Epidermoid cyst of the scrotum: a case report

A 52-year-old male visited our department for a painless swelling from the right side of the anus to the right scrotum that he first noticed 5 years earlier. Palpation revealed a small fist-sized elastic solid mass with a smooth surface from the central area to the inferior pole of the right scrotum. This mass was clearly demarcated from the contents of the scrotum and not adherent to the scrotal skin. A diagnosis of a tumorous lesion in the scrotum was made, and the tumor was resected. Histopathological examination demonstrated a scrotal epidermoid cyst. To our knowledge, this is the 17th case reported in Japan.     

Thoracic arachnoid cyst presenting incomplete features of Brown-Séquard syndrome: a case report

Spinal intradural arachnoid cyst presenting incomplete features of Brown-Séquard syndrome is very rare. Only 6 cases have been reported. We report one in a thoracic lesion. A 42-year-old man noticed thermohypesthesia in his right leg, and monoparesis in his left leg. On admission, he presented incomplete features of Brown-Séquard syndrome below the Th7 level. MRI showed the spinal cord to be displaced antero-laterally to the right at Th6-7 level. Myelography and CT myelography failed to show the cyst wall, but an arachnoid cyst was totally removed with T5-8 osteoplastic laminotomy. Sensory disturbance has not changed postoperatively, but motor weakness in his left leg recovered within one month after the operation. No cystic lesion has been detected by MRI during the ten months since the operation. We investigated all seven cases in the literature including our case which showed incomplete features of Brown-Séquard syndrome. As regards to the location of the cyst, all cases were at the mid-thoracic level. And four cases were at the midline. These results suggest that the mechanism of Brown-Séquard syndrome associated with spinal arachnoid cyst may be related not only to the laterality of the lesion but also to the asymmetrical circulation in the watershed area.     

Burr hole neuroendoscopic fenestration of quadrigeminal cistern arachnoid cyst: technical case report

Arachnoid cysts of the quadrigeminal cistern have been managed by cyst shunting and craniotomy with cyst fenestration. Two children are presented who underwent successful burr hole neuroendoscopic fenestration of symptomatic quadrigeminal plate cysts. The literature is reviewed with regard to the treatment of quadrigeminal arachnoid cysts, and the neuroendoscopic management of these cysts is described.     

Hemihypertrophy with a liver cyst: a case report

An 8-month-old girl with a right-sided hemihypertrophy was found to have a large abdominal mass. At exploration, the mass, arising from the antero-inferior edge of the right lobe of the liver, was pedunculated and measured 17 cm x 12.5 cm x 12.5 cm. This was excised and histology confirmed it to be a benign single cyst of the liver.     

Cavernous hemangioma of the scrotum: a case report

A 19-year-old male consulted our department, complaining of a painful scrotal mass. On palpation, the mass was discriminated from testis, epididymis, and spermatic cord in the left scrotum. He underwent total excision of the mass. Pathologic examination revealed cavernous hemangioma. Scrotal hemangioma is a relatively rare lesion and this is the 37th case reported in Japan.     

Syringomyelia associated with posterior fossa cyst: a case report

We report a case of a 47-year-old woman with a posterior fossa cyst associated with syringomyelia and hydrocephalus. Her birth was traumatic and she had suffered a fractured skull. About 10 years prior to coming to our department she had occipitalgia and a pain had developed over a month from her right shoulder to hand. Shortly before presenting occasional electric-like shocks were felt in her right hand associated with coughing and hiccuping. Magnetic resonance imaging (MRI) revealed a large midline posterior fossa cyst, hydrocephalus and syrinx (C1-Th11). Cisternography could not demonstrate communication between the cyst and the subarachnoid space and the 4th ventricle was present but without communication with the cyst. The cyst was tentatively diagnosed as an arachnoid cyst. One week after placement of a cyst-peritoneal shunt, CT scans showed a decrease in cyst and ventricle size and 2 months later a follow-up MRI revealed resolution of the syringomyelia. We suspected that cyst-peritoneal shunt was effective for this patient who had syringomyelia associated with incommunicated posterior fossa cyst.     

Solitary bone cyst with epiphyseal involvement: a case report

A large solitary bone cyst involving the epiphysis produced 5.0 cm shortening of the proximal humerus in a 15-year-old girl. Biopsy revealed the cyst was filled with thin yellow fluid under pressure and lined by a fibrous membrane. X-rays 9 months after biopsy demonstrated progressive cyst obliteration. A review of literature revealed no similar case. It is postulated that solitary cysts rarely may involve the physeal and epiphyseal structures and thereby retard longitudinal bone growth.     

Radiographic diagnosis: arachnoid cyst in a dog

Lauren's intestinal type of gastric cancer was proposed to be dependent on long-term environmental factors and is always preceded by chronic premalignant change. A cohort study was performed and demonstrated an increased cancer risk of gastric remnant after gastric surgery for benign disease. It is generally believed that after gastrectomy the residual stomach has an environmental change and, thus, enters a neoplastic process. Based on the carcinogenic theory of intestinal-type tumour, it would be of interest to know whether the intestinal-type tumour is more common in gastric remnant cancer. Forty patients with gastric remnant cancer had gastrectomy in the Veterans General Hospital-Taipei. Another 683 patients with primary gastric carcinoma underwent resection and were used as controls. The clinical characteristics, tumour stage and intestinal-type tumour were analysed in gastric remnant cancer and were compared with the various portions of primary gastric carcinoma. Although the overall distribution of intestinal-type carcinoma in gastric remnant (45%) was no different to that of any other portion of stomach cancer, intestinal-type carcinoma was more common in the early stage of gastric remnant (73%) and distal stomach (73%), but not in the proximal stomach (50%), which was supposed to have the same characteristics as the gastric remnant because of identical anatomic location. More than expected, intestinal-type carcinoma in early gastric remnant cancer together with a long incubation interval between primary surgery and later tumour occurrence were compatible with the theory of carcinogenesis of intestinal-type carcinoma.     

Subdural hematoma associated with arachnoid cyst

We describe 3 young patients with history of mild cranial trauma who presented the rare association of subdural hematoma and arachnoid cyst. Clinical and radiological signs are reviewed.     

Bifid scrotum, perineal hamartoma and high imperforate anus: a case report

This is a case report of a newborn patient with imperforate anus, urethro-colonic fistula, perianal hamartoma, and bifid scrotum. Successful staged repair of these anomalies is described together with review of the embriology related to the case.     

Iatrogenic arachnoid cyst with distinct clinical picture as a result of bone defect in the floor of the middle cranial fossa: case report

OBJECTIVE AND IMPORTANCE: This kind of arachnoid cyst has not previously been described as a complication of a cranial base bone defect. Recognition of this rare complication may be delayed, because clinicians are unaware of its possibility. CLINICAL PRESENTATION: A 22-year-old man presented with severe headache and increasing difficulty in breathing and swallowing. A physical examination revealed a pulsatile mass in the oral cavity, arising from the parapharyngeal area. A cystic mass that protruded into the oral cavity, through a dural and bony defect in the left middle fossa, was detected on neuroimages. INTERVENTION: A left frontotemporal craniotomy was made, and the cyst was decompressed. Duraplasty was performed with lyophilized dura. The bone defect was managed with a calvarial free bone graft and a pedicled myofacial flap. Serial neuroimaging studies performed postoperatively showed that the cyst had decreased in size. CONCLUSION: This report describes an unusual complication of a cranial base bone defect. Although not all bone defects in the cranial base require reconstruction, management of the large bone defect, particularly in the middle fossa, should preferably be accomplished with the help of a bone graft to support the dural graft.     

Duplication cyst of the antrum: a case report

A four generation family (UoM1) was ascertained with Waardenburg syndrome type 1 (WS1). The proband exhibited both WS1 and septo-optic dysplasia. A G to C transversion was identified in PAX3 exon 7 in four subjects affected with WS1 in this family including the proband. This glutamine to histidine missense mutation at position 391 may also affect splicing. There are over 50 mutations characterised in PAX3 in WS1 patients; however, this is the first example of a WS1 mutation in exon 7 of PAX3.     

Bilateral arachnoid cysts, seizures and severe encephalopathy: case report

A case is presented of a 3 1/2-year-old girl with a clinical picture of very severe psychomotor retardation, autistic behavior, and repetitive convulsive episodes starting in the neonatal period and resistant to any pharmacological treatment. Electroencephalography showed generalized abnormalities. Magnetic resonance imaging of the brain disclosed arachnoid cysts in both temporal fossae with marked hypoplasia of both temporal lobes. It is proposed that the severity of symptoms is related to the magnitude of underlying anatomical lesions as well as the associated intractable epilepsy.     

Accessory soleus presenting as a posterior ankle mass: a case report and literature review

The accessory soleus muscle is a rare anatomic variant that may present as a mass in the posterior-medial aspect of the ankle in young adults. The presence of such a mass may result in pain and difficulty with running. We present a case of accessory soleus muscle in a 21-year-old soldier and review the literature. We present the first magnetic resonance imaging studies in the American literature, to our knowledge, of this unusual anomaly.     

Adenocarcinoma arising in a tailgut cyst: report of a case

We report herein the unusual case of a 66-year-old woman found to have adenocarcinoma arising in a tailgut cyst. The patient had been observed for 6 months following the discovery of a presacral cystic mass measuring 10 x 9 cm for which she had refused surgery. The serum tumor marker, carcinoembryonic antigen, became slightly elevated, and diagnostic imaging distinctly revealed a tumorous lesion with papillary projection into the cyst lumen. The cystic mass was then excised through the transsacral approach. The pathological findings were compatible with moderately differentiated adenocarcinoma arising in a tailgut cyst. This entity is extremely rare, and only six cases, including our own, have been reported in the English literature. Early complete excision is advised because it is almost impossible to determine for certain whether presacral cystic masses are benign or malignant prior to surgery.     

Petrous apex arachnoid cyst: radiographic confusion with primary cholesteatoma

The advent of combined computed tomography (CT) and magnetic resonance imaging (MRI) for the evaluation of petrous apex lesions has improved the otologist's ability to differentiate among many disease processes. Temporal bone CT details osseous anatomy, whereas MRI delineates soft tissue signal characteristics. The employment of these two imaging modalities is often successful in differentiating between cholesterol common entities encountered in the petrous apex. The finding of a smoothly marginated, expansile, bone eroding lesion on CT, coupled with hypointensity on T1-weighted and hyperintensity on T2-weighted images on MRI, is highly suggestive of cholesteatoma. The authors recently encountered two cases of arachnoid cyst involving the petrous apex that shared the same imaging features seen with the more common cholesteatoma. One patient presented with tic douloureux, whereas the other had a spontaneous transotic cerebrospinal fluid leak. The contemporary skull base surgeon should include arachnoid cyst as a rare possibility in the evaluation and treatment of petrous apex lesions.     

Smooth-muscle hamartoma of the tunica dartos of the scrotum: report of a case

Corticosteroids are effective in bringing about a clinical remission in patients with ulcerative colitis. However, in severely relapsed cases, corticosteroids are not always effective even when a high dosage is administered. In addition, the long-term use of corticosteroids often causes serious side effects. Therefore, an alternative treatment for active ulcerative colitis is necessary in order to avoid these clinical problems. In the present pilot study, the efficacy of leukocytapheresis using a centrifugal procedure was evaluated for corticosteroid-resistant, active ulcerative colitis. Fourteen patients with corticosteroid-resistant severely active ulcerative colitis were treated by leukocytapheresis. Thirteen patients (92.9%) achieved clinical remission within 4 weeks after the apheresis, and remained in remission for 8 months on average without any additional corticosteroid therapy. In the remaining patient, in whom remission was not induced, a total colectomy was performed immediately after the fourth course of leukocytapheresis. No significant side effects were noticed throughout the therapy. Both colonoscopic and histological examinations confirmed the beneficial effect of this procedure in terms of the reduction of severe inflammation of the affected colon. We found that the expression of two adhesion molecules, L-selectin and VLA4a, on the surface of peripheral leukocytes was decreased after this new therapy.     

Prenatal diagnosis of a large fetal arachnoid cyst

A case of prenatal diagnosis and management of a giant fetal arachnoid cyst is presented. The importance of an accurate diagnosis is highlighted and the use of three-dimensional ultrasound is discussed. The recent literature is reviewed.     

Hemorrhagic arachnoid cyst with third nerve paresis: CT and MR findings

We report the CT and MR appearance of a nontraumatic hemorrhagic arachnoid cyst presenting with a third nerve paresis in a 37-year-old man. The cyst, located in the left suprasellar area, contained a fluid-blood level with stigmata of subacute hemorrhage on both CT and MR studies.