Hernandez Vicente J. Giant and recurrent enterogenous cyst of the frontal lobe: case report. Childs Nerv Syst 2011; 27:1333-9. [PMID: 21519960 DOI: 10.1007/s00381-011-1463-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Monica Lara
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain.
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Cobb WS, Makosch G, Anand VK, Schwartz TH. Endoscopic transsphenoidal, transclival resection of an enterogenous cyst located ventral to the brainstem: case report. Neurosurgery 2010; 67:522-6. [PMID: 21099582 DOI: 10.1227/neu.0b013e3181fa24f4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Enterogenous cysts are rare tumors found most commonly in the spine, but they have also been reported intracranially. Cases of enterogenous cysts located within the posterior fossa have traditionally been resected via difficult craniotomies that require prolonged retraction and risk injury to cranial nerves. We describe a method for resection of an enterogenous cyst located anterior to the brainstem via the endoscopic transsphenoidal approach. CLINICAL PRESENTATION A 37-year-old man was found to have a 2-cm mass anterior to the brainstem during routine screening after a trauma. The mass was located within the prepontine cistern, enhanced with gadolinium contrast, and showed no restrictive diffusion. This lesion was most consistent with an enterogenous cyst. A minimally invasive endoscopic endonasal transsphenoidal transclival approach was performed for gross total resection of the tumor. CONCLUSION We discuss the endoscopic transsphenoidal approach used for the resection of an enterogenous cyst in the posterior fossa anterior to the brainstem. The transsphenoidal approach provides direct access to lesions in this location using a minimally invasive technique while avoiding excessive brain retraction or injury to cranial nerves. In addition, we provide an updated review of the literature for enterogenous cysts located within the posterior fossa.
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Affiliation(s)
- William S Cobb
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
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Tucker A, Miyake H, Tsuji M, Ukita T, Ito S, Matsuda N, Ohmura T. Neurenteric cyst of the lower clivus. Neurosurgery 2010; 66:E224-5. [PMID: 20023530 DOI: 10.1227/01.neu.0000361998.93841.c3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neurenteric cysts (NCs) typically arise as benign ventral intradural extramedullary developmental malformations of the spine which contain heterotopic epithelium resembling the intestinal or respiratory tracts. Intracerebral NCs are extremely rare, though the frequency of symptomatic reports and incidental findings is increasing, perhaps because of advances in neuroimaging. Recognition of the unique radiographic and histopathologic features of this entity is of growing importance in the treatment of cysts of the neural axis. We present an unusual case of an NC arising at the lower clivus. CLINICAL PRESENTATION A 58-year-old man presented with occipitalgia, diplopia, a bilateral hearing deficit, and mild dysphagia. Computed tomography and magnetic resonance imaging demonstrated a 5 x 2 x 3-cm extra-axial cystic midline mass anterior to the brainstem at the lower clivus with posterior cyst wall enhancement. INTERVENTION The patient underwent a left lateral suboccipital total macroscopic resection of the lesion. Microscopic examination and histopathologic findings were consistent with a diagnosis of NC. CONCLUSION We describe the clinical presentation, imaging, and histopathologic characteristics, and discuss the diagnosis and surgical treatment of this rare lesion and related pathologic entities. Because of the remote possibility of delayed recurrence, even in cases of apparent total cyst wall removal, long-term serial imaging and a consideration of reoperation for recurrences is advisable.
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Affiliation(s)
- Adam Tucker
- Department of Neurological Surgery, Nishinomiya Kyoritsu Neurosurgical Hospital, 12-1 Imazu Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan. tucker @nk-hospital.or.jp
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