11/494. Clinical significance of magnetic resonance cholangiopancreatography for the diagnosis of cystic tumor of the pancreas compared with endoscopic retrograde cholangiopancreatography and computed tomography. BACKGROUND: Cystic tumor of the pancreas has been investigated by a variety of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is being widely used as a non-invasive diagnostic modality for investigation of the biliary tree and pancreatic duct system. The purpose of this study was to compare MRCP images with those of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) in order to clarify the diagnostic efficacy of MRCP for cystic tumor of the pancreas. methods: We retrospectively studied 15 patients with cystic tumor of the pancreas that had been surgically resected and histopathologically confirmed. There were five cases of intraductal papillary adenocarcinoma, five of intraductal papillary adenoma, two of serous cyst adenoma, two of retention cyst associated with invasive ductal adenocarcinoma and one of solid cystic tumor. RESULTS: In all cases MRCP correctly identified the main pancreatic duct (MPD) and showed the entire cystic tumor and the communication between the tumor and the MPD. On the other hand, the detection rate by ERCP of the cystic tumor and the communication between the cystic tumor and the MPD was only 60%. Although the detection rates by CT for the septum and solid components inside the cystic tumor were 100 and 90.0%, respectively, those of MRCP for each were 58.3 and 20.0%. CONCLUSION: MRCP is capable of providing diagnostic information superior to ERCP for the diagnosis of cystic tumor of the pancreas. Although MRCP may provide complementary information about the whole lesion of interest, the characteristic internal features of cystic tumor of the pancrease should be carefully diagnosed in combination with CT. ( info) |
12/494. mucocele of the anterior clinoid process: case report. OBJECTIVE AND IMPORTANCE: Of the primary intracranial mucoceles, those arising from the optic canal or anterior clinoid process are extremely rare. To our knowledge, only five cases have been reported. The pathogenesis of mucoceles at this unusual site is unclear, but the previously reported cases suggest that these mucoceles may originate from pneumatizing air cells in the anterior clinoid processes. CLINICAL PRESENTATION: A 43-year-old woman presented with diplopia. magnetic resonance imaging showed a small mass, compressing the optic nerve, in the medial portion of the left anterior clinoid process. The medial portion of the anterior clinoid process surrounding the mass was eroded and the bony margins of the mass were well corticated in computed tomographic scans. There was no direct connection between any paranasal sinus and the mass cavity, as assessed in imaging studies and intraoperatively confirmed. The pathological diagnosis after the operation indicated a mucocele. CONCLUSION: Considering the absence of air cells in the anterior clinoid processes, the mucocele in this case might have originated from ectopic mucinous tissue that appeared during the development of the optic canal, rather than from a pneumatizing air cell. ( info) |
| We treated a patient with a complete invagination of the cecum which contained a mucocele of the appendix secondary to an obstruction by endometriosis. Preoperatively, a barium enema showed a crab's claw-like area without filling in the oral side of the transverse colon. An emergency laparotomy was performed and revealed a mucocele of the appendix to have induced appendicecal invagination; however, no colonic invagination was observed. An appendicecal resection was thus done. Pathologically, the resected specimen was a mucosal hyperplasia with mucin-secreting lesions of the appendix. The theories regarding the pathogenesis of appendicecal mucocele are reviewed and discussed. ( info) |
14/494. Isolated intracranial mucocele. Intracranial mucoceles have been previously reported as direct extradural extensions of mucoceles of the paranasal sinuses. We describe a patient with 2 silent mucoceles isolated within the parenchyma of the frontal lobe of the brain. The patient had undergone multiple previous intranasal polypectomy and ethmoidectomy procedures, and the unsuspected mucoceles were discovered on a computed tomographic scan obtained to evaluate recurrent rhinosinusitis symptoms. craniotomy was required for removal of the mucoceles. ( info) |
15/494. mucocele-like formation leading to neurological symptoms in prolactin-secreting pituitary adenomas under dopamine agonist therapy. BACKGROUND: mucocele-like formation associated with pituitary adenomas, to the best of our knowledge, has been paid little attention. We report three adult male patients with a mucocele-like formation that developed behind the tumor and led to neurological symptoms in prolactin-secreting pituitary adenomas (prolactinomas) under dopamine agonist therapy. CLINICAL PRESENTATION: Three adult male patients with prolactinomas developed hyperprolactinemia and new neurological symptoms during dopamine agonist treatment. In each case, the pathogenesis of these symptoms was due in part to a mass enlargement with development of a mucocele-like formation behind a prolactinoma. In our patients, a prolactinoma with a suprasellar extension originally filled the sphenoid sinus. When dopamine agonist therapy became ineffective, new symptoms, such as progressive visual impairment other than typical hemianopsia or headache, developed and mass enlargement was found on MRI. MRI demonstrated two different components: an enhancing prolactinoma and a nonenhancing mucocele-like formation behind the tumor. Two patients had compression of the optic nerves by a mass. Transnasal removal of mucoceles and adenomas led to resolution of the neurological symptoms. CONCLUSION: Early suspicion of a mucocele-like formation under dopamine agonist therapy for prolactinomas is important in order to avoid a delay in surgery, because a change in medical treatment will be ineffective. ( info) |
16/494. Superficial mucocele: report of 4 cases. Four cases of the lesion first described as superficial mucocele by Eveson in 1988 are reported. All of the lesions developed in adult women; two of the women had concurrent oral lichen planus. The mucoceles were found on the soft palate, the buccal mucosa, and the upper and lower labial mucosa. The etiologic factors and pathogenesis of this lesion are discussed. ( info) |
17/494. Endoscopic marsupialization of bilateral lacrimal sac mucoceles with nasolacrimal duct cysts. A lacrimal sac mucocele is an uncommon disease usually treated by ophthalmologists. In rare cases, it is sometimes associated with a nasolacrimal duct cyst presenting as an intranasal cystic mass, which needs the involvement of an otolaryngologist in diagnosis and management. Two cases of lacrimal sac mucoceles with nasolacrimal duct cysts are presented with a brief literature review. Both cases presented with intranasal cystic masses that caused nasal obstruction and were cured with endoscopic marsupialization of the cysts. ( info) |
18/494. Double gall bladder with two disease processes. A double gall bladder is a rare congenital anomaly which is usually diagnosed by preoperative ultrasonography. Either one, or both lobes, of the double gall bladder, may be diseased. We report a patient in whom the two lobes were affected by different disease processes, namely, cholesterosis, and cholelithiasis with mucocele. ( info) |
19/494. Intracranial mucocele as a complication of endoscopic repair of cerebrospinal fluid rhinorrhea: case report. OBJECTIVE AND IMPORTANCE: Endoscopic repair of an anterior cranial fossa cerebrospinal fluid (CSF) fistula has gained widespread acceptance. We report a case of mucocele development at the site of an endoscopic CSF leak repair. CLINICAL PRESENTATION: A 46-year-old woman underwent functional endoscopic sinus surgery for nasal obstructive symptoms. The surgery was complicated by an intraoperative CSF leak from the posterior cribriform plate/anterior sphenoid, which was repaired immediately using bone and mucosa grafts. Two years postoperatively, a 13-mm anterior cranial base mass was found incidentally. This mass increased to 20 mm over the next year. INTERVENTION: The anterior cranial base mass was excised via a right frontal craniotomy and confirmed histologically to be a mucocele. CONCLUSION: Endoscopic repair of an anterior cranial base CSF fistula with mucosal grafts may lead to formation of a mucocele. ( info) |
20/494. Frontal mucocele presenting as a subcutaneous tumour on the forehead. A 57-year-old Japanese woman had a 3-month history of an asymptomatic subcutaneous tumour on the forehead. The patient presented a slightly elevated, elastic soft subcutaneous mass, 3 cm in diameter, on the mid to left-side forehead. Slight swelling of the left upper eyelid was observed. CT scanning and magnetic resonance images revealed a sharply demarcated cystic mass from the subcutaneous area on the forehead expanding into the frontal sinus and intracranial space. The tumour was diagnosed as a frontal mucocele and combined external and endoscopic approaches were performed. It is rare that a patient with a frontal mucocele is initially referred as a case of a subcutaneous tumour because most of the patients complain primarily of the ophthalmic symptoms. However, the present case reminds us that frontal mucocele is one of the differential diagnoses for a subcutaneous mass on the forehead. ( info) |