Adult granulosa cell tumour of the testis and bony metastasis. A report of the first case of granulosa cell tumour of the testicle metastasising to bone

Granulosa cell tumour is among the rarest forms of testicular cancer. Only 21 cases have been reported to date and only 4 have metastasised. All documented metastases are intra-abdominal. We present the first case of granulosa cell tumour of the testis metastasising to bone (tibia), presenting 6 years after orchidectomy. This highlights the need to maintain a high index of suspicion for extra-abdominal metastases during long-term follow-up in patients with previous testicular granulosa cell tumour.

Choroid plexus papilloma of the posterior third ventricle during infancy & childhood: report of two cases with management morbidities

We report two cases of posterior third ventricular choroid plexus papilloma, one in an 8-month-old infant and another in a two-year-old child. These cases presented with features of obstructive hydrocephalus. Both these patients underwent a ventriculo-peritoneal (VP) shunt surgery prior to the tumor excision. Following the VP shunt surgery both patients developed ascitis requiring exteriorization of the abdominal end of the shunt. There was a clear proof of CSF overproduction: 1400-1500 ml/day in the eight-month-old infant and 900-1200 ml/day in the two-year-old child. In the former it was transient and could be treated with revision of the VP shunt whereas in the second case a ventriculo-arterial shunt had to be done. In the second case a staged reduction cranioplasty was also performed for an enormously enlarged head (head circumference--74 cm). Interesting clinical and radiological findings and useful management strategies are described.

Pediatric giant cell granuloma of the temporal bone: a case report and brief review of the literature

Giant cell granuloma of the skull base is a distinct rare clinicopathologic lesion, which progressively destroys the involved bone. It causes increased intracranial pressure and mass effect on the brain. Histologically it may mimic an aneurysmal bone cyst, giant cell tumour and the brown tumour of hyperparathyroidism. Although cited by some authors, the role of trauma in its aetiology is still considered controversial. Authors present an interesting case of a 12 year old Omani boy who sustained a cricket bat injury to his right temporal region from which he initially recovered but later on progressively developed vertigo, tinnitus, right hearing loss and a mild right facial weakness. Computed tomography (CT scan) and Magnetic resonance imaging (MR scan) revealed a large destructive lesion of the temporal bone. Microsurgical excision was curative. Interesting clinicoradiological findings are presented with a brief review of the literature.

Symptomatic cranial fibrous dysplasias: clinico-radiological analysis in a series of eight operative cases with follow-up results

Cranial fibrous dysplasias are rare and comprise less than one percent of all primary bone lesions. These painless progressively expanding destructive bone swellings produce cosmetic deformities (commonest), sino-orbital and auditive complications (less common), peripheral compressive cranial neuropathies (uncommon) and compressive central neurological manifestations (rarest). Until recently some of the primary dysplastic skull base lesions were either treated expectantly or excised incompletely. In a significant percentage of cases, these lesions were considered inaccessible. However, with the development of modern neuro-imaging (CT and MRI) and the applications of current skull base approaches, the more aggressive and radical surgical procedures are being undertaken, with a significant improvement in overall outcome. We present a series of 8 cases of fibrous dysplasia in the age group of 10-33 years with a mean age of 19.75 years. Four cases each had monostotic type and polyostotic type. All patients presented with mild to moderate headaches, and seven cases with some form of cosmetic deformity. In 4 patients there was a unilateral proptosis, while only two had visual deterioration. One patient had anosmia and one hearing impairment. In one case fibrous dysplasia was hemicranial, and in another case the disease was pancranial. Neuro-imaging studies have well delineated the extent of the lesions. In two patients with unilateral fronto-orbital fibrous dysplasia, the removal of dysplastic bone, autoclaving and remodeling and replacement were performed. In two patients of sphenoidal wing fibrous dysplasia a total excision was possible. In the remaining four patients, a partial excision was performed. Overall outcome was good. There was no mortality. One patient had recurrent post-operative extradural haematomas. The authors present the results of an analysis of eight surgically treated cases of symptomatic cranial fibrous dysplasias along with their long-term outcome and the lessons learnt from this series.

An unusual posterior mediastinal lipoblastoma with spinal epidural extension presenting as a painful suprascapular swelling: case report and a brief review of the literature

Lipoblastoma is a rare benign pediatric neoplasm of fetal-embryonal fat with little risk of recurrence following total microsurgical excision, but it may progress to local invasion or infiltration if not treated surgically. No adjuvant therapies are usually necessary once the tumor is excised. It is best diagnosed on histopathological studies following excision. An unusual posterior mediastinal lipoblastoma in a 2-year-old Omani girl with spinal epidural extension clinically manifested as a progressive painful suprascapular swelling is reported. It was initially construed to be a benign lipoma, but progressively increasing pain and mild imbalance whilst walking with a tendency to fall on the right side prompted neurosurgical referral and eventual total excision without any added morbidity. Interesting clinical and neuroimaging (CT & MRI) findings are presented and discussed, with a brief review of the literature.

Congenital intra-extracranial dumbbell schwannoma of temporal fossa unassociated with any major cranial nerve

Intracranial schwannomas commonly arise from the vestibular nerve and less commonly from other cranial nerves. On rare occasions, they may be intraparenchymatous, intraventricularor intrasellar. However, the occurrence of a congenital solitary intracranial extradural schwannoma unrelated to any cranial nerve in the absence of von Recklinghausan's syndrome is exceptional. The authors report a unique, heretofore unreported case of a congenital temporal extradural schwannoma, unassociated with any known cranial nerve and with a transcranial extension presenting as a temporal fossa mass since birth in a 16-year-old female patient. Total resection of this tumour was uncomplicated. A brief review of the relevant literature is presented.

An unusual presentation of an intra-parenchymatous frontal yolk sac tumour : case report

Yolk sac tumours are rare conditions among the germ cell tumours. Intracerebral germ cell tumours are exceedingly rare. A 15 year old girl presenting with a one week history of raised intracranial pressure is described. She had bilateral papilloedema and a right 6th nerve palsy. CT scan showed an intra-parenchymatous right frontal ring enhancing lesion of 2 cms diameter. The patient underwent microsurgical total excision of the tumour, followed by chemotherapy. She was asymptomatic at three years following surgery.

Aspergillus spinal epidural abscess

Spinal abscess due to Aspergillus is rare. A young boy with chronic granulomatous disease and aspergillosis of the rib had been treated with antifungal treatment 3 months earlier. The patient presented with a brief history of progressive paraparesis. Imaging showed D9--11 vertebral involvement and destruction of the D10 vertebral body with angulation and a large dorsally placed, multiloculated epidural abscess extending from D6 to L2. There was also extensive granulation anterior to and on either side of the vertebrae. The patient underwent extensive laminectomy and decompression of all the loculi and partial removal of the granulation tissue. Aggressive medical treatment was started. The authors recommend an aggressive surgical and medical approach in such cases of disseminated invasive aspergillosis, even though the result may not be very satisfactory. This report discusses the full clinical profile and management of Aspergillus spinal epidural abscess and emphasizes the need to follow up these cases to detect recurrence and new lesions, even if the patients are on adequate medical treatment. In spite of all efforts, high morbidity and mortality is common in such patients.

Sciatica due to malignant nerve sheath tumour of sciatic nerve in the thigh

Malignant peripheral nerve sheath tumour (MPNST) is a rare malignant neoplasm arising from the supportive non-neural component of the peripheral nerves. An unusual case of pain and weakness of the foot and calf muscles due to a giant MPNST of the sciatic nerve in the posterior compartment of the thigh is presented. The patient was already investigated as a case of sciatica due to a lumbar disc disease with a negative magnetic resonance imaging and then unsuccessfully operated elsewhere twice, with a misdiagnosis of tarsal tunnel syndrome. Neurosurgical referral prompted a diagnostic magnetic resonance study of the thigh, revealing the lesion, which was completely excised microsurgically with total relief in the pain and partial improvement in the weakness and sensations in the sole of the foot.

Congenital and late-onset primary haemangiomas of the temporalis muscle: case report

We report on two patients with haemangiomas of the temporalis muscle, one congenital and one of late onset, which were diagnosed on computed tomography. Both were resected successfully and both patients are well with no signs of recurrence 3(1/2) years and 18 months later, respectively.

Endodermal cyst of septum pellucidum and pregnancy: a case report

BACKGROUND

Endodermal or Neurenteric cysts are commonly found in spine. Their intracranial occurrence is rare and such a cyst in the septum pellucidum is exceptional.

METHOD

We report a woman, with 33 week pregnancy, presenting in a semiconscious state due to raised intracranial pressure (ICP) due to hydrocephalus caused by a large lesion in the septum pellucidum. Computed tomography (CT) revealed the lesion which was better characterised by the Magnetic Resonance Imaging (MRI). First baby was delivered by LSCS and bilateral ventriculo-peritoneal shunts were inserted; and later on the cyst was excised.

RESULT

There was full neurological recovery following the insertion of VP shunt. After excision of cyst cerebrospinal fluid (CSF) pathway was established and shunts could be removed. Post-operative period was complicated by septic ventriculitis. Eventually patient was discharged home in excellent condition.

CONCLUSION

Endodermal cyst of septum pellucidum is an uncommon condition. Such lesions may be large when revealed, good outcome is expected after surgical excision.

Pathological prognostic factors in breast carcinoma

OBJECTIVE

Pathological prognostic factors in breast cancer are now widely used to predict biological behavior of cancer and to plan its effective management. In this paper, we attempt to evaluate the reports from our histopathology laboratory spanning over a period of 4 years, to assess completeness in recording these factors. It will enable us to improve and standardize reporting on breast cancer.

METHODS

The pathology reports of primary carcinoma of the breast diagnosed in our laboratory from 1st January 1994 to 31st December 1997 (4 year period) were reviewed for details on tumor size, histological type and grade, presence or absence of tumor emboli in vascular channels, proximity of the tumor to resection margins and lymph node status.

RESULTS

Tumor size was not recorded in 1 case each in 1994, 1995 and 1996 and 2 cases in 1997. Histological type was mentioned in all cases in 1995 and 1997. It was not mentioned in 1 case in 1994 and 3 cases in 1996. Out of 77 cases with axillary clearance, the total number of lymph nodes was recorded in 83% of cases. The number of lymph nodes with metastasis was recorded in 71% of cases.

CONCLUSION

Our histopathology laboratory receives the majority of surgical biopsies carried out in the Sultanate of Oman. During our study period we received a total of 45354 biopsies. From 1993 onwards, pathological prognostic factors of breast carcinoma were incorporated in our pathology reports following the publication of major and leading articles regarding the same. This study shows an improvement in the quality of reports after introducing this concept in 1994. This study clearly reveals the necessity for written protocols to be established, to standardize and improve the quality of reporting.

Frontal intraosseous cryptic hemangioma presenting with supraorbital neuralgia

Primary intraosseous cranial hemangiomas are rare benign tumors comprising 0.2% of all osseous neoplasms. Symptomatic cranial cryptic hemangiomas are extremely rare. We report the case of a 43-year-old man with a cryptic hemangioma of the superior orbital rim. Radiological investigations revealed it to be an intraosseous cryptic mass which was totally excised and the supraorbital nerve was decompressed, relieving the patient of his symptoms. Histopathology showed features of an intraosseous hemangioma.

Pattern of breast neoplasms in Oman

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Gastric carcinoma in the Sultanate of Oman: Incidence and distribution

Gastric carcinoma has always been considered a major problem in the Sultanate of Oman. This study was conducted to document the cases in Oman over a two-year period, in order to determine incidence, age, sex and geographical distribution of the condition. All cases of gastric carcinoma in Omani nationals presenting to the medical facilities throughout Oman from November 1987 to November 1989 were reviewed from pathology records, surgical database records and by personal communication with surgeons at regional hospitals. Specimens taken at surgery or endoscopic biopsy were examined and classified according to Lauren's criteria. Over the two-year period, 104 cases of gastric carcinoma were observed. This represented an annual incidence of 4.2/100,000 population, but when adjusted to the standard European population age distribution (in the Oman population, 51% are under 15 years of age), the incidence was 8.6/100,000. The male:female ratio was 1.6:1 and the peak age group was 60-69. All tumors were advanced and most were located in the antral part of the stomach. There were more intestinal types of tumors than diffuse and a preponderance of intestinal metaplasia. This first survey of stomach carcinoma in Oman will provide a reference for future studies and indicates the need for earlier detection.