1/9. Giant cell ependymoma of the spinal cord. Case report and review of the literature.Several rare histological variants of ependymoma have been described. The authors report on a patient in whom cervical spinal cord astrocytoma was originally diagnosed after evaluation of a limited biopsy specimen. More abundant tissue obtained during gross-total resection included areas of well-differentiated ependymoma. The histological features of the tumor were extremely unusual, with a major component of pleomorphic giant cells. Its histological, immunohistochemical, and electron microscopic features, however, were consistent with ependymoma. Only two cases of terminal filum and two of supratentorial giant cell variant of ependymoma have been reported. To the authors' knowledge, this represents the first case of giant cell ependymoma of the spinal cord. The clinical significance is the potential for misdiagnosis with anaplastic (gemistocytic) astrocytoma, especially in cases in whom limited biopsy samples have been obtained.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/9. Undifferentiated endometrial carcinoma of the uterus: marked effect of chemotherapy with tetrahydropyranyl-adriamycin, paclitaxel, and carboplatin.Undifferentiated endometrial carcinoma of the uterus is rare, and is thought to show a poor prognosis. To date, there is no consensus as to the optimal chemotherapy for this carcinoma. We report a rare case of this carcinoma in a patient who was treated surgically in combination with chemotherapy using a regimen designed by us. This chemotherapy consists of tetrahydropyranyl-adriamycin, paclitaxel, and carboplatin. This regimen is called TTJ [tetrahydropryanyl-adriamycin, taxan (paclitaxel), JM-8 (carboplatin)] chemotherapy and showed a marked effect. The patient was a 52-year-old woman with a giant tumor of the uterus measuring 28 x 18 x 13 cm and weighing 3386 g. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy, but residual carcinoma remained on the surface of the small intestine. Pathologically tumor tissues comprised the whole uterus except for the uterine cervix and there were tumor tissues in the omentum. She was treated with six courses of TTJ chemotherapy without major side-effects. Currently, she remains alive without metastasis 41 months after hysterectomy. This report describes a rare case of undifferentiated endometrial carcinoma of the uterus and introduces TTJ chemotherapy resulting in the remarkable effect on this carcinoma.- - - - - - - - - - ranking = 0.33333333333333keywords = giant (Clic here for more details about this article) |
3/9. Giant cell carcinoma of the hypopharynx: pathologic diagnosis and natural history.A 48-year-old man was initially seen with a giant cell carcinoma arising in the right piriform fossa. Following debulking, the tumour was treated with chemoradiation. The patient subsequently underwent laryngopharyngectomy. Distant metastases developed 10 months following treatment, despite the absence of locoregional recurrence. To our knowledge, this is the first reported case of giant cell carcinoma of the hypopharynx and first giant cell carcinoma of the laryngopharynx treated with chemoradiation. Based on our experience, surgery should remain the primary intervention to achieve locoregional control.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/9. No evidence of disease after radiofrequency ablation in delayed nephrectomy specimens.OBJECTIVES: Computed tomography and magnetic resonance imaging are routinely used during follow-up of radiofrequency ablation (RFA) of renal masses. Widespread acceptance of needle ablation is limited by the need to rely on radiographic criteria to confirm effective ablation. In this report, we correlated the long-term radiographic appearance of RFA with the histologic findings in three delayed nephrectomy specimens. This should enhance our understanding of the histopathologic features of successful RFA and highlight potential shortcomings of modern imaging after ablation. methods: Radiographic and histologic data were analyzed in 3 patients who underwent delayed partial or total nephrectomy after RFA, performed for complications or misinterpretation of postablation surveillance imaging findings. RESULTS: Two delayed nephrectomies were performed for new enhancement at the periphery of the ablation zone margin and one for RFA-related ureteropelvic junction obstruction. At the initial ablation, all 3 patients had biopsy-proven renal cell carcinoma, and the mean time to delayed nephrectomy was 18 months. Histologically, all three demonstrated absence of residual cancer within the ablation zone. In the patients with enhancement at the periphery of the ablation zone, a granulomatous foreign body giant cell reaction was found. CONCLUSIONS: RFA is an effective technology for eradicating small renal cell carcinomas. However, proper image interpretation after ablation is a crucial component of patient care. New enhancement at the peripheral margin of the tumor ablation zone does not invariably suggest malignant recurrence, but a benign granulomatous reaction. Additional experience with interpretation of cross-sectional imaging is required to better understand the radiographic evolution of radiofrequency-ablated renal tumors.- - - - - - - - - - ranking = 0.33333333333333keywords = giant (Clic here for more details about this article) |
5/9. Fatal postoperative 'pituitary apoplexy': its cause and management.Two cases of giant pituitary tumours are reported. The patients underwent transcranial operation, one by the pterional and one by the subfrontal route. Only partial resection of the tumour was possible in each instance for various reasons. Acute worsening of the clinical condition in the immediate postoperative phase led to reoperation in both patients. In one case the reoperation was carried out within 45 min of the closure of the wound and in the other after 12 h. Massive swelling of the tumour with evidence of haemorrhagic infarction was a surprise finding. After a turbulent postoperative phase, both patients died. We postulate that these patients developed pituitary apoplexy of the residual tumours.- - - - - - - - - - ranking = 0.33333333333333keywords = giant (Clic here for more details about this article) |
6/9. Craniofacial treatment of giant-cell tumors of the sphenoid bone.We report a craniofacial approach for resection of a giant-cell tumor of the sphenoid bone. Complementary radiotherapy was performed because of the incomplete tumor remotion. Four-year follow-up is presented.- - - - - - - - - - ranking = 1.6666666666667keywords = giant (Clic here for more details about this article) |
7/9. Giant cranial base tumours.Thirty-three patients with giant (diameter > or = 4.5 cm) cranial base tumours who underwent surgery at the Hadassah Hospital over the last ten years are described. Twenty-three of the patients had meningiomas, 4 neurinomas, one giant cell tumour, one haemangiopericytoma, and 4 had malignant meningiomas. Four tumours were at the cerebellopontine angle, 9 within the anterior cranial fossa, 8 petroclival, 8 on middle fossa floor, and 4 along the sphenoid ridge. The average pre-operative symptom duration was 31 months, range 3-180 months. Nineteen patients had a radical tumour resection, 10 subtotal, and 4 a partial resection on an average 1.7 operations per patient. The mean follow-up period from the first operation was 39 months (range 2-120). There was no mortality peri-operatively or during the follow-up period. The mean pre-operative Karnofsky score was 68 and at the last follow-up 76. There was no correlation between histology and degree of resection, complications, or status at last follow-up. The best resections (92% radical) and outcome (mean Karnofsky 92) with the least number of operations (mean 1.4) were in the anterior fossa and along the sphenoid wing. The patients requiring the most operations (mean 2.1), having the smallest percentage of radical resections (25%) and the least favourable outcomes (mean Karnofsky 52) were those with petroclival tumours. patients with giant cranial base tumours have a good overall long-term prognosis, but especially those with petroclival tumours challenge us to improve our techniques.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
8/9. Giant intrasacral schwannoma forming a presacral mass: a report of an unusual cause of lumbosacral radiculopathy.Schwannomas are extremely rare tumours deriving from cells within the neurilemma. The authors report a case of giant intrasacral schwannoma presenting in the presacral region. The tumour presented with a lumbosacral pain and it was removed totally by two-stage surgical intervention. When seen five years after the second surgical intervention, the patient was asymptomatic. The rarity of such cases prompted this report.- - - - - - - - - - ranking = 0.33333333333333keywords = giant (Clic here for more details about this article) |
9/9. Metastatic malignant meningioma of the liver with hypoglycemia: report of a case.We herein present the case of a 68-year-old male who suffered an episode of hypoglycemic shock 2 years after undergoing total removal of a bifrontal parasagittal malignant meningioma. Imaging studies revealed three giant hypervascular tumors with a cystic portion in the right lobe, but no confirmed preoperative diagnosis could be made. At laparotomy, liver tumors were found in the medial segment of the left lobe as well as in the right lobe, and thus an extended right lobectomy was performed. All the resected tumors were histologically diagnosed as metastatic malignant meningiomas of the liver. Despite subsequent transarterial chemoembolization for a recurrence in the residual liver, the patient died 11 months after surgery. To the best of our knowledge, only one other case of a hepatectomy for liver metastases from an intracranial malignant meningioma has been reported in the literature, but there has never been any report of surgical treatment for a metastatic meningeal tumor in the liver associated with hypoglycemia. Although our surgical treatment provided effective palliation, the prognostic significance of a surgical strategy for such patients has yet to be established.- - - - - - - - - - ranking = 0.33333333333333keywords = giant (Clic here for more details about this article) |