Sudden death of an 18-year-old man with homocystinuria and intracranial inflammatory pseudotumor (IPT)

Sudden unexpected death from oligodendroglioma: a case report and review of the literature

Sudden and unexpected deaths due to asymptomatic 5 primary brain tumors are extremely rare, with an incidence that ranges from 0.16 to 3.2%. Usually, such tumors are glioblastomas or, less commonly, astrocytomas. Asymptomatic oligodendrogliomas causing sudden death are hardly ever reported among medico-legal investigated cases.We report a rare case of sudden and unexpected death from a previously asymptomatic and undiagnosed, well-differentiated, grade II oligodendrogloioma (WHO classification). According to the autopsy and the microscopic findings brain edema as a result of obstruction of the cerebrospinal fluid flow due to hemorrhagic leakage of the oligodendroglioma is incriminated as the most probable physiopathological mechanism for the sudden death. Diagnosis is mainly based on the special microscopic features of the tumor cells (typical "fried-egg" appearance), interrupted by a dense network of branching capillaries. We discuss further the pathophysiological mechanisms of death and present a short review of literature.

Intraventricular inflammatory pseudotumor: report of two cases and review of the literature

Inflammatory pseudotumors (IP) are non-neoplastic lesions characterized by collagenous stroma and polyclonal mononuclear infiltrates. It is best characterized in the lung, but can occur in the CNS, mimicking a neoplastic process. We discuss the available literature and our cases in order to elucidate best medical practices when confronted with such a lesion. We report on two cases of intraventricular inflammatory pseudotumor in patients who presented with symptoms of CSF obstruction. Both patients were treated surgically with significant clinical improvement. Histopathologically, both specimens revealed a plasma cell granuloma variant of IP. A Medline search for English articles identified 46 cases of CNS IP, only eight of which were located within the ventricle. As with our case, most patients presented due to CSF obstruction or mass effect. Radiographically, the lesions have a variable appearance although most enhanced with gadolinium. Complete resection was achieved in 67% with a 12% rate of recurrence. With incomplete resection or biopsy alone, progression is seen despite steroid or radiation administration. Malignant transformation was only reported once. CNS IP is a rare pathological entity that cannot be diagnosed through clinical presentation or radiographic characteristics, but rather through a careful neuropathological inspection. The available literature suggests that complete resection with close follow-up is necessary.

Voriconazole proves effective in long-term treatment of a cerebral cryptococcoma in a chronic nephropathic HIV-negative patient, after fluconazole failure

Although being a rare occurrence, brain cryptococcoma may represent an emerging issue, because of its relationship with a broadening range of risk factors, including malignancies, neutropenia, end-organ failure, bone marrow and solid-organ transplantation, and multiple underlying causes of primary-secondary immunodeficiency. A cerebral cryptococcoma in a chronic nephropathic HIV-negative subject with homocystinuria, completely cured with neurosurgery and voriconazole after fluconazole failure, is described.