We report two cases of neurinoma arising from the lumbar nerve roots, with different proliferating patterns.The first case was a 77-year-old male who complained of low back pain with sensory desturbance of the lower limbs.Gradually, he developed bladder and bowel dysfunction and worsening of his intermittent claudication Roentgenographic examination showed osteolysis of the L4 vertebral body and disappearance of the right pedicle of the fourth lumbar vertebra. Magnetic resonance imaging showed a tumorous lesion spreading from the spinal canal to the intervertebral foramen and the fourth vertebral body. T1-weighted images showed the tumor to be of iso signal intensity and with T2-weighted images, high signal intensity images were found.The second case was a 56-year-old male who complaind of pain in the left lower limb. Roentgenographic examination did not show any change in his lumbar vertebra. MR imaging showed a tumorous lesion arising from the left third lumbar nerve root. The lesion spread from the intervertebral foramen to the extravertebral foramen. With T1-weighted images, the tumor was seen to be of iso signal intensity and with T2-weighted images, high signal intensity.
We reported a 42-year-old female patient with a malignant peripheral nerve sheath tumor (MPNST) arising within the radial nerve in her left axilla. She had noticed a subcutaneous mass in this area in 1988. The tumor had grown slowly. We performed partial excision of the tumor in 1997, which was histologically diagnosed as a plexiform neurofibroma. Since then, it increased in size more rapidly, became harder, and was complicated with pain. In August 2000, we performed a second partial excision and confirmed the malignant change. The tumor was totally excised and radical dissection of the lymph nodes of the left axilla was performed. Resulting radial nerve palsy was relieved by tendon transfers which were done one month later. She returned to work as a nurse two months after the last surgery. [Skin Cancer (Japan) 2001; 16: 319-323]
A case of candida spondylitis affecting the lumber spine is reported. An eighty-one-year old man underwent colectomy for sigmoid colon cancer. Three months after the abdominal surgery, he had high fever and low back pain. Roentogenographic examination and MR imaging demonstrated abscess of the third to fourth intervertebral disk space and psoas abscess. Microbiological examination of a specimen obtained by needle biopsy revealed infection of candida tropicalis. Intravenous elimination of the furuconazole and cast immobilization rapidly improved his clinical symptom, although the C-reactive protein and erythrocyte sedimentation continued to be high for one year because of recurrent bacterial pneumonia. Thus MR imaging proved to be very useful for detecting the bone condition and inspecting diminishment of the abscess.
This report describes two hemodialysis patients with cervical myelopathy due to calcification of the ligamentum flavum. The patients were male aged 59 and 57 who had been hemodialysed for 2 years and 3 months, and 22 years respectively. Their chief complaint were gait and precise motion disturbance. Computed tomography after myelography clearly showed the calcified lesion of the yellow ligament, which markedly compressed the spinal cord. We performed spinous process-splitting laminoplasty, which decreased their symptoms.Certain hypotheses were studied in the previous report on the causes of the calcification of the ligamentum flavum; for example mobile stress of the yellow ligament, estrogen decrease, and calcium metabolism disorder. Hemodialysis causes calcium metabolism disorder and calcium deposit to soft tissues like the periarticulation, vasculum and subcutis. There has however been no report on the observation of calcification at the yellow ligament.We believe that hemodialysis which causes calcium metabolism disorder is related to the calcification of the ligamentum flavum.
Mycotic aneurysms happen in some infectious diseases and psoas abscesses are a relatively rare disease in recent years. We treated a case of mycotic aneurysm accompanied by a psoas abscess, in which the aneurysm ruptured making the patient critically ill. Only 8 such cases have benn reported. Computed tomography is useful for diagnosis of psoas abscesses. Although mycotic aneurysms accompanied by a psoas abscess are extremely rare, we should pay attention to such cases.
This paper reports a case of total elbow arthroplasty for mutilans deformity with olecranon fracture in rheumatoid arthritis. A 55-year-old woman presented with a 12-year history of arthritis involving the hands, wrists, hips, knees, ankles, and elbows. She had already undergone bilateral TKA and THA. She could walk only with a pair of crutches. At one point she stumbled and fell, fracturing her left olecranon process. She underwent total elbow arthroplasty and osteosynthesis. The fracture was treated with tension-band wiring after the components were implanted. Three weeks later, pain was completely relieved and she was able to walk with crutches. The arc of flexion ranged from 20 degrees to 120 degrees. The result of the operation was satisfactory. During the operation, we suffered approach, prosthetic selection and humeral component placement.
Malignant Rhabdoid Tumor (MRT) is a rare neoplasm which usually arises from the kidney of infants. Extrarenal MRT is also known to occur in other organs or soft tissue. We report a case of retroperitoneal MRT which developed in the paravertebral region and invaded into the intrathecal sac through the intervertebral foramen. A twenty seven year old female who had developed severe sciatica ten months earlier was referred to our hospital. MR imaging disclosed no evidence of spinal tumor. Three months later, a mass in intrathecal sac at the level of L4/5 vertebra was seen. Postmyelogram CT scan revealed an intradural mass at the same level. Surgical treatment was performed to the intrathecal region. Histological and immunohistochemical examinations revealed is as MRT.
Magnetic resonance imaging (MRI) has become an important diagnostic tool in diagnosing spinal cord tumors. But differential diagnosis is very difficult with only MRI.Spinal meningiomas account for about 10% of primary spinal cord tumors in Asia. We studied three patients with spinal meningiomas in order to show special findings. T1-weighted images showed various intensities, but their signal intensities on T2-weighted images were similar to those of the spinal cord in all cases. We considered these to be special findings with MRI in spinal meningioma. The relationship between pathological type (e. g. psammomatous type, fibroblastic type, and transitional type) and MRI was not clear. Preoperative diagnosis of ossified spinal meningioma was made from MRI.
A case of multiple neurilemmoma in the cauda equina, the posterior mediastinum and peripheral nerves is reported. A 24 year old male presented with gait disturbance and muscle weakness in the lower extremities. His past history included the presence of multiple neurilemmomas in the left upper extremities.Myelography and MR imaging showed tumors in the intradural space between the thoracic level and the sacral level. All resected tumors showed the same pattern of Antoni A tissue and Antoni B tissue. In comparing this patient with neurofibrolmatosis type 2, we conclude that the diagnosis of this patient is neurilemmomatosis and not neurofibromatosis because of the absence of cardinal features of neurofibromatosis. Patients with neurilemmomatosis should be carefuly observed for the development of other neuro mas such as acoustic neurinoma.
We report a case of intramuscular myxoma occurring in the adductor brevis. A sixty-year-old man was referred to our hospital with a large soft tissue mass in the left thigh detected by abdominal CT. MR-imaging disclosed a large mass that was homogenous hypointense with respect to the adjacent muscle on T1-weighed image and hyperintense on T2-weighed image. The mass showed remarkable irregular postcontrast enhancement. We removed the tumor completely after the final diagnosis of intramuscular myxoma by open biopsy. Intramuscular myxomas are benign lesions both clinically and histologically, but may cause confusion in preoperative roentgenographic diagnosis if these are identified with unusual expression.
