1/18. Foreign body reaction to hemostatic materials mimicking recurrent brain tumor. Report of three cases.Chemical agents routinely used in neurosurgery to achieve intraoperative hemostasis can cause a foreign body reaction, which appears on magnetic resonance (MR) images to be indistinguishable from recurrent tumor. Clinical and/or imaging evidence of progression of disease early after surgical resection or during aggressive treatment may actually be distinct features of granuloma in these circumstances. A series of three cases was retrospectively analyzed for clinical, imaging, surgical, and pathological findings, and the consequences they held for further disease management. All patients were boys (3, 3, and 6 years of age, respectively) and all harbored primitive neuroectodermal tumors. Two tumors were located in the posterior fossa and one was located in the right parietal lobe. Two boys exhibited clinical symptoms, which were unexpected under the circumstances and prompted new imaging studies. One patient was asymptomatic and imaging was performed at planned routine time intervals. The MR images revealed circumscribed, streaky enhancement in the resection cavity that was suggestive of recurrent disease. This occurred 2 to 7 months after the first surgery. At repeated surgery, the resected material had the macroscopic appearance of gelatin sponge in one case and firm scar tissue in the other cases. Histological analysis revealed foreign body granulomas in the resected material, with Gelfoam or Surgicel as the underlying cause. No recurrent tumor was found and the second surgery resulted in imaging-confirmed complete resection in all three patients. Because recurrent disease was absent, the patients continued to participate in their original treatment protocols. All patients remain free from disease 34, 32, and 19 months after the first operation, respectively. During or after treatment for a central nervous system neoplasm, if unexpected clinical or imaging evidence of recurrence is found, a second-look operation may be necessary to determine the true nature of the findings. If the resection yields recurrent tumor, additional appropriate oncological treatment is warranted, but if a foreign body reaction is found, potentially harmful therapy can be withheld or postponed.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
2/18. A foreign body embedded in the mobile tongue masquerading as a neoplasm.foreign bodies in a mobile tongue are rarely presented to the laryngologist, because such bodies are commonly lodged superficially and are easily removed by the patients themselves or by general practitioners. Thus, it is rare that a foreign body totally embedded in the mobile part of the tongue presents as an enlarged tongue mass. We have described a 64-year-old female with a 3-month history of an enlarged mass in the anterior right tongue. physical examination showed a mass located in the anterior right tongue, with intact mucosa and normal color. A benign tongue neoplasm was considered first. However, a fish bone totally embedded in the mobile tongue with granuloma formation was encountered during the incisional biopsy operation. Complete removal of the foreign body with granuloma was achieved under local anesthesia. There was no neuromuscular or neurosensory deficit of the tongue in the follow-up period of 2 years. Although an embedded foreign body in the mobile tongue is a rare condition, it should be considered in the work-up of a patient with an enlarged tongue mass, with or without a history of swallowing a foreign body.- - - - - - - - - - ranking = 5keywords = neoplasm (Clic here for more details about this article) |
3/18. cholesterol granuloma of the cerebello-pontine angle.An unusual case of cholesterol granuloma of the temporal bone is described presenting as a cerebellopontine tumor. This lesion seemed to arise from an inflammatory process obstructing pneumatized cells. It consists of extradural granulation tissue and must be distinguished from intradural epidermoid cyst, which is, instead, a dysembryogenetic neoplasm. Simple drainage of the granuloma was accomplished by posterior fossa approach, but the lesion recurred after a year. The diagnosis and surgical management of cholesterol granuloma are discussed.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
4/18. Vertebral body granuloma of the cervical region after pencil injury.OBJECTIVE AND IMPORTANCE: granuloma formation has been reported as a rare complication of pencil lead injury. Insufficient data exist regarding pencil lead injuries of the cervical spine. We present the findings in an 18-year-old male patient with secondary granuloma formation after a penetrating transoral pencil injury. We suggest that imaging characteristics and a detailed history will assist with the diagnosis of such lesions. CLINICAL PRESENTATION AND INTERVENTION: The patient was an 18-year-old man who presented with cervical pain. His history included falling as a child while having a pencil in his mouth. T2-weighted imaging studies documented a 1- x 1-cm enhancing lesion posterior to the vertebral body at the C3 level. The patient underwent a C3 vertebrectomy, and specimens were notable for infection, pencil lead, and granuloma formation. CONCLUSION: In the evaluation of a potential granuloma or mass lesion of the cervical spine in a child or adolescent, the differential diagnosis may include a neoplasm. Although computed tomography is an ideal tool to detect foreign objects, including pencil leads, only awareness of the potential for pencil lead injuries and that pencil lead fragments may remain unrecognized on computed tomographic scans will assist the physician in diagnosing such injuries.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
5/18. Expanding MIRAgel scleral buckle simulating an orbital tumor in four cases.PURPOSE: To describe four patients with an enlarging orbital mass from a swollen MIRAgel scleral buckle that simulated an orbital neoplasm. methods: In a retrospective, single-center case series at the Ocular Oncology Service at wills eye Hospital of Thomas Jefferson University, 4 eyes of 4 patients were referred for evaluation and treatment of a suspected orbital tumor. RESULTS: The initial presenting features were orbital mass (case 1), strabismus (case 2), and conjunctival mass with orbital extension (cases 3 and 4). Each patient vaguely recalled previous uncomplicated retinal detachment surgery 12 to 20 years earlier. Confirmation of the buckling implant material was made with the retina surgeon in 3 cases. A nontender, forniceal conjunctival mass, deep to the Tenon fascia and appearing as a translucent firm elevation was seen in all 4 cases. Axial CT (case 1) revealed a circumscribed anterior temporal orbital mass, believed to be a large inclusion cyst, 4 times thicker than the nasal scleral buckle. Ocular ultrasonography depicted an echolucent mass in the episcleral region (cases 3 and 4) that was 2 times thicker than the nasal scleral buckle (case 3). Excision was attempted in case 1, but only piecemeal removal was achieved, leading to extensive postoperative inflammation and decreased vision. The other 3 cases were followed conservatively without excision because they were each recognized to be a swollen MIRAgel implant and not an orbital tumor. CONCLUSIONS: MIRAgel scleral buckle material can greatly enlarge over a period of 10 years and simulate an orbital tumor or orbital cyst. patients often do not recall details of the retinal surgery. Caution is advised regarding excision of this material because it is friable and can lead to extensive postoperative inflammation.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
6/18. cholesterol granuloma of the maxillary sinus resembling an invasive, destructive tumor.The case of a maxillary sinus cholesterol granuloma posing as a malignant tumor is presented. The patient was referred to the authors' clinic with symptoms typical of maxillary sinusitis, but physical examination suggested the presence of neoplasm. radiology also resulted in confusing, tumor-like pictures. Histological examination of a preoperative tissue sample identified the process as a cholesterol granuloma, which was removed by a classic Caldwell-Luc operation. The patient has been symptom free since the operation. The pathogenesis of cholesterol granuloma is described, and the problems of establishing a diagnosis without preoperative histology are discussed.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
7/18. Long-term management of extensive tracheal stenosis due to formic acid chemical burn.We report on a 26-year-old woman who during early infancy (6 months) suffered from a chemical burn of the skin and upper airways due to spill of formic acid powder. Twenty years after the initial injury, she presented with dyspnea and stridor due to severe tracheal stenosis. Several interventional bronchoscopic manipulations were initiated: incision of the stenotic lesion with Nd:YAG laser and dilatation with a valvuloplasty balloon which enabled silicone stent placement which was subsequently kept in place for 3 years. Complications during the 4th year after stenting led to the successful replacement of this stent by two autoexpandable metallic stents covering the total length of the trachea from the subglottic area to the carina. In post-burn inhalation injuries, a complex inflammatory process may be active for many years after the initial insult. These injuries respond to prolonged tracheal stenting and a conservative approach is recommended.- - - - - - - - - - ranking = 0.046003263778732keywords = complex (Clic here for more details about this article) |
8/18. FDG PET CT features of an intraabdominal gossypiboma.Retained surgical sponge or gossypiboma in the abdominal cavity is an infrequent but serious surgical complication that may lead to medicolegal problem. The incidence of a surgical sponge retained at operation is difficult to estimate, but it has been reported as 1 in 100 to 3000 for all surgical interventions and 1 in 1000 to 1500 for intraabdominal operations. The natural evolution of a retained sponge, if aseptic, is to cause a foreign body reaction, followed by organization to form a foreign body granuloma, which may mimic a soft tissue neoplasm. Although features of CT and MR imaging of gossypibomas have been documented in the literature, they have often been misinterpreted preoperatively owing to the rarity of gossypibomas in daily clinical practice and to the low index of clinical suspicion. We report the FDG PET CT findings of a 42-year-old woman who had undergone cesarean sections twice previously, with an intraabdominal gossypiboma found incidentally in a routine health examination. We hope the PET CT findings in this case offer us useful adjunctive information to conventional imaging studies in the diagnosis of gossypiboma.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
9/18. Suture foreign body granuloma masquerading as renal neoplasm.Foreign body granulomas and pseudotumors due to retained surgical linen are well known in surgical practice. These lesions usually correspond to the actual size of residual foreign body and have characteristic presentation according to the anatomy involved. Renal suture granuloma is a rare postoperative complication of renal surgery due to persistence of sutures used to close the pelvicalyceal system/nephrotomy incisions and usually present as incidentally detected small mass lesions. This case of a suture foreign body granuloma presenting with hematuria, large peripheral mass lesion and characteristic computed tomography picture of renal cell carcinoma confounded the diagnosis and underwent laparoscopic radical nephrectomy. In retrospect, such lesions warrant the use of selective needle biopsy and intraoperative frozen section confirmation to clinch diagnosis. Mass lesions occurring in a previously operated kidney should have granuloma as a differential diagnosis.- - - - - - - - - - ranking = 4keywords = neoplasm (Clic here for more details about this article) |
10/18. Infected suture granuloma: a case report.Suture granulomas mimic neoplasms in clinical appearance and may increase in frequency as dental implant therapy increases. This case report illustrates the clinical and histologic features of this sometimes perplexing postoperative complication.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
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