Infantile gliosarcoma: a case and a review of the literature

INTRODUCTION

Gliosarcoma in infant is a very rare entity.

CASE REPORT

The authors present a case of gliosarcoma in a 23-month-old boy. The patient was admitted to our hospital with persistent headache and frequent vomiting. MR imaging demonstrated a large frontal well-circumscribed lesion with a heterogeneous gadolinium enhancement. Although macroscopically the tumor was totally extirpated, the boy died of rapid tumor regrowth 2 months after surgery. The surgical specimens obtained from the tumor showed an admixture of two distinctive neoplastic tissues. One was a malignant mesenchymal feature. Its fibrosarcomatous nature was characterized by spindle-shaped cells with fine fibers that were deeply stained in silver preparations for reticulin. The other was gliomatous tissue forming islands surrounded by the sarcomatous tissues. Its glioblastomatous nature was obvious, as it was characterized by endothelial proliferation and perinecrotic pseudopalisading. Both tissues were histologically malignant, as evidenced by mitotic figure, high cellularity, atypical features, and variability.

DISCUSSION

The literature concerning gliosarcomatous tumors is reviewed, and pathological and clinical features of the tumor are briefly discussed.

Surgical treatment of falcotentorial meningioma

Meningiomas arising from the falcotentorial junction are rare. Among our surgical experience of 375 meningiomas, only 4 cases of so-called falcotentorial meningiomas were encountered. We present these four surgical cases. An occipital transtentorial approach was used in three cases, and a combined midline occipital and suboccipital approach in one case. Total tumour excision was impossible in two cases because of engulfing deep venous structures including the great vein of Galen. Postoperative Gamma knife radiosurgery was performed in these two cases. On the other hand, a posteriorly located tumour was relatively easy to remove, and macroscopic total removal was accomplished. In conclusion, precise microvascular anatomical knowledge is indispensable to satisfactorily excise meningiomas in the falcotentorial area without significant morbidity.

[Primary central nervous system malignant lymphoma originating from the cerebellum and extending along the lower cranial nerves]

We report a case of primary central nervous system (CNS) malignant lymphoma of the central nervous system originating from the cerebellum and growing along the lower cranial nerves. A 67-year-old woman presented with hoarseness, vertigo, nausea, and vomiting. Gd-DTPA enhanced MRI showed a homogeneous enhanced mass lesion extending from the cerebellum to the medulla oblongata around the jugular foramen on the right side. Although pre- and intra-operative diagnosis had been schwannoma, histopathological examination revealed a B-cell, diffuse malignant lymphoma. The growth pattern of malignant lymphoma in the present case, which extended extra-axially, is considered to be rare. We discuss here the growth patterns and difficulties of diagnosis of primary CNS malignant lymphoma in this area.

[Brain abscess following thalamic hemorrhage: a case report]

Brain abscess following stroke is rare. We present a case of brain abscess which developed after hypertensive thalamic hemorrhage. A 51-year-old man had a left thalamic hemorrhage. Three months later, the patient was admitted to our hospital due to deterioration of right hemiparesis and motor aphasia. On admission, CT scan showed a ring-like high density area with peripheral edema in the left thalamus. T1-weighted magnetic resonance (MR) images revealed a large ring-enhanced lesion with surrounding edema in the same region. Laboratory examination demonstrated no signs of infectious disease. The patient's neurological state rapidly deteriorated 10 days after admission. Yellowish pus was aspirated during the emergent surgery. Bacteriological study of the pus revealed Staphylococcus Aureus. His symptoms improved after surgery followed by antibiotics therapy. The correct diagnosis prior to surgery was difficult in the present case because of lack of any signs of infection. Our case indicates that possibility of brain abscess should be taken into consideration as a rare differential diagnosis following intracerebral hemorrhage.

[Selective peripheral denervation for spasmodic torticollis involving the levator scapulae muscle]

Patients with laterocollis or rotatory type torticollis tend to show abnormal contraction of the levator scapulae muscle and the scalene muscles. These muscles are innervated from the anterior branches of the cervical spinal nerves. Because of this, the traditional Bertrand operation dealing with posterior branches does not adequately affect the symptoms of laterocollis. The authors report selective denervation of the levator scapulae muscle in three patients and discuss its rationale. All the three patients underwent denervation of both the C1-C6 posterior spinal rami and the branches from the C3 and C4 anterior rami to the levator scapulae muscle. We added myotomy of the scalene muscle in one patient, and denervation of the omohyoid muscle which is innervated from the ansa cervicalis and the descending branch of the hypoglossal nerve. The pre/post-operative Tsui scores were 12/4, 15/1, and 14/3 respectively. There were no complications. We conclude that selective peripheral denervation of the levator scapulae muscle is safe and effective in the treatment of laterocollic type torticollis.