1/8. Gliomatosis peritonei: a report of two cases and review of the literature.Gliomatosis peritonei is the implantation of miliary glial tissue within the peritoneal cavity of patients with ovarian teratomas. Up to now 86 cases of this rare entity have been reported. In addition to the small number of reported gliomatosis peritonei cases, a condition easily mistaken for peritoneal carcinomatosis, we report two further cases, one combined with endometriosis (fifth case published until now) and one without endometriosis. Both cases were followed up for more than 5.5 years. Thus, further data concerning biological behaviour and prognosis of this rare entity are made available. In addition, a review of all cases published until today is provided, thus summarising the data presently known.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/8. Paranasal sinus teratocarcinosarcoma with intradural extension.Teratocarcinosarcoma, although a rare neoplastic entity, should be considered as a differential diagnosis in any middle-aged adult presenting with a history of intermittent unilateral epistaxis and nasal obstruction. Tissue biopsy may fail to reveal a full spectrum of histologic heterogeneity in these tumours, and definitive diagnosis is usually made with tumour resection. Aggressive treatment including surgery followed by adjuvant radiation therapy is advocated and confers a better rate of survival than radiotherapy alone. Our current report is unique in two respects. First, disease recurrence is usually manifested very early on, leading some authors to conclude that a neoplastic-free interval of 3 years or longer probably indicates a good chance of being cured. Our patient, in contrast, experienced a disease-free interval of 4 years before evidence of recurrence emerged. Second, intracranial extension with brain parenchymal involvement has not been previously reported despite the tumour's proximity to the anterior cranial fossa and its locally aggressive behaviour with frequent bony invasion. Despite intracranial invasion, our patient experienced a long disease-free interval. As such, even advanced disease should be treated aggressively.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/8. Paraneoplastic limbic encephalitis masquerading as chronic behavioural disturbance in an adolescent girl.AIM: To describe an unusual but treatable cause of behavioural disturbance in adolescence. methods: The case is reported of a 15-y-old girl presenting with acute confusion, memory problems and psychotic symptoms following an 18-mo history of change in personality, school failure and running away from home. A review of the literature is also presented. RESULTS: microbiology, toxicology, computed tomography and magnetic resonance imaging did not show any pathology of the central nervous system. Bilateral ovarian immature teratomas were eventually diagnosed and removed. The rapid improvement in the patient's mental and cognitive functions after corticosteroid treatment and the abnormality shown on the single photon emission computed tomography suggested a diagnosis of paraneoplastic limbic encephalitis. CONCLUSION: Paediatricians and neurologists should be aware of this rare disease entity among the more common conditions of behavioural problems and substance abuse in adolescents.- - - - - - - - - - ranking = 6keywords = behaviour (Clic here for more details about this article) |
4/8. Intrapericardial teratoma in the newborn.Two cases of intrapericardial teratomas occurring in the newborn are reported. The first was a cystic, well differentiated tumour which was totally excised. The child was alive and well with no evidence of the disease 10 months later. The second was a predominantly solid teratoma which consisted of both mature and immature tissues. It was removed but recurred 2 months later with pleural and pericardial invasion. The patient underwent reoperation but death occurred 9 days after surgical treatment. The recurrence was histologically similar to the primary tumour. The second case is probably the first malignant intrapericardial teratoma described in a neonate. Its morphology and clinical behaviour suggest that, as in ovarian and sacrococcygeal teratomas, the presence of immature neuroepithelium carries a poor prognosis. In such cases radio- or chemotherapy should be performed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/8. radiology of retroperitoneal cystic teratoma in adult: a case report.Retroperitoneal teratoma is a rare tumour in adults. A case is reported in which the radiologic pattern led to preoperative diagnosis of cystic teratoma, indicating surgical removal, which benefited the patient. However, size, calcification, and demonstration of cystic or solid components, are not predictive of benign tumour behaviour. Definite diagnosis was made possible by histopathology.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/8. Paradoxical response of a pineal immature teratoma to combination chemotherapy.A case of primary intracranial germ cell tumour is reported in a 5-year-old Chinese boy who presented with symptoms and signs of increased intracranial pressure. Computed tomography (CT) scan of the brain revealed a multicystic tumour over the pineal region. Stereotactic biopsy yielded enteric epithelium and isolated cells with hyperchromatic nuclei and high nuclear-to-cytoplasmic ratio, suggesting the diagnosis of an immature teratoma. Grossly elevated serum and cerebrospinal fluid (CSF) levels of alpha-fetoprotein and mildly elevated levels of beta human chorionic gonadotrophin suggested the simultaneous presence of embryonal tissues. Combination chemotherapy with cisplatin, etoposide, and bleomycin resulted in a gradual but complete normalisation of the serum and CSF tumour markers. Paradoxically, the patient's consciousness deteriorated and repeat CT scan after 3 months of treatment showed that the tumour was actually increasing in size. Complete surgical removal was attempted and histologic sections of the specimen revealed only mature teratomatous tissues. The child is now well and remains disease-free with minimal left hemiparesis 12 months after completion of treatment. This case illustrates the importance of combined neoadjuvant chemotherapy and surgery in the management of intracranial non-germinomatous germ cell tumour harbouring both germ cell and teratomatous components, while monitoring of both biochemical and radiological parameters are necessary in assessing the clinical behaviour of mixed germ cell tumours.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/8. Continuing clozapine despite neutropenia.BACKGROUND: A 40-year-old chronic schizophrenic patient whose psychosis and associated violent behaviour resolved on clozapine, required chemotherapy for a testicular teratoma with pulmonary metastases. His treatment was initially delayed due to refusal to consent. TREATMENT: The patient finally agreed to orchidectomy and cytotoxic therapy, and following agreement by the CPMS, clozapine continued to be dispensed despite neutropenia and 'red alert' status on full blood count. DISCUSSION: This is the only patient to continue clozapine despite 'red alert' status, and as such is an exceptional case, but may open the way for such patients in the future.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
8/8. Recurrent immature teratoma: lack of correlation between serum level and immunohistochemical detection of serum alpha-fetoprotein.We present the clinicopathologic and immunohistochemical features of a pure immature ovarian teratoma that had arisen in a 15-year-old girl. At original diagnosis immature extra ovarian implants were noted (grade 3) accompanied by moderately elevated serum alpha-fetoprotein (AFP) levels. AFP was immunohistochemically demonstrable in immature endodermal elements. The immature neural tissue present was negative for AFP, and no other tumor elements were recognisable. serum AFP fell post-operatively to within normal limits. Despite five courses of chemotherapy and asymptomatic status, the patient re-presented 15 months after original diagnosis with a massive abdominal and pelvic tumor recurrence with predominantly mature glial tissue, but some persistent immature foci. There was no associated increase in serum AFP at this time. AFP was, however, persistently detectable immunohistochemically in immature endodermal components only. Immature neural elements were no longer identified. Disappearance of immature neural tissue in the tumor recurrence may have been related to chemotherapy. This case demonstrates the lack of correlative ability of serum AFP levels with both clinical behaviour and immunohistochemical demonstration of AFP expression in the tumor recurrence.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |