RESUMO
OBJECTIVE: To report the case of an infant with infrequent cranial osteomyelitis as a complication of furuncular myiasis. CASE DESCRIPTION: The patient was a 4-month-old male who presented to the emergency department with a nodular skull lesion with edema, tenderness, pain, and purulent drainage, as well as progress of the ulcerated lesion and evidence of larvae inside. Antibiotic treatment was initiated, and the patient was taken to the operating room to remove the larvae, but he had no symptomatic improvement. A skull radiograph was taken to visualize the osteolytic lesion, and a 3D computed tomography scan showed osteomyelitis of the external parietal surface. Antibiotic management readjustment continued for a total of six weeks, and a skin flap was used with clinical improvement. COMMENTS: Myiasis is defined as the infestation of vertebrates with fly larvae. In mammals, larvae can feed on host tissue and cause a wide range of infestations depending on their location in the body. The cranial osteomyelitis as a complication of myiasis described in this report seems to be an exceptional case.
Assuntos
Miíase/complicações , Miíase/parasitologia , Osteomielite/etiologia , Neoplasias Cranianas/parasitologia , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Terapia Combinada , Seguimentos , Humanos , Imageamento Tridimensional/instrumentação , Lactente , Larva/parasitologia , Masculino , Miíase/diagnóstico , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Alta do Paciente/normas , Radiografia/métodos , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Neoplasias Cranianas/patologia , Retalhos Cirúrgicos/transplante , Tomografia Computadorizada por Raios X/métodosRESUMO
ABSTRACT Objective: To report the case of an infant with infrequent cranial osteomyelitis as a complication of furuncular myiasis. Case description: The patient was a 4-month-old male who presented to the emergency department with a nodular skull lesion with edema, tenderness, pain, and purulent drainage, as well as progress of the ulcerated lesion and evidence of larvae inside. Antibiotic treatment was initiated, and the patient was taken to the operating room to remove the larvae, but he had no symptomatic improvement. A skull radiograph was taken to visualize the osteolytic lesion, and a 3D computed tomography scan showed osteomyelitis of the external parietal surface. Antibiotic management readjustment continued for a total of six weeks, and a skin flap was used with clinical improvement. Comments: Myiasis is defined as the infestation of vertebrates with fly larvae. In mammals, larvae can feed on host tissue and cause a wide range of infestations depending on their location in the body. The cranial osteomyelitis as a complication of myiasis described in this report seems to be an exceptional case.
RESUMO Objetivo: Relatar um caso de criança com osteomielite craniana infrequente como complicação da miíase furuncular. Descrição do caso: Paciente do sexo masculino, com quatro meses de idade, que se apresentou no pronto-socorro com lesão nodular no crânio com edema, sensibilidade, dor e drenagem purulenta, com evolução da lesão ulcerada e evidência de larva no interior. O tratamento com antibióticos foi iniciado e o paciente foi levado à sala de cirurgia para remover as larvas, mas não houve melhora. Uma radiografia do crânio foi realizada para visualizar a lesão osteolítica e uma tomografia computadorizada em 3D mostrou osteomielite da superfície parietal externa. O reajuste do tratamento com antibióticos foi mantido por um total de seis semanas e um retalho cutâneo foi realizado com melhora clínica. Comentários: Miíase é definida como a infestação de vertebrados com larvas de moscas. Nos mamíferos, as larvas podem se alimentar do tecido hospedeiro e causar uma ampla variedade de infestações, dependendo da sua localização no corpo. A osteomielite como complicação da miíase, apresentada nesse caso, parece ser uma forma não usual de complicação dessa doença.
Assuntos
Humanos , Animais , Masculino , Lactente , Osteomielite/etiologia , Neoplasias Cranianas/parasitologia , Miíase/complicações , Miíase/parasitologia , Osteomielite/tratamento farmacológico , Osteomielite/diagnóstico por imagem , Alta do Paciente/normas , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Neoplasias Cranianas/patologia , Retalhos Cirúrgicos/transplante , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Seguimentos , Terapia Combinada , Imageamento Tridimensional/instrumentação , Larva/parasitologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Miíase/diagnósticoRESUMO
BACKGROUND Intraosseous cavernous skull hemangiomas are rare benign vascular tumors that are usually found incidentally on imaging, with an asymptomatic and slow-growing course. We present a case in which the patient had a mass on her forehead for many years, which began to grow rapidly after head trauma. Imaging characteristics play a crucial role in the diagnosis and description of this disease, and in differentiating it from other more common calvarial lesions that may present with a similar clinical picture. Here, we report an unusual presentation of a large skull hemangioma and discuss the different radiologic imaging findings and pathologic correlations. CASE REPORT A 58-year-old female with history of a lump on her forehead since childhood, which began to grow rapidly after experiencing a closed-head injury. Due to its large size, she went on to seek further management. Radiologic images revealed a frontal skull lesion suggestive of an intraosseous hemangioma. She underwent embolization of the tumor, and 2 days later underwent bilateral frontal craniectomy and cranioplasty. Histopathologic findings confirmed this diagnosis. CONCLUSIONS Intraosseous skull hemangioma may be confidently diagnosed and differentiated from other skull lesions by its imaging characteristics. An accurate diagnosis is essential to selecting correct management and avoiding complications.
Assuntos
Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/patologia , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias Cranianas/patologia , Feminino , Traumatismos Cranianos Fechados/complicações , Hemangioma Cavernoso/cirurgia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Cranianas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
El carcinoma epidermoide del hueso temporal es una neoplasia derivada de células epidérmicas del estrato espinoso, y que dado su baja incidencia, y presentación clínica similar a un cuadro de otitis media crónica colesteatomatosa, su diagnóstico es habitualmente tardío. El estudio del carcinoma epidermoide del hueso temporal se realiza con tomografía computarizada, la que evidencia erosión ósea. Sin embargo, existen distintos diagnósticos diferenciales, tanto malignos como benignos, que pueden provocar hallazgos similares en la tomografía computarizada. La resonancia magnética (RM) es un método de exploración de gran valor complementario para el estudio del carcinoma de oído medio. La RM con secuencia de difusión HASTE ha surgido como herramienta de estudio en patología de hueso temporal, tales como colesteatomas y teratomas de oído medio, pese a esto, no existen reportes en la literatura de la presentación imagenológica del carcinoma epidermoide de hueso temporal utilizando este método. En este artículo se presenta un caso clínico de una paciente con carcinoma epidermoide de oído medio, cuyo estudio preoperatorio incluyó RM-HASTE. Aun cuando se requiere un mayor número de casos para establecer el patrón imagenológico, se concluye que esta técnica es de utilidad para diferenciar este tumor de otitis media crónica colesteatomatosa.
Squamous cell carcinoma of the temporal bone (SCC) is a malignancy originated from epidermis spinous cells. Its low incidence and similar presentation to cholesteatomas, contributes to its late diagnosis. The most widely used study for this tumor is computed tomography (CT), which mainly evidences erosion of the temporal bone. There are several other diagnoses, malignant and benign, that could provoke similar findings at the CT. Magnetic resonance imaging (MRI) is a method of great value to study SCC. MRI with HASTE diffusion sequence has recently emerged as an important tool in the study of temporal bone pathologies, such as cholesteatoma and middle ear teratoma, despite this, there are no reports in the literature of the imaging presentation of SCC using this method. This article presents a clinical case of a patient with SCC, in whose preoperative study was performed HASTE-MRI. Although a larger number of cases are required to establish an imaging pattern, it is concluded that this technique is useful to differentiate this tumor from middle ear cholesteatomas.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Cranianas/diagnóstico por imagem , Osso Temporal , Neoplasias da Orelha/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Cranianas/cirurgia , Neoplasias Cranianas/patologia , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/patologia , Imageamento por Ressonância Magnética/métodos , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologiaRESUMO
A 7-month-old boy with malignant rhabdoid tumor of the right lateral neck, status post resection and chemotherapy, underwent FDG PET/CT for restaging. The images showed diffuse increased activity in the spleen and in the bone marrow of the appendicular bones and the spine, which is related to hematopoietin administered after chemotherapy. The images also revealed intense activity in the region of sphenoid bone, which is not a common region to have elevated FDG activity. The subsequent MRI scan showed that this activity was due to not-yet-converted red marrow in the sphenoid bone in this pediatric patient.
Assuntos
Fluordesoxiglucose F18 , Osso Esfenoide/diagnóstico por imagem , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tumor Rabdoide/complicações , Tumor Rabdoide/diagnóstico por imagem , Tumor Rabdoide/patologia , Neoplasias Cranianas/complicações , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias Cranianas/patologia , Osso Esfenoide/patologiaRESUMO
Introduction: The removal of ethmoidal tumors with secondary extension to the cranial base and/or facial region involves a high complexity and it is associated to a high morbility. Objective: To determine the results of craniofacial surgery in patient with ethmoid extended tumors. Methods: It was carried out a traverse retrospective descriptive study. The sample was conformed by the patients intervened surgically of anterior cranial base lesions by means of a combined craneofacial surgery during the period: January of the 2009 to January of the 2012 in the National Institute of Oncology and Radiobiology with a 2 year pursuit. Descriptive statistical variables were used. Results: 20 patients were intervened. The age average was of 44,8 years. It prevail the masculine sex (65 percent). Nasal obstruction constitutes the most frequent presentation. Adenocarcinoma and epidermoid carcinoma constituted the most frequent malignant lesions. Inside the benign lesions prevail the invertedpapiloma. The techniques more employees were the bilateral frontal craneotomy and total etmoidectomy. The most frequent complication was the cerebrospinal fluid leak. The 2 years overall survival in patients with malignant lesions was 35 percent. Conclusions: A high number of complications was identified but they didnt affect the survival neither the quality of life. An acceptable rate of survival was achieved in malignant lesions.
Introducción: La remoción de lesiones etmoidales con extensión secundaria a la base cranealy/o región facial, entraña una elevada complejidad y se encuentra asociada a una elevada morbilidad. Objetivo: Determinar los resultados de la cirugía combinada craneofacial en pacientes con neoplasias etmoidales extendidas. Métodos: Se realizó un estudio descriptivo retrospectivo transversal. La muestra estuvo conformada por los pacientes intervenidos quirúrgicamente de lesiones de base craneal anterior mediante un abordaje combinado craneofacial durante el período: enero de 2009 a enero de 2012 en el Instituto Nacional de Oncología y Radiobiología con un seguimiento de 2 años. Se emplearon variables estadísticas descriptivas. Resultados: Fueron intervenidos 20 pacientes. El promedio de edad fue de 44,8 años. Predominó el sexo masculino (65 por ciento). La obstrucción nasal constituyó la presentación más frecuente. El adenocarcinoma y el carcinoma epidermoide constituyeron las lesiones malignas más frecuentes. Dentro de las lesiones benignas predominó el papiloma invertido. Las técnicas más empleadas fueron la craneotomía frontal bilateral y la etmoidectomía total. La complicación más frecuente fue la fístula de líquido cefalorraquídeo. La supervivencia global a los 2 años en los pacientes con lesiones malignas fue del 35 por ciento. Conclusiones: Se identificó un elevado número de complicaciones pero no afectaron la supervivencia ni la calidad de vida. Se logró una aceptable tasa de supervivencia en lesiones malignas.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Osso Etmoide , Neoplasias Cranianas/cirurgia , Neoplasias Cranianas/patologia , Craniotomia , Estudos Transversais , Epidemiologia Descritiva , Invasividade Neoplásica , Complicações Pós-Operatórias , Análise de SobrevidaRESUMO
BACKGROUND: Multiple myeloma is a plasmatic cell neoplasm that is characterized by skeletal destruction, renal failure, anemia and hypercalcemia. The skull plasmacytomas represent less than 1% of the head and neck tumors, they can be the primary lesion or occur as a secondary manifestation of multiple myeloma in 20-30% of the patients, or they can even manifest several years later after the diagnosis of plasmacytoma. Although some of the lesions may be surgically accessible, the aggressive natural behavior will complicate the evolution of the patients. We present two cases of Mexican women with intracranial plasmacytomas, one of them associated with multiple myeloma. CLINICAL CASES: The first case was a 24 year-old woman diagnosed with a multiple myeloma with plasmacytic-plasmablastic bone infiltration that was removed in 90%. She presented a local recurrence that required a second intervention for removal. The second case was a 62 year-old female with a malignant intracranial tumor of plasma cells that was totally resected. Both patients received adjuvant treatment based on chemotherapy and radiation therapy with favorable results. The patients died at 5 and 1.5 years respectively due to renal failure secondary to systemic disease. CONCLUSIONS: We propose chemotherapy and radiation therapy as an essential part of treatment for this condition, as the aggressive behavior of the neoplasms can complicate the evolution, despite being surgically accessible.
Antecedentes: el mieloma múltiple es una neoplasia de células plasmáticas caracterizada por destrucción ósea, insuficiencia renal, anemia e hipercalcemia. Los plasmacitomas de los huesos del cráneo representan menos de 1% de los tumores de cabeza y cuello. Se manifiestan como lesión primaria o secundaria a mieloma múltiple en 20-30%, incluso pueden aparecer varios años después del diagnóstico. Los autores comunicamos dos casos de pacientes mexicanas con lesiones plasmocíticas intracraneales, asociadas con mieloma múltiple.Casos clínicos: el primer caso es el de una paciente de 24 años de edad, con diagnóstico de mieloma múltiple e infiltración ósea que fue extirpado en 90%. Experimentó una recidiva local que requirió otra intervención para su remoción. El segundo caso es el de una mujer de 62 años de edad con un tumor intracraneal de células plasmáticas que se resecó en su totalidad. Ambas recibieron terapia adyuvante con quimio y radioterapia con resultados favorables. Las pacientes fallecieron a los 5 y 1.5 años, respectivamente, por insuficiencia renal como consecuencia de la enfermedad sistémica. Conclusiones: se propone a la quimioterapia y radioterapia como parte esencial del tratamiento de este tumor porque su comportamiento natural agresivo puede complicar la evolución, a pesar de ser accesibles quirúrgicamente.
Assuntos
Encéfalo/patologia , Osso Frontal/patologia , Mieloma Múltiplo/patologia , Neoplasias Orbitárias/patologia , Plasmocitoma/patologia , Complicações Neoplásicas na Gravidez/patologia , Neoplasias Cranianas/patologia , Quimioterapia Adjuvante , Terapia Combinada , Irradiação Craniana , Craniotomia , Evolução Fatal , Feminino , Osso Frontal/cirurgia , Humanos , Falência Renal Crônica/etiologia , Meninges/patologia , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/terapia , Recidiva Local de Neoplasia , Neoplasias Orbitárias/cirurgia , Osteólise/etiologia , Osteólise/patologia , Plasmocitoma/irrigação sanguínea , Plasmocitoma/complicações , Plasmocitoma/terapia , Gravidez , Complicações Neoplásicas na Gravidez/terapia , Radioterapia Adjuvante , Neoplasias Cranianas/complicações , Neoplasias Cranianas/terapia , Adulto JovemAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Orelha/patologia , Orelha Média/patologia , Processo Mastoide/patologia , Papiloma Invertido/patologia , Neoplasias Cranianas/patologia , Neoplasias da Orelha/cirurgia , Invasividade Neoplásica , Recidiva Local de Neoplasia , Papiloma Invertido/cirurgia , Neoplasias Cranianas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Introduction: Acoustic nerve tumors have been recognized as a clinico-pathologic entity for at least 200 years, and they represent 90% of cerebellopontine angle diseases. Histologically, the tumors are derived from Schwann cells of the myelin sheath, with smaller tumors consisting of elongated palisade cells, while in large tumors, cystic degeneration can be found in the central areas, possibly due to deficient vascularization. We retrospectively reviewed 825 cases of vestibular schwannomas, reported between January 1984 and August 2006, in which the patients underwent surgery to remove the tumor. Objective: To evaluate signs, symptoms, aspects of clinical diagnosis, including the results of audiological and imaging studies, and surgical techniques and complications. Methods: A retrospective chart review. The medical records of all patients undergoing surgical treatment for schwannoma during the period indicated were reviewed. Results and Conclusion: Hearing loss was the first symptom reported in almost all cases, and tumor size was not proportional to the impairment of the auditory threshold. The surgical techniques allowed safe preservation of facial function. In particular, the retrolabyrinthine route proved useful in small tumors, with 50% preservation of hearing...
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Audiometria de Resposta Evocada , Audiometria da Fala , Neoplasias Cranianas/diagnóstico , Neoplasias Cranianas/patologia , Nervo Vestibulococlear/patologia , Neuroma Acústico/etiologia , Neuroma Acústico/patologiaRESUMO
Primary bone lymphoma is a rare disease, which usually has a different presentation and evolution than lymphomas of other locations. We are presenting a case of primary bone lymphoma of rapid growth, in cranial and sternal locations. In its evolution, once the excision of the primary lesion of the skull was performed, the patient presented new lesions of rapid growth at the skull and femur level, and progression of pre-sternal lesion. With large B-cell diffuse non-Hodgkin lymphoma pathology, the patient initiated R-CHOPP (cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab) with rapid reduction of all lesions without evidence of progression after the six cycles.