Experimental Knee-Joint Fractures A Preliminary Report

Twenty-eight patients with spinal tumours (11 malignant and 17 benign) detected in their first two decades of life have been reviewed. Twenty-six of the 28 patients had neurological disturbances, and a significant difference in the duration of debut symptoms in the benign and malignant groups could be demonstrated. X-ray survey was positive in 11 cases in the benign group and in three cases in the malignant group.     

Non-Functioning Malignant Neuro-Endocrine Tumour of the Pancreas: a Case Report with a Review of the Literature

Cystic abnormalities of the pancreas encompass a wide variety of lesions ranging from the non-malignant pseudo-cyst to neoplastic lesions. Although cystic neoplasms of the pancreas are rare, differentiation is important in determining the proper treatment.

A 55-year-old female presented with a cystic abdominal mass. Her computed tomography scan showed a cystic mass of 102 χ 99 χ 97 mm which was well-circumscribed and homogeneous with few thin septations and mild contrast enhancement of the fibrous wall located in the body of the pancreas. Percutaneous diagnostic aspiration of the cyst fluid was performed under ultrasonic guidance for proper diagnosis and management, which revealed a CEA greater than 200 ng/ml (0–3) and amylase within normal limits 30U/L (< 100). High CEA and normal amylase values supported the diagnosis of mucinous cystadenoma rather than pseudo-cyst. With these findings, the patient underwent distal pancrea-tectomy with splenectomy. Pathological analysis revealed a mucinous cystadenoma of the pancreas. This report is a confirmation that cyst fluid analysis can provide a pre-operative classification of these diagnostically difficult lesions.     

Inflammatory myofibroblastic tumours of the maxillary sinus: A brief clinical report and review of the literature

Although inflammatory myofibroblastic tumours (IMTs) have been accepted as a clonal neoplasm, their pathology is poorly understood due to variable presentation. There is no identifiable cause and they are usually observed as tumour growth combined with inflammation. In the current WHO classification, IMTs are designated as intermediate malignancies. In terms of biological potential, IMTs are classified under ‘rarely metastasizing’. IMTs are rare in the maxillary sinus but, when reported, can be locally aggressive or even destructive if they invade the orbit. The authors present a brief clinical report describing a five-year-old girl with a slow-growing mass in the right maxillary sinus extending into the lacrimal sac and its management.     

Extra embryonic elements in testicular tumours

Extra embryonic elements in germ cell tumours resemble the trophectoderm or yolk sac endoderm which are the extra embryonic membranes of the developing embryo. True chorionic (trophoblastic) differentiation with syncytiotrophoblast and cytotrophoblast, perhaps with a villous pattern, is rare and is associated with a very poor prognosis and with hCG production. Isolated syncytiotrophoblastic cells also produce hCG but are prognostically less sinister. Yolk sac elements occur in two thirds of non seminomatous germ cell tumours, and affect all age groups. Pure forms of yolk sac tumour (YST) occur but are not common except in infants. They are often associated with AFP production but AFP is not a specific marker for YST. Yolk sac tumours have a similar prognosis to malignant teratoma undifferentiated (MTU: embrvonal carcinoma).     

Discovery of escapee tumour cells—a milestone in cancer surgery

Background

Complete excision of tumour is the basic principle of curative surgery and traditionally oncological en-bloc tumour resection is a common practice. However, ironically, it is questionable whether surgery itself will cause tumour spillage.

Method

From January 2019 to March 2022, 133 tumour-related operations were performed. Routine operating field toileting was performed using warm normal saline before the end of operations. A filter was connected to the suction device throughout the whole operation processes. Sediments being trapped by the filter were sent for histopathology to look for the presence of spillage tumour cells—escapee tumour (ET) cells.

Results

A total of 26 (19.5%) of the collected residue showed the presence of ET cells while 16 residue samples (12%) revealed the presence of atypical cells. Incomplete resection (R1, R2 resection; P = .005, B = 1.519), advanced N-stage (N2 or N3 disease; P = .031, B = 1.510) and certain cancer type (oesophageal cancer in this study; P = .027, B = −1.567) are the statistically significant factors related to the presence of ET cells.

Conclusion

Tumour spillage occurs during operations. Long-term follow-up and larger-scale studies are required to determine the clinical significance of the positive ET cell cases and how to prevent tumour spillage during operations in the future.     

Giant supratentorial meningeal haemangiopericytoma in a newborn

Summary A brain tumour in a newborn is rare. The incidence of congenital tumours is 0,34 per one million births.We report a case of a huge right hemispheric tumour operated upon successfully in a child 5 days old, who had a total tumoural excision and an uneventful outcome with 5 months follow up.This tumour appears to be the first meningeal haemangiopericytoma described in a newborn. Adequate treatment and histological findings are discussed. Meningeal haemangiopericytomas are now considered as originating in pericytes, in the light of recent immunopathological results, and are to be separated from true meningiomas.     

An unusual case of paratesticular mesothelioma on the site of previously excised epididymal adenomatoid tumour

INTRODUCTIONMalignant paratesticular tumours are rare. We report a case of paratesticular malignant mesothelioma in a patient who had excision of an adenomatoid tumour on the same site in 2 occasions previously.PRESENTATION OF CASEA middle aged man who had an adenomatoid tumour excised from his left hemiscrotum fifteen years previously was referred with a suspicious left epididymal lump. This was followed up sonographically for 2 years until it showed signs of enlargement and testicular invasion; it was then managed with radical orchidectomy. The histology showed paratesticular epithelioid malignant mesothelioma. The patient was referred to the Oncologists for further management.DISCUSSIONParatesticular tumours are commonly benign. Scrotal ultrasonography is the preferred diagnostic imaging method. Paratesticular malignant mesotheliomas are very rare and appear to have poor prognosis. The optimal adjuvant treatment post radical orchidectomy is not established yet. In our case there is suggestion of possible malignant transformation from previous adenomatoid tumour.CONCLUSIONIn recurrent paratesticular tumours the clinicians should question the possibility of malignant transformation and manage these cases accordingly.     

Intracranial intraparenchymal schwannoma: Report of three cases

Summary Intracranial intraparenchymal schwannomas are rare. We report three patients with an intracranial intraparenchymal schwannoma and discuss the clinical and neuroradiological aspects of this particular tumour. The patients were a 21-year-old male, a 64-year-old female and a 17-year-old male. The tumours were located in cerebrum in two patients and the cerebellum in one patient. Computerized tomography (CT) scans demonstrated a slightly high density area with homogeneous enhancement by contrast medium. Magnetic resonance imaging (MRI) showed slightly low signal intensity on the T1-weighted image, high or mixed signal intensity on the T2-weighted image and homogeneous enhancement by gadolinium diethylene triamine penta-acetic acid (Gd-DTPA). Radiological studies revealed cystic components in 2 of the 3 patients. All tumours were firm, well-demarcated, and completely removed. The diagnosis of schwannoma was derived from histological and immunohistochemical studies in all 3 cases; 2 cases were also examined by electron microscopy.     

Giant-cell tumour of bone

Summary Thirty-nine patients with giant-cell tumours of bone were reviewed. Twelve of these were unusually large. Fungation of the tumours did not occur spontaneously but only after incision or trauma. Fungation of the tumour or local infiltration of soft tissues was not always associated with histological signs or a clinical course of malignancy. Radical resection in the lower limbs lead to frequent complications with fracture through the bone graft and thorough but more conservative local curretage is recommended particularly in the weight bearing bones.

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Résumé Révision de 39 cas de tumeurs osseuses à cellules géantes, dont 12 de volume inhabituel. Ces tumeurs ne s'ulcèrent pas de façon spontanée, mais à la suite d'une incision chirurgicale ou d'un traumatisme. L'ulcération de la tumeur ou l'infiltration locale des parties molles ne s'accompagne pas toujours de signes histologiques de malignité ni d'une évolution clinique défavorable.Au niveau des membres inférieurs la résection complète entraîne souvent des complications avec fracture de la zone greffée. Un traitement plus conservateur par curettage local minutieux est donc plus particulièrement recommandé au niveau des os qui supportent le poids du corps.

     

Benign mixed glial-mesenchymal tumour (“glio-fibroma”) of the spinal cord

Summary An intramedullary tumour of the cervical spinal cord, occurring in a female aged 45, was found to be composed of an isomorphous astrocytoma densely intermingled with desmoid tumour tissue.Such a benign mixed glial-mesenchymal tumour or gliofibroma, has not been previously reported.     

Supratentorial ependymomas in childhood: Clinicopathological findings and prognosis

Summary Out of 29 supratentorial ependymomas in children under 10 years of age, operated on between 1951 and 1989, 18 were situated in the hemispheres and 11 in the midline.15 of the 18 hemispheric tumours, but only 4 of the 11 intra- or paraventricular ependymomas allowed complete removal. The operative mortality within the observation period of nearly 40 years was 27% for tumours in the midline and 11% for those in the hemispheres.The grade of malignancy rose with increasing distance from the ventricular level. 5-year survival without recurrence was 75% in grade 2 and 31% in grade 3 ependymomas. The total rate of recurrence was 58%.New tumour growth can be delayed by postoperative irradiation, at least in grade 2 ependymomas. It can be prevented, if at all, only by total resection of the primary tumour.Part of this paper was presented at the 41st Annual Meeting of the German Society for Neurosurgery in Düsseldorf, F.R.G., May 27–30, 1990.     

Primary Primitive Neuro-ectodermal Tumour of the Lung

A case of intrapulmonary primitive neuro-ectodermal tumour (PNET) without thoracic wall involvement is presented in a 33-year-old man. PNET of the thoracopulmonary region, also called Askin tumour, is a rare undifferentiated sarcoma usually involving the thoracic wall. Primary intrapulmonary PNET without parietal pleura or thoracic wall involvement is very rare.

The correlation between anatomo-pathological aspects and clinical imaging is emphasized, which is discussed in the light of the most recent literature.     

Neurosurgical experience with tumours of the pineal region at Clinica Puerta de Hierro

Summary The clinicopathological experience with 50 cases of pineal region tumours at Clinica Puerta de Hierro is presented. In this series, 88% of the patients were evaluated by CT-scan. Pineal region tumours make up approximately 0.7% of the intracranial expansive processes in the Spanish population. The largest group of lesions appearing in this localization is that of the germinomas (38%), followed by nontumoural lesions (20%) and tumours generally considered to be of the vicinity, such as meningiomas, gliomas and metastases (18%), tumours of the pineal parenchyma (14%), and non-germinoma germinal tumours (10%).In our series, in addition to an intracranial hypertension syndrome, an ophthalmological and, to a minor degree, an endocrinological syndrome predominate in germ-cell tumours, with a cerebellar syndrome appearing in gliomas of the pineal region.All the patients in the series diagnosed as having a germinoma and treated by irradiation are alive, and free of disease, after follow-up ranging from 2 to 20 years (mean: 8 years). The experience obtained with the present series supports the opinion that, in radiosensitive tumours, surgical resection adds no therapeutic benefit to treatment with radiotherapy alone.We suggest that when dealing with a tumour of the pineal region, CT-scan and clinical assessment now permit an initial selection of patients susceptible to surgery as a first therapeutic option, indicating those patients who, because they are considered to have either a probable germinoma or a tumour of uncertain diagnosis, should undergo stereotaxic biopsy or trial radiotherapy and, only when this has proved a failure, should be subjected to open surgery.     

Ovarian haemangioma: A rare case report

INTRODUCTIONHaemangioma of ovary is a rare tumour.PRESENTATION OF CASEWe report an ovarian haemangioma which presented as an acute abdomen due to an adnexal mass.DISCUSSIONWe report an ovarian haemangioma which presented as an acute abdomen due to an adnexal mass. Haemangiomas have been reported in other organs but ovarian haemangioma is a rare tumor, usually asymptomatic and presenting as an incidental finding. Large lesions tend to present clinically with pain. A few cases have been described in the literature.CONCLUSIONConsidering their rare occurrence such tumors are a diagnostic challenge.     

Leiomyoma of kidney: An Indian experience with literature review

INTRODUCTIONLeiomyoma of kidney is an exceptional finding in the urinary tract. Though most of these tumors are detected on autopsy, still it remains a diagnostic challenge.PRESENTATION OF CASEWe report three adult cases of renal leiomyoma in our institute who presented with abdominal mass and haematuria in last 8 years.DISCUSSIONLeiomyoma has been reported in other organs but renal leiomyoma is rare tumour, though in autopsy series they are second in order of frequency among the renal mesenchymal neoplasms, and few cases have been described in the literature. Still no Indian experience is evaluated on this rare site of occurrence.CONCLUSIONConsidering the difficulty of clinical diagnosis of this tumour, strong suspicion is indicated when a patient presents with voluminous, well circumscribed renal lesions.     

Breast cancer and the immune system: opportunities and pitfalls

The identification of tumor-associated antigens, and advances in our understanding of human immunology, have resulted in renewed interest in tumor immunology. A variety of approaches have been utilized in recent years against different tumor types. The results from some of these studies have been encouraging, but it is not yet clear whether they will be applicable to patients with breast cancer.     

Current brain tumour models with particular consideration of the transplantation techniques

Summary The most well known brain tumour models will be discussed. It is a series of animal experiments with an induced tumour and with heterologous and homologous transplantation.This work will deal especially with technical problems, which have not so far been satisfactorily resolved. With the aid of a stereotaxic operation method, the exactness of the technique of transplantation could be improved.The tumour contamination problem of the injection pathway as well as of the cerebral spinal fluid compartment is satisfactorily resolved.The authors have at their disposal a standardized cerebral glioma model in the rat in order to study the interstitial chemotherapy of brain tumours.     

A Systemic “dumb-bell” haemangiopericytoma

Summary Systemic haemangiopericytoma is a rare soft tissue tumour originating from pericytes which are contractile pericapillary cells, and represents less than one percent of all vascular neoplasms [5]. The most common site of involvement is the thigh followed by the retroperitoneum, while the paraspinal location is very rare [1, 3].We report the first case of systemic dumb-bell haemangiopericytoma illustrated radiologically, which mimick, a dorsal dumb-bell neurinoma.