1/93. Sclerosing mesenteritis seen clinically as pancreatic pseudotumor: two cases and a review.Sclerosing mesenteritis is an uncommon nonneoplastic inflammatory process in the mesentery that is seen as a pseudotumor, usually involving the small bowel mesentery, the mesenteric fat, and less commonly, the mesentery of the large bowel. We report two cases of sclerosing mesenteritis and review the literature on this rare disease. Both patients had pain, profound weight loss, and a mass on computed tomography (CT) scan of the abdomen. The provisional diagnosis was pancreatic neoplasm on the basis of clinical presentation and imaging studies. The diagnosis of sclerosing mesenteritis was established by histologic findings in biopsy material obtained at laparotomy in both cases. Interval histologic studies in one patient who had a high CA 19-9 level, progressive biliary ductal and partial duodenal compression, revealed a transitional histologic pattern from predominant inflammation and fat necrosis to predominant fibrosis. This may explain the varied descriptive terms used in the literature to describe this entity.- - - - - - - - - - ranking = 1keywords = mater (Clic here for more details about this article) |
2/93. Histopathologic effects of radiofrequency catheter ablation in previously infarcted human myocardium.INTRODUCTION: The use of catheter-based radiofrequency (RF) ablation for the treatment of ventricular tachyarrhythmias due to previous myocardial infarction has been steadily increasing. The histopathologic changes caused by this technique are not well described in humans. methods AND RESULTS: Three patients with hemodynamically tolerated ventricular tachycardias (VTs) due to previous myocardial infarction underwent endocardial mapping and catheter based RF ablation. All patients received between 5 and 11 RF lesions each of 60-second duration. One patient underwent myocardial resection of a left ventricular aneurysm 1 day following RF ablation, one expired 7 days after RF ablation, and one expired 9 months after RF ablation. None of the deaths occurred as a result of RF ablation. Pathologic specimens obtained early after RF ablation revealed areas of focal acute inflammation and fibrin deposition. Later specimens revealed several focal areas of fibrosis and granulation tissue. Specimens obtained late after RF ablation revealed a dense band of fibrosis, measuring 17 x 17 x 5 mm (1,250 mm3). CONCLUSION: Catheter-based RF ablation of ischemic VT in humans causes lesions that initially resemble coagulation necrosis. This is followed by the development of an inflammatory infiltrate and, finally, the development of fibrosis. Repeated application of RF ablation may result in much larger lesions than have been previously reported.- - - - - - - - - - ranking = 0.22982262239344keywords = dura (Clic here for more details about this article) |
3/93. A case of renal pseudotumor associated with chronic pachymeningitis.BACKGROUND: A 56-year-old woman was referred to our hospital with a left renal mass. methods/RESULTS: Radiologic studies demonstrated a solitary space-occupying lesion in the left kidney and a malignant tumor was suspected. Left radical nephrectomy was then performed. Pathological examination revealed a sclerotic fibrous lesion with a rather distinct margin and no evidence of malignancy. These pathological findings were consistent with the diagnosis of a renal pseudotumor. CONCLUSIONS: This patient had a history of chronic pachymeningitis that formed a thoracic epidural focus causing spinal cord compression and the histologic appearance of this focus was similar to the renal lesion. It was concluded that this was a rare case of a renal pseudotumor associated with multifocal fibrosclerosis.- - - - - - - - - - ranking = 0.22982262239344keywords = dura (Clic here for more details about this article) |
4/93. Postoperative alveolar hydatid disease with cutaneous-subcutaneous involvement.The first Japanese case of alveolar hydatid disease with cutaneous-subcutaneous lesions is reported. The patient, a 58-year-old man who developed an indurated subcutaneous tumor on the right side of the abdomen, had had partial hepatectomy of the right lobe for echinococcosis thirteen years earlier. Clinically, the tumor was adherent with a fistulosis communication to deeper structures. Histopathologically, multiple PAS-positive cuticular layers with foreign body granulomas and fibrosis were observed between the dermis and subcutaneous fatty tissue. Surgical excision of the swelling provided the patient with temporary relief. To our knowledge, only eight cases of subcutaneous alveolar hydatid disease have been reported throughout the world. Ours, the ninth case, highlights the importance and difficulty of treating of alveolar hydatid disease.- - - - - - - - - - ranking = 0.22982262239344keywords = dura (Clic here for more details about this article) |
5/93. Subretinal fibrosis and choroidal neovascularization in Vogt-Koyanagi-Harada syndrome.BACKGROUND: To describe clinical findings of subretinal fibrosis and choroidal neovascularization in patients with Vogt-Koyanagi-Harada (VKH) syndrome. methods: We retrospectively reviewed 75 medical records of patients with VKH seen at the National eye Institute, Bethesda, maryland between 1978 and 1996. Recorded data included age, gender, race, duration of disease, extraocular manifestations, best-corrected visual acuity, slit-lamp biomicroscopy, retinal examination, retinal photographs and fluorescein angiograms. We sought features that correlated with the visual outcome. RESULTS: Thirty of 75 (40%) patients developed subretinal fibrosis. Eleven patients (14.7%) had choroidal neovascularization. Presence of subretinal fibrosis was associated with a longer duration of the disease (42.6 vs 19.1 months, P = 0.07). patients with subretinal fibrosis had worse visual acuity than those without subretinal fibrosis (26.2 vs 57.3 ETDRS letters read, P < 0.001) after adjusting for duration of disease (P = 0.021), degree of vitreous haze (P = 0.074), and use of immunosuppressive therapy (P = 0.008). CONCLUSIONS: Presence of subretinal fibrosis in patients with VKH is associated with a poor visual prognosis. The diagnosis of choroidal neovascularization and subretinal fibrosis presents a challenge in the management of this disease.- - - - - - - - - - ranking = 0.68946786718031keywords = dura (Clic here for more details about this article) |
6/93. Chronic unilateral ureteral obstruction represented as renin-dependent hypertension.A 50-year-old woman developed renin-dependent hypertension immediately after accidental unilateral ureteral ligation during hysterectomy, and the hypertension lasted for 5 months. Surgical release of the obstruction was carried out 157 days after the ligation. Then, her blood pressure was normalized. However, the obstructed kidney showed intensive tubulointerstitial fibrosis and functional recovery was not obtained. This case suggests that the renin-angiotensin system may be upregulated in human kidney during unilateral ureteral obstruction for a long duration.- - - - - - - - - - ranking = 0.22982262239344keywords = dura (Clic here for more details about this article) |
7/93. Capillary hemangioma of the spinal cord. Report of four cases.The authors describe the clinicopathological features of four cases of capillary hemangioma of the spinal cord. All occurred in adult patients. The presenting symptoms were similar to those of more common intramedullary tumors. Radiologically, they resemble other vascular spinal cord tumors. All patients underwent surgery, and the outcomes varied. Histologically, the lesions resembled capillary hemangioma of skin or of soft tissue that is composed of lobules of small capillaries with associated feeding vessels, all enveloped by a delicate fibrous capsule. Capillary hemangiomas of the central and peripheral nervous system are extremely rare. Although examples of these lesions have been described as occurring in the dura mater and in peripheral nerve, including spinal nerve roots, none has occurred within the spinal cord. knowledge of their existence may help practitioners to avoid misdiagnosis of tumor and resultant overtreatment of these benign lesions.- - - - - - - - - - ranking = 1.2298226223934keywords = mater, dura (Clic here for more details about this article) |
8/93. Cervical epidural pseudotumor and multifocal fibrosclerosis. Case report and review of the literature.The authors present the case of a 45-year-old man suffering from progressive quadriplegia due to an expansive C3-T2 epidural mass. Neuropathological examination demonstrated pseudotumor tissue. The patient had had an orbital pseudotumor 5 years before admission, and other systemic manifestations of an idiopathic inflammatory disease were discovered. This case is extremely rare. Nine cases of multifocal fibrosclerosis with central nervous system involvement are described in the literature. To the authors' knowledge, this is the first description of a cervical epidural pseudotumor. Modern imaging has made the diagnosis of such an entity possible, and it is important for the neurosurgeon to consider this syndrome because the combination of surgery and systemic medical therapy can ensure a long-term survival with good quality of life.- - - - - - - - - - ranking = 1.3789357343606keywords = dura (Clic here for more details about this article) |
9/93. Diabetic mastopathy: a report of 5 cases and a review of the literature.BACKGROUND: Diabetic mastopathy is an unusual fibroinflammatory breast lesion that characteristically presents in premenopausal women with long-standing type 1 diabetes mellitus with multiple microvascular complications. The pathogenesis of this condition is believed to involve an autoimmune reaction to the accumulation of abnormal matrix induced by hyperglycemia. Clinicopathologic features include the development of dense keloidlike breast masses that are often recurrent or bilateral or both. Clinical distinction from a malignancy can be difficult. However, the benign nature of this lesion is easily recognized on histologic examination, and it is not associated with an increased incidence of epithelial or stromal neoplasia. HYPOTHESIS: A constellation of histopathologic and clinical features is necessary to make the diagnosis of diabetic mastopathy. Unnecessary surgery can be avoided in the clinical follow-up of patients with multiple, bilateral, and recurrent lesions. DESIGN: Case series. patients AND methods: Between December 1993 and December 1998, 5 premenopausal women with type 1 diabetes mellitus of 18 to 23 years' duration presented with nontender, palpable, firm-to-hard breast masses. To date, progression of the tumorlike proliferations has been bilateral and recurrent in 2 patients, bilateral in a third patient, and recurrent in a fourth. The fifth patient has developed neither bilateral nor recurrent lesions. Imaging studies did not in any patient demonstrate a focal lesion. All lesions were treated by either excisional (4 patients) or core (1 patient) biopsy. The resected specimens were examined histopathologically. RESULTS: Gross examination of the specimens showed firm masses with homogeneous tannish-white cut surfaces. They measured between 3.0 and 6.0 cm in maximum diameter. Microscopic examination showed keloidal fibrosis with ductitis, lobulitis, and vasculitis. The clinical profile in combination with these pathologic features is characteristic of diabetic mastopathy. CONCLUSIONS: physicians should be aware of the association of long-standing diabetes mellitus with the development of benign fibroinflammatory breast lesions when managing these in premenopausal women. We outline the constellation of findings on clinical examination, medical history, imaging studies, and histopathologic examination that are required to make the diagnosis of diabetic mastopathy. Although these breast masses may be recurrent, they are not premalignant. In the appropriate setting, the diagnosis can be made by core biopsy, avoiding unnecessary surgeries in patients with multiple, bilateral, or recurrent lesions.- - - - - - - - - - ranking = 0.22982262239344keywords = dura (Clic here for more details about this article) |
10/93. Fibromucinous T-cell lymphoma: a new clinicopathologic variant of mycosis fungoides?We report a case of mycosis fungoides associated with extensive dermal fibrosis and mucin deposition. The patient developed indurated plaques with diffuse tightening of the skin reminiscent of the sclerosing disorder scleromyxedema, which was later associated with nodules and lymphadenopathy. skin biopsies showed diffusely thickened collagen bundles in the dermis and mucin deposition with a dense infiltrate of atypical lymphocytes with an immunophenotypic pattern indicative of mycosis fungoides. In our opinion, these clinical and histopathologic features are unusual for mycosis fungoides and can be construed as a distinct fibromucinous variant. Alternatively, this may represent a fibrosing reaction pattern similar to that described with systemic T- and B-cell lymphomas or a variety of inflammatory disorders.- - - - - - - - - - ranking = 0.22982262239344keywords = dura (Clic here for more details about this article) |
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