1/35. Traumatic aneurysm and carotid-cavernous fistula following transsphenoidal approach to a pituitary adenoma: treatment by transcranial operation.A 39-year old woman presented with galactorrhoea. magnetic resonance imaging revealed an intrasellar tumour. During transsphenoidal surgery to remove the tumour, arterial bleeding occurred from the right internal carotid artery (ICA). The bleeding was stopped by packing with Surgicel. The operation was discontinued at this point and the intrasellar tumour was not removed. Four-vessel angiography was performed on the third day after the operation, revealing a traumatic (false) ICA aneurysm and a low-flow carotid-cavernous fistula (CCF) on the right side. The patient did not have any neurological deficit, and was re-operated on transcranially. Both the traumatic ICA aneurysm and the CCF were excluded from the circulation by a Sundt-Kees cuff clip. The patency of the ICA was preserved.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/35. Acquired tumors arising from congenital hypertrophy of the retinal pigment epithelium.BACKGROUND: Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is widely recognized to be a flat, stationary condition. Although it can show minimal increase in diameter, it has not been known to spawn nodular tumor that is evident ophthalmoscopically. OBJECTIVES: To report 5 cases of CHRPE that gave rise to an elevated lesion and to describe the clinical features of these unusual nodules. methods: Retrospective medical record review. RESULTS: Of 5 patients with a nodular lesion arising from CHRPE, there were 4 women and 1 man, 4 whites and 1 black. Three patients were followed up for typical CHRPE for longer than 10 years before the tumor developed; 2 patients were recognized to have CHRPE and the elevated tumor concurrently. visual acuity was decreased in 3 patients, mainly due to cystoid macular edema. The tumor was located between the equator and ora serrata in all 5 patients. There was no predilection for quadrant of the fundus. The flat part of the lesion was black and had visible lacunae in all 5 patients. The CHRPE ranged in basal diameter from 3 x 3 mm to 13 x 11 mm. The size of the elevated lesion ranged from 2 x 2 x 2 mm to 8 x 8 x 4 mm. The nodular component in all cases was supplied and drained by slightly prominent, nontortuous retinal blood vessels. Yellow retinal exudation occurred adjacent to the nodule in all 5 patients and 1 patient developed a secondary retinal detachment. Two tumors that showed progressive enlargement, increasing exudation, and progressive visual loss were treated with iodine 125-labeled plaque brachytherapy, resulting in deceased tumor size but no improvement in the visual acuity. CONCLUSIONS: Congenital hypertrophy of the retinal pigment epithelium can spawn a nodular growth that slowly enlarges, attains a retinal blood supply, and causes exudative retinopathy and chronic cystoid macular edema. Although no histopathologic evidence is yet available, we believe that the tumor probably represents either an acquired adenoma or a reactive proliferation of the retinal pigment epithelium. The best treatment of these lesions is not yet established.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/35. Benign renal angiomyoadenomatous tumor: a previously unreported renal tumor.We describe a unique benign tumor of the kidney in a 93-year-old man. Microscopically the tumor was composed of an intimate intermixture of epithelial component and smooth muscle tissue, which formed the stroma of the tumor. In some parts the epithelial cells in adenomatous tubular formations were endowed with clear snouts. These clear snouts had a blister-like quality and grew on the secretory cells lining the tubules. No atypias, mitoses, or pleomorphism were present in the tumor. The muscular component consisted of poorly cellular, HMB-45-negative, leiomyomatous bundles, which greatly differed from that of angiomyolipoma. It encircled the whole tumor and intimately intermingled with the epithelial component. These leiomyomatous bands formed focally abortive vessels, which had incomplete and irregular walls and lacked an elastic layer. Even more interesting was a peculiar vascularization of the tumor. All epithelial tubular structures of the tumor revealed an intimate association with small capillaries. A fine labyrinth of the capillaries rimmed the rows of the epithelial cells. To the best of our knowledge this tumor differs from all previously described.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/35. Endovascular access to the meningohypophyseal trunk.SUMMARY: We describe a novel technique to selectively catheterize the meningohypophyseal trunk (MHT) and its branches. We emphasize the difficulty in accessing the MHT via an ipsilateral approach because of the geometric orientation of this vessel to the parent internal carotid artery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/35. growth hormone-secreting pituitary adenoma associated with primary moyamoya disease--case report.A 40-year-old female presented with growth hormone (GH)-secreting pituitary adenoma associated with primary moyamoya disease manifesting as amenorrhea, acromegaly, and transient ischemic attack. Magnetic resonance (MR) imaging revealed a tumor mass extending from the sella turcica to the suprasellar cistern, and MR angiography demonstrated stenoses in the bilateral internal carotid arteries with basal moyamoya vessels. Her blood GH and insulin-like growth factor (IGF-1) levels were elevated to 78.94 and 923.0 ng/ml, respectively. The patient underwent removal of the pituitary adenoma because her ischemic symptoms disappeared after oral aspirin medication. Subtotal resection resulted in persistence of the high blood GH and IGF-1 levels. Postoperative MR angiography showed progression of the stenoses in the bilateral internal carotid arteries. Excess systemic GH and IGF-1 may participate in the progression of vascular disease and so could have caused the deterioration of the moyamoya disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/35. Transmandibular transpterygoid approach to the nasopharynx, parapharyngeal space, and skull base.The nasopharynx, upper part of the parapharyngeal space, and skull base are relatively inaccessible to the surgeon without major postoperative complications. Operative fields reached by conventional approaches through the palate and maxillary sinus are too limited and narrow to remove extensive tumors. The authors applied a transmandibular transpterygoid approach for the removal of five residual nasopharyngeal carcinomas (NPCs) after full doses of irradiation, one pleomorphic adenoma of the nasopharynx, and one large parapharyngeal schwannoma extending into the jugular foramen. This approach offers a wide operative field so that large blood vessels and cranial nerves can be managed easily. All tumors were successfully resected. Two patients with benign neoplasma had uneventful recoveries after treatment. Of five patients with NPC, two are alive with no evidence of disease for 68 months and 50 months, respectively, while two died of metastases to the liver and bones. The other patient is alive with metastases in the lungs. No tumor recurred in the local primary site, however. Since the number of NPC cases is small, the usefulness of surgical removal of the postirradiation residual NPC is not clear. Our experience proved that the transmandibular transpterygoid approach is a practical method in the treatment of neoplastic lesions in the nasopharynx, parapharyngeal space, and skull base.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/35. Phlebosclerotic colitis coincident with carcinoma in adenoma.Phlebosclerosis of the colon is a rare disease characterized by a thickening of the wall of the colon with fibrosis, hyalinization and calcification to the affected veins. These symptoms result in a type of ischemic colitis known as phlebosclerotic colitis. A case of phlebosclerotic colitis coincident with carcinoma in adenoma is reported. A 74-year-old Japanese woman was admitted to hospital because of a mass in her right lower abdomen. Abdominal computed tomography examination revealed linear calcifications in the wall of the cecum and the ascending colon. colonoscopy revealed dark purple mucosa with multiple ulcers in the cecum and the ascending colon. biopsy specimens showed a marked hyalinous thickening of the wall of small blood vessels in the mucosa. Phlebosclerotic colitis was suspected because of negative results with amyloid stain. Alternative ileocolic angiography showed the serpentine of the peripheral nature blood vessels and pooling at the late venous phase. Microscopic examination of the surgically resected colon revealed mucosal and submucosal fibrosis, and a thickening of the venous wall with fibrosis, hyalinization and calcification from the mucosa to the serosa, which caused a marked luminal narrowing. A small polypoid lesion was also found in the affected region and was diagnosed histologically as carcinoma in adenoma. To our knowledge, this is the first reported case of phlebosclerotic colitis complicated by carcinoma.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/35. Effect of gamma knife radiosurgery on a pituitary gonadotroph adenoma: a histologic, immunohistochemical and electron microscopic study.The morphologic findings in a pituitary macroadenoma removed from a 65-year old man by the transsphenoidal approach 9 months after gamma knife surgery are reported. The tumor was immunoreactive for FSH beta and showed ultrastractural features consistent with an oncocytic gonadotroph adenoma. Accumulation of connective tissue separating small groups of adenoma cells was evident. Several dilated vessels and numerous vascular endothelial growth factor immunopositive adenoma cell were noted. By electron microscopy the endothelial linings frequently showed discontinuities with platelet accumulation attached to the gaps. Several vessels were severely injured showing necrosis of endothelial cells. It can be concluded that gamma knife surgery caused severe alterations in pituitary adenoma microcirculation indicating that vascular injury plays a crucial role in tumor shrinkage.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/35. Disseminated carcinomatosis of bone marrow from submucosal carcinoma in adenoma of the rectum.A 62-year-old man was admitted because of paresis of the legs and a bleeding tendency. He was diagnosed as metastatic bone cancer with disseminated intravascular coagulation (DIC). In spite of treatment, his general condition progressively deteriorated and he died of respiratory failure 13 days later. autopsy revealed a carcinoma in adenoma in the rectum. Although the depth of cancer invasion was confined to the submucosal layer, disseminated carcinomatosis of the bone marrow and tumor emboli in blood vessels of the lung were present.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/35. Intrasellar and parasellar cellular schwannoma.The complexity of the anatomy of the sella turcica and its surroundings accounts for the large number of pathologic entities that may involve this critical area. Intrasellar and parasellar schwannomas are exceedingly rare; only a handful of true sellar tumors of this nature have been reported in the English literature. These lesions may simulate nonsecretory pituitary adenomas clinically and neuroradiologically. Although benign, complete surgical resection of these tumors is usually difficult because of their size, invasiveness, and rich vascularity. From the histopathologic stand point, those cases lacking typical schwannoma histomorphologic features may pose a diagnostic challenge to the pathologist, especially at the time of frozen section examination, because they may resemble other spindle cell neoplasms more common to that location, such as fibrous meningothelial tumors. We report a case of intrasellar and parasellar cellular schwannoma lacking common and reliable neurilemmomatous features, such as the coexistence of cellular Antoni A and loose Antoni B areas, Verocay bodies, and hyalinized thickened vessels. In addition, features infrequently seen in schwannomas were identified in the specimen, including the presence of psammoma bodies, nuclear optically clear pseudoinclusions, and fine intracytoplasmic melanin-like pigment. Ultimately, the use of immunohistochemistry was necessary to achieve a definitive pathologic diagnosis. Cellular schwannoma expands the pathologic differential diagnosis of spindle cell neoplasms of sellar location that the pathologist should have in mind, especially at the time of frozen section examination. The clinical, histopathologic, and neurosurgical aspects of primary cellular schwannomas of the sella turcica are reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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