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Zavala-Romero L, Villanueva-Castro E, Datta-Banik R, Ortiz-Altamirano AG, Rodriguez-Esquivel MM, Cienfuegos-Meza J, Arriada-Mendicoa JN. Mature Teratoma at the Lumbar Spinal Cord: A Case Report and Literature Review. Cureus 2024; 16:e52307. [PMID: 38357074 PMCID: PMC10866183 DOI: 10.7759/cureus.52307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Mature spinal teratoma is a rare type of germ cell tumor that arises from any of the three germ cell layers (ectoderm, mesoderm, and endoderm) and consists of differentiated tissues and structures that reflect the cellular organization and morphology of normal adult tissues. It has the ability to grow independently and cause compressive symptoms when found in this rare location. In this article, we present the case of a 29-year-old male patient with the onset of neurological symptoms beginning with pelvic limb paresthesias and progressing to back pain. Magnetic resonance imaging (MRI) revealed a tumor at L1-L4, which was resected by laminotomy, and histopathology revealed a mature intradural teratoma. Fortunately, this histologic type had a good prognosis for our patient, who had a significant clinical improvement. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology with PubMed and Google Scholar to find similar case reports and to summarize the main features of this disease, which contributes to the understanding of its diagnostic presentation, treatment, and prognosis, improving clinical practice in the management of similar cases. The rarity of this condition, together with its wide clinical heterogeneity and prognosis, underscores the importance of a thorough evaluation of cases of intramedullary lesions, where the consideration of uncommon diseases in the differential diagnosis should be highlighted.
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Affiliation(s)
- Lilian Zavala-Romero
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Rudradeep Datta-Banik
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | | | - Jesús Cienfuegos-Meza
- Department of Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Tena-Suck ML, Piña-Ballantyne SA, Cienfuegos-Meza J, Jiménez-López MA, Ávalos-Arias A. Schwannoma and Post-vaccine Changes: A Case Report. Cureus 2023; 15:e48223. [PMID: 38054147 PMCID: PMC10694482 DOI: 10.7759/cureus.48223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
Schwannomas are benign sheaths of Schwann cells that can present with degenerative and morphological changes; necrosis or hemorrhage are rare findings in these tumors. We present the case of a 28-year-old man with a C2-C4 cervical Schwannoma who experienced upper limb paresthesia in 2020 while presenting with COVID-19 symptoms. The patient later recovered and came to our institution, where surgery was scheduled one year after the initial diagnosis. One week before surgery, the patient received the first dose of the Moderna vaccine. Despite being asymptomatic, the patient underwent successful total resection of the schwannoma, which was confirmed histologically. However, extensive necrosis with abundant foamy macrophages was observed, suggesting a possible link to post-vaccine effects.
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Affiliation(s)
- Martha-Lilia Tena-Suck
- Neuropathology, Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Suárez, Mexico, MEX
| | | | - Jesús Cienfuegos-Meza
- Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico, MEX
| | | | - Andrea Ávalos-Arias
- Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico, MEX
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Monjarás-Romo G, Zavala-Romero L, Tejada-Pineda MF, Meraz-Soto JM, Ballesteros-Herrera D, Cienfuegos-Meza J, Alcaráz-Félix RJ, Moreno-Jiménez S. Lhermitte-Duclos Disease: A Case Series. Cureus 2023; 15:e44326. [PMID: 37779805 PMCID: PMC10536449 DOI: 10.7759/cureus.44326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Lhermitte-Duclos disease (LDD), or dysplastic cerebellar gangliocytoma, is a rare benign tumor characterized by unilateral hemispheric cerebellar expansion. It is linked to mutations in the phosphatase and tensin homolog (PTEN) gene, which inhibit the phosphatidylinositol-3'-kinase pathway, leading to increased cell division and defective neuronal migration. This study aims to compare the clinical, radiological, histopathological, surgical resolution, and follow-up characteristics of reported cases of this rare condition. An in-depth search of LDD patients' clinical records at our institute between 2003 and 2023 was conducted, in addition to a systematic literature review on PubMed. Three patients with a diagnosis of LDD were found. Cerebellar abnormalities, varying headaches, and visual impairment were all present clinically. On T2 in the posterior fossa, all three MRI scans displayed the typical hyperintense parallel streak appearance. The histopathological report showed that large ganglion cells had replaced the granular layer, Purkinje cells had degenerated, the molecular layer had become hyper-myelinated, and synaptophysin and chromogranin were positive. Partial tumor resection and avoiding intracranial hypertension were the main goals of treatment. Genetic follow-up was conducted for all three patients. Neurosurgeons must be aware of LDD to provide close genetic monitoring despite the benign nature of the tumor because of its link to Cowden syndrome and elevated risk of cancer in other organs.
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Affiliation(s)
- Gonzalo Monjarás-Romo
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Lilian Zavala-Romero
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | | | - Juan Marcos Meraz-Soto
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Daniel Ballesteros-Herrera
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Jesús Cienfuegos-Meza
- Pathology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | | | - Sergio Moreno-Jiménez
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
- Neurosurgery-Radiosurgery Department, American British Cowdray Medical Center, Mexico, MEX
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Tirado-García LA, Piña-Ballantyne SA, Cienfuegos-Meza J, Tena-Suck ML. Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Diffuse Demyelinating Plaques: A Case Report of an Atypical Presentation. Cureus 2023; 15:e41595. [PMID: 37559837 PMCID: PMC10408726 DOI: 10.7759/cureus.41595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an autoimmune disease triggered by antibodies against the NR1 subunit of this receptor. It has a wide variety of presentations, including abnormal behavior, psychosis, seizures, abnormal movement, insomnia, and irritability. The diagnosis is confirmed by the presence of one of the six main symptoms and anti-NR1 immunoglobulin G (IgG)-positive antibodies in the cerebrospinal fluid (CSF) after the exclusion of other disorders. We present a case of an 18-year-old female with progressive paresthesia and muscle weakness that compromised walking and psychiatric symptoms. She was admitted to a private institution where magnetic resonance imaging (MRI) revealed pseudotumoral lesions, which led to surgical intervention. The original histopathological diagnosis was of a pleomorphic xanthoastrocytoma (PXA) WHO grade 2. As symptoms persisted, she was referred to our institution where a new MRI was performed, and a biopsy was re-evaluated. It showed perivascular inflammatory infiltrates composed of T cells, intense peripheral gliosis, nodules of macrophages, and reactive astrocytes in the white matter with fragmentation and vacuolation of myelin sheets, suggesting a demyelinating process in contrast to neoplasia. CSF analysis was performed, and it was positive for anti-NMDA antibodies. Immunohistochemical positivity for N-methyl-D-aspartate (NMDA) was observed in the neuronal nuclei, which led to the diagnosis.
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Affiliation(s)
- Luis-Angel Tirado-García
- Neuropathology, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Jesús Cienfuegos-Meza
- Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Martha-Lilia Tena-Suck
- Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Tenorio-Flores E, Garcia-Blanco MDC, Cienfuegos-Meza J, González-Hermosillo LM, Roldan-Valadez E. ASYMPTOMATIC PRIMARY BREAST ANGIOSARCOMA IN 45-YEARS-OLD WOMAN. Rejr 2021. [DOI: 10.21569/2222-7415-2021-11-3-185-190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Bornstein L, Macedo-Perez O, Gonzalez IL, Bautista-Wong C, Cienfuegos-Meza J, Campos-Peralta K, Jimenez-Fuentes E. P1.09-22 Programmed Death Ligand-1 Expression in Non-Small Cell Lung Cancer in Mexican Population and Correlation with Clinicopathologic Features. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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