Hikaru Maruiwa

High-grade adenoid cystic carcinoma originating from the lacrimal gland

Among primary lacrimal gland tumors, adenoid cystic carcinoma (ACC) is the most common malignant epithelial neoplasm; it is characterized by local intracranial invasion. A case with unusual dumbbell-type intracranial extension representing cavernous sinus syndrome is described. A 49-year-old woman was admitted to our hospital with right cavernous sinus syndrome. Computerized tomographic (CT) scans and magnetic resonance (MR) imaging demonstrated well-enhanced intraorbital and middle fossa tumors mimicking multifocal mass lesions. Operative findings revealed an ACC originating from the lacrimal gland and extending into the right cavernous sinus and middle fossa along the nerve sheath in the superior orbital fissure. Although MR image findings of intracranial ACC often resemble the image findings for meningiomas, intracranial ACC is very aggressive in comparison with meningioma. It is best treated surgically and aggressively.

Fatal hemorrhage from rupture of the intracranial internal carotid artery caused by aspergillus arteritis.

To the best of our knowledge, this is the first reported case of combined intracranial and extracranial hemorrhage due to aspergillus cerebral arteritis. Knowledge of the imaging and the importance of early diagnosis and treatment are emphasized. A 78 year old man developed progressive right-sided visual impairment and diplopia. Magnetic resonance imaging demonstrated a mass lesion located in the right orbital apex, with extension to the cavernous sinus and the right middle cranial fossa. Cerebral angiography showed no aneurysmal dilatation. He was scheduled for transnasal biopsy. However, the patient died of massive epistaxis and intracranial hemorrhage. Postmortem examination revealed an aspergillus granuloma of the orbit and the skull base involving the intracranial and extracranial internal carotid artery. Aspergillus fumigatus was identified by culture. The characteristic feature of the fungal infection is a low-intensity signal on T2-weighted magnetic resonance images. This finding may be useful in diagnosing fungal infection.

Production of platelet-activating factor by neuronal cells in the rat brain with cold injury

Abstract The production and localization of platelet-activating factor (PAF) in the brain following focal brain injury were examined. Immunofluorescent staining was used to detect PAF in the rat brain with cold-induced local brain injury. After cold injury, immediate-early PAF staining was observed within the cold lesion followed later by immunoreactivity in the ipsilateral white matter. PAF immunoreactivity was also clearly seen both in cortical neurons adjacent to the cold lesion and in the ipsilateral hippocampus which showed delayed neuronal degeneration. The data suggest that PAF synthesis occurs in the neuronal cells in the perilesional area and hippocampus as well as within the cold lesion site during the early stages of cold-induced brain injury. PAF expression may contribute to the onset and progression of further brain damage, such as delayed axotomy and delayed neuronal loss. [Neurol Res 2001; 23: 605-611]

Recurrent left frontal lobe cystic tumor in a 49‐year‐old woman

A 49-year-old woman presented with a chief complaint of a headache of 1 month’s duration. MRI revealed a ringenhanced cyst with a plaque-like mass in the left frontal lobe (Fig. 1). Surgical exposure revealed an elastic, soft, yellow, plaque-like mass in the left frontal lobe, which by gross criteria was removed successfully. The patient’s postoperative course was uneventful. However, 9 months after surgery, the patient again complained of a headache; an MRI revealed an irregular, enhanced polycystic mass in the left frontal lobe. Macroscopic findings during the second surgical procedure revealed a polycystic tumor infiltrating into surrounding normal brain tissue. Subtotal tumor removal was performed. Postoperatively, the patient received adjuvant temozolomide and radiotherapy. After 2 years of follow-up sessions subsequent to the second procedure, the patient remains well with no tumor recurrence seen on MRI.