Accurate Preoperative Diagnosis Research Articles

Extra-Adrenal Paraganglioma on Fine-Needle Aspiration Cytology: A Case Series.

Paragangliomas (PGs) are rare tumors that most commonly occur in the head and neck region and along the sympathetic chain. Fine-needle aspiration cytology is not commonly used for the diagnosis of PG due to the potential risk of hemorrhage and hypertensive crisis. As a result, limited studies describe the cytological features of PGs. In this case series, we will discuss the fine-needle aspiration features of three cases of extra-adrenal PGs. The cellular arrangement in smears was either singly scattered or loosely cohesive clusters. The cells were polygonal with pleomorphic nuclei, abundant granular cytoplasm, and bland chromatin. Cellblock showed two types of cells with focal acinar formation. Immunohistochemistry also confirmed the diagnosis. These results were also in keeping with radiological findings. Fine-needle aspiration cytology, along with clinicoradiological findings, can help in making an accurate preoperative diagnosis of PG.

A case of gastric granular cell tumor successfully treated by laparoscopic and endoscopic cooperative surgery.

We describe a case of gastric granular cell tumor (GCT) treated with laparoscopic and endoscopic cooperative surgery (LECS). A 30-year-old male was referred to our hospital for the investigation of a subepithelial lesion (SEL). Contrast-enhanced computed tomography and esophagogastroduodenoscopy revealed a 15mm SEL within the posterior wall of the gastric body. Endoscopic ultrasound revealed a well-demarcated, homogenous, hypoechoic lesion in the submucosa, suggesting partial invasion into the muscularis propria. Biopsy using the bite-on-bite technique showed a gastric GCT diagnosis. The patient underwent LECS, and pathological findings confirmed a benign gastric GCT without muscularis propria invasion, lymphovascular invasion, or lymph node metastasis. The patient remained recurrence-free after 24months.Despite unresolved issues such as setting the resection margins; indications for resection, and accurate preoperative diagnosis of the invasion depth, including muscularis propria invasion, LECS may be useful for gastric GCT in the form of SEL, especially for lesions that cannot be ruled out to invade the muscularis propria invasion.

Diagnostic dilemma: a collision of pancreatic neuroendocrine tumor G3 and adenocarcinoma with extensive fibrosis.

An 82-year-old man presented with intermittent abdominal pain and elevated liver enzymes. Blood tests showed normal levels of tumor markers (CEA, CA19-9, NSE). Contrast-enhanced computed tomography (CE-CT) revealed a 20mm hypovascular mass in the pancreatic head. Magnetic resonance imaging indicated low intensity on both T1- and T2-weighted images and high intensity on diffusion-weighted images. Endoscopic ultrasonography visualized an irregular hypoechoic mass. Initially, it was diagnosed as pancreatic ductal adenocarcinoma (PDAC) based on imaging. Subsequent histopathological analysis via endoscopic ultrasound-guided fine-needle aspiration revealed a neuroendocrine tumor (NET). The preoperative diagnosis was changed to a pancreatic NET grade1. Consequently, a pancreaticoduodenectomy was performed. Histopathological examination of the resected specimen unveiled a mixed tumor-NET-Grade1/Grade3 and invasive PDAC. No clear transition between the NETs and PDAC was observed. The high grade of NET with significant fibrosis contributed to decreased enhancement of CE-CT. Finally, we diagnosed this case as a pancreatic collision tumor involving both NET and PDAC components, with lymph node metastases attributed to the NET components. In this case, achieving an accurate preoperative diagnosis was challenging despite utilizing both imaging and biopsy diagnostics. This unique case underscores the difficulties encountered in the preoperative assessment of mixed tumors.

Pseudoangiomatous stromal hyperplasia causing bilateral galactomastia with short-term recurrence after surgery: a case report.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare, benign breast lesion characterized by collagen proliferation, often identified as an incidental microscopic finding. Clinically, it may present as a palpable, well-defined breast mass or, in rare instances, as a diffuse, bilateral process leading to significant breast enlargement. We herein report a case of extensive diffuse PASH with short-term recurrence following lesion resection at another hospital. Because of the severity of symptoms, the patient underwent bilateral mastectomy at our facility. This article reviews the clinical, radiologic, and pathologic features of PASH and emphasizes the importance of an accurate preoperative imaging diagnosis for guiding appropriate treatment.

CHOLECYSTITIS WITH CHOLELITHIASIS WITH TUBERCULAR PATHOLOGY: A CASE REPORT

An extremely uncommon condition that manifests as calculous or acalculous cholecystitis is gallbladder tuberculosis (GBTB). It is challenging to make an accurate preoperative diagnosis of GBTB, and this literature survey emphasizes that postcholecystectomy or postmortem diagnosis is the norm in the majority of patients. Although GBTB is a very rare condition, people from endemic areas who have risk factors including a history of tuberculosis or underlying immunosuppression should be suspected of having it. Since radiography lacks pathognomic features, gallbladder tuberculosis is only diagnosed through histology of the removed specimen. Here, we detail an extremely unique case of gallbladder tuberculosis that was unexpectedly discovered during histopathological examination.

Cystic ductal adenocarcinoma of pancreas complicated with neuroendocrine tumor: A case report and review of literature

BACKGROUND Difficulties in making an accurate preoperative diagnosis of cystic pancreatic lesions pose a challenge for radiologists. It would be helpful to report rare cases and review the literature. CASE SUMMARY In the present report, a case of a patient with a pancreatic cystic lesion initially misdiagnosed as a pseudocyst by radiologist was documented, which was later pathologically confirmed as pancreatic ductal adenocarcinoma with neuroendocrine tumor. However, subsequent literature review yielded no previous reports of pancreatic ductal adenocarcinoma with neuroendocrine tumors and cystic lesions. Therefore, literature on the imaging diagnosis of pancreatic cystic lesions was instead reviewed and discussed. CONCLUSION Careful evaluation of the characteristics revealed by multimodal imaging techniques, medical history, laboratory examination data and follow-up observations, is critical to the diagnosis and treatment of pancreatic cystic disease. We provide valuable insights into the diagnosis of pancreatic cystic disease through a rare case report and literature review.

Splenic Epidermoid Cyst arising within an Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Cystic Neoplasm-a diagnostic enigma

Abstract Introduction/Objective Accessory spleens are congenital embryological aberrations usually found within the splenic hilum with no clinical significance. An IntraPancreatic Accessory Spleen (IPAS) is an uncommon benign pancreatic lesion encountered clinically. A splenic epidermoid cyst arising within an IPAS is exceedingly rare and is discussed below. Methods/Case Report A 68-year-old male presented with intermittent post-prandial epigastric pain radiating to the left flank for >1.5 years. Radiological imaging identified a 5.2 cm calcified cyst in the pancreatic tail with a differential of mucinous pancreatic neoplasm/ pancreatic pseudocyst. Additionally, a 2.8cm lobulated solid hypoechoic mass was seen at the porta hepatis with a differential of enlarged lymph node/benign neoplasm. Laboratory biochemical tests were within normal limits except for mildly elevated ferritin. Fine needle aspiration biopsy was indeterminate. The patient elected to proceed with surgical resection. A laparoscopic distal pancreatectomy with splenectomy and excision of the hilar mass was performed. The hilar mass was analyzed by hematopathology and revealed a hyaline- vascular variant of Castleman disease. On gross examination of the distal pancreatic/splenectomy specimen, a well- demarcated cystic lesion with brownish fluid was noted within the pancreatic tail. Microscopic examination revealed a nonpathological pancreas separated by a fibrous capsule with a large cyst arising within an intrapancreatic accessory spleen. The cyst was lined with multilayered non-keratinized CK5/6, and p63 positive squamous epithelium with no lymphocytic infiltrates and absent hair/ dermal appendages confirming a splenic epidermoid cyst. Post-operative follow-up at 6 weeks was uneventful. Results (if a Case Study enter NA) NA Conclusion An epidermoid cyst arising within an intrapancreatic accessory spleen (ECIAS) is extremely rare thus precluding accurate preoperative diagnosis as this entity shares similar radiological imaging characteristics as other cystic lesions such as mucinous pancreatic cysts. It is important for anatomic pathologists to recognize and consider the intrapancreatic compartment as a possible location for accessory spleens. Accurate preoperative diagnosis can prevent unnecessary surveillance and/or extensive surgical resection.

The Role of Fine-Needle Aspiration Cytology in the Evaluation of Breast Lumps.

Background Breast cancer is the most frequently diagnosed cancer in women worldwide, accounting for more than one in ten new cancer cases each year. It ranks as the second leading cause of cancer-related mortality among women. The majority of patients present with palpable breast lumps. Effective surgical management of breast cancer largely depends on accurate preoperative pathological diagnosis. This study evaluates the diagnostic accuracy and prognostic implications of fine-needle aspiration cytology (FNAC) compared with core needle biopsy (CNB) in breast carcinoma. Objectives The objectives of this study are to assess the sensitivity and specificity of FNACand CNB, to compare the diagnostic accuracy of FNAC and CNB against histopathological findings from gross specimens in the evaluation of breast lumps, and to identify and examine the limitations associated with both FNAC and CNB procedures. Materials and methods This study included female patients presenting with clinically suspicious palpable breast lumps at the General Surgery OPD of Bankura Sammilani Medical College and Hospital, Bankura. All patients underwent FNAC followed by CNB. The cytological and CNB diagnoses were compared with the final pathological diagnosis obtained from excisional biopsy. Results The study included 44 female patients aged 20 to 70 years. The most common age group for breast carcinoma was 50-59 years (36.36%). Malignancy was diagnosed in 75% of cases (33/44), with right breast involvement (65%) being more common than the left. The upper outer quadrant (59%) was the most frequently affected area. Among the 33 confirmed malignant cases, 69.70% had lesions larger than 5 cm. FNAC demonstrated a sensitivity of 93.93%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 84.61%, and diagnostic accuracy of 95.45%. CNB showed a sensitivity of 96.97%, specificity of 100%, PPV of 100%, NPV of 91.67%, and diagnostic accuracy of 97.73%. Both methods correlated significantly with the final histopathology results (p < 0.05). FNAC identified ductal carcinoma in 93.55% of cases, while CNB identified it in 96.77%. Conclusion CNBprovides additional information on receptor status but is more resource-intensive. FNACremains a cost-effective and time-efficient first-line diagnostic tool, especially in resource-constrained settings like rural India. FNAC should be employed for initial diagnosis, with CNB reserved for cases requiring further clarification.

A flexible deep learning framework for liver tumor diagnosis using variable multi-phase contrast-enhanced CT scans

BackgroundLiver cancer is a significant cause of cancer-related mortality worldwide and requires tailored treatment strategies for different types. However, preoperative accurate diagnosis of the type presents a challenge. This study aims to develop an automatic diagnostic model based on multi-phase contrast-enhanced CT (CECT) images to distinguish between hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and normal individuals.MethodsWe designed a Hierarchical Long Short-Term Memory (H-LSTM) model, whose core components consist of a shared image feature extractor across phases, an internal LSTM for each phase, and an external LSTM across phases. The internal LSTM aggregates features from different layers of 2D CECT images, while the external LSTM aggregates features across different phases. H-LSTM can handle incomplete phases and varying numbers of CECT image layers, making it suitable for real-world decision support scenarios. Additionally, we applied phase augmentation techniques to process multi-phase CECT images, improving the model’s robustness.ResultsThe H-LSTM model achieved an overall average AUROC of 0.93 (0.90, 1.00) on the test dataset, with AUROC for HCC classification reaching 0.97 (0.93, 1.00) and for ICC classification reaching 0.90 (0.78, 1.00). Comprehensive validation in scenarios with incomplete phases was performed, with the H-LSTM model consistently achieving AUROC values over 0.9.ConclusionThe proposed H-LSTM model can be employed for classification tasks involving incomplete phases of CECT images in real-world scenarios, demonstrating high performance. This highlights the potential of AI-assisted systems in achieving accurate diagnosis and treatment of liver cancer. H-LSTM offers an effective solution for processing multi-phase data and provides practical value for clinical diagnostics.

Renal Cell Carcinoma With Tumor Thrombus Extending Into the Inferior Vena Cava and the Right Atrium Demonstrated by 68 Ga-DOTATATE PET/CT.

Approximately 10% of all renal cell carcinoma (RCC) patients develop a venous tumor thrombus, a major negative prognostic factor. Surgical excision is commonly required for RCC patients with tumor thrombus. Accurate preoperative diagnosis and assessment of tumor thrombus level is vital because the level of thrombus may influence treatment decisions. MRI, contrast-enhanced CT, 18 F-FDG PET/CT, and 68 Ga-PSMA PET/CT have been used to diagnose and evaluate the extent of tumor thrombus in RCC. However, no case of RCC with inferior vena cava tumor thrombus showing 68 Ga-DOTATATE uptake has been reported yet. Herein, we report a case of metastatic RCC with tumor thrombus in the inferior vena cava on 68 Ga-DOTATATE PET/CT.

The role of cricoarytenoid joint ankylosis in bilateral vocal cord immobility.

To stratify the severity of cricoarytenoid joint fixation (CAJF) by surgery and understand the role of it played in the bilateral vocal fold immobility (BVFI). The second objective emphasizes on the significance of the preoperative differential diagnosis from neurogenic immobility with medical history and endoscopic findings. A retrospective review was conducted of 74 patients between 2005 and 2022. Careful medical history inquiry, and videolaryngoscopy are conducted to recruit the appropriate surgical candidates. All patients underwent arytenoid remobilization (AR) followed by vocal fold medialization with arytenoid adduction (AA) or lateralization with suture lateralization (SL). The severity of CAJF is graded during the operation or inferred based on the period from operation to recurrence. A total of 18 patients, aged between 18 and 76years, were analyzed. Among them, 14 cases were classified as the adducted type with ventilation problems, with three presenting with dyspnea, and 11 requiring artificial airways. Additionally, four patients presented with the abducted type, characterized by aphonia. Meanwhile, two additional cases were considered for comparison but were not included in this cohort of 18 subjects due to incorrect diagnosis and inappropriate management. Using AR procedure, the AA procedure offered three aphonia subjects a voiced sound without airway impairment and the SL procedure decannulated 100% (11/11) of the artificial airways and improved the airway patency in 100% (3/3) of the non-tracheostomized subjects despite the severity of CAJF. The severity of joint ankylosis was distributed as follows: In the aphonia group, there were three subjects with grade I, one subject with grade II, and 0 subjects with grade III. In the ventilation group, there was one subject with grade I, seven subjects with grade II, and six subjects with grade III. In contrast, the two cases used for comparison experienced recurrent dyspnea and failed decannulation because the AR procedure was not performed. The follow-up period was averaged in 58 and 14months at least. From this experience, it is the accurate preoperative diagnosis instead of the severity of CAJF that determines the successful rate in airway patency and voiced phonation if the AR procedure is utilized. Careful medical history inquiry and videolaryngoscopic examination can correctly differentiate the mechanical from neurogenic origin without the help of EMG. Evidence of level: 4.

Diffusion-Weighted Magnetic Resonance Imaging for the Diagnosis of Lymph Node Metastasis in Patients with Biliary Tract Cancer.

Objective: The diagnostic efficacy of the apparent diffusion coefficient (ADC) in diffusion-weighted magnetic resonance imaging (DW-MRI) for lymph node metastasis in biliary tract cancer was investigated in the present study. Methods: In total, 112 surgically resected lymph nodes from 35 biliary tract cancer patients were examined in this study. The mean and minimum ADC values of the lymph nodes as well as the long-axis and short-axis diameters of the lymph nodes were assessed by computed tomography (CT). The relationship between these parameters and the presence of histological lymph node metastasis was evaluated. Results: Histological lymph node metastasis was detected in 31 (27.7%) out of 112 lymph nodes. Metastatic lymph nodes had a significantly larger short-axis diameter compared with non-metastatic lymph nodes (p = 0.002), but the long-axis diameter was not significantly different between metastatic and non-metastatic lymph nodes. The mean and minimum ADC values for metastatic lymph nodes were significantly reduced compared with those for non-metastatic lymph nodes (p < 0.001 for both). However, the minimum ADC value showed the highest accuracy for the diagnosis of histological lymph node metastasis, with an area under the curve of 0.877, sensitivity of 87.1%, specificity of 82.7%, and accuracy of 83.9%. Conclusions: The minimum ADC value in DW-MRI is highly effective for the diagnosis of lymph node metastasis in biliary tract cancer. Accurate preoperative diagnosis of lymph node metastasis in biliary tract cancer should enable the establishment of more appropriate treatment strategies.

Super minimally invasive surgery changing the treatment paradigm for rectal cancer

The treatment mode for patients with low rectal cancer (LRC) is still mainly surgical treatment. With the advancement of medical technology, the current surgical mode is more inclined towards super minimally invasive surgery (SMIS) that preserves organs and functions. SMIS belongs to organ preservation surgery, including non-full thickness and full-thickness resection under digestive endoscopy, laparoscopic or robotic full-thickness resection, and transanal minimally invasive surgery, which can cover all stages of TNM staging. The paper elaborates on the importance of preoperative accurate diagnosis and risk stratification in selecting appropriate SMIS methods, the new progress of imaging technology in accurately predicting lymph node metastasis, providing preoperative TNM staging and risk stratification, and guiding SMIS treatment. Finally, the paper introduces the SMIS surgical options for the treatment of LRC that have been developed and are currently in the clinical research stage, with the aim of maximizing the quality of life for LRC patients.

Clinical and therapeutic implications of cavernous sinus invasion in pituitary adenomas.

Invasion of the cavernous sinus by pituitary adenomas impedes complete surgical resection, compromises biochemical remission, and increases the risk of further tumor recurrence. Accurate preoperative MRI-based diagnosis or intraoperative direct inspection of cavernous sinus invasion are essential for optimal surgical planning and for tailoring postoperative therapeutic strategies, depending on whether a total resection has been achieved, or tumoral tissue has been left in surgically inaccessible locations. The molecular mechanisms underlying the invasive behavior of pituitary adenomas remain poorly understood, hindering the development of targeted therapies. Some studies have identified genes overexpressed in pituitary adenomas invading the cavernous sinus, offering insights into the acquisition of invasive behavior. Their main limitation however lies in comparing purely intrasellar specimens obtained from invasive and non-invasive adenomas. Further, precise anatomical knowledge of the medial wall of the cavernous sinus is crucial for grasping the mechanisms of invasion. Recently, alongside the standard intrasellar surgery, extended endoscopic intracavernous surgical procedures with systematic selective resection of the medial wall of the cavernous sinus have shown promising results for invasive secreting pituitary adenomas. The first- and second-generation somatostatin agonist ligands and cabergoline are used with variable efficacy to control secretory activity and/or growth of intracavernous remnants. Tumor regrowth usually requires surgical reintervention, sometimes combined with radiotherapy or radiosurgery which is applied despite their benign nature. Unraveling the molecular pathways driving invasive behavior of pituitary adenomas and their tropism to the cavernous sinuses is the key for developing efficient innovative treatment modalities that could reduce the need for repeated surgery or radiotherapy.

Tubal mesosalpinx cysts combined with adnexal torsion in adolescents: a report of two cases and review of the literature

BackgroundTubal mesosalpinx cysts are paratubal cysts, that account for approximately 10% of adnexal masses, and the presence of these cysts combined with adnexal torsion is a rare acute abdominal condition, with few cases reported in the literature. We reported two cases of adolescent tubal mesosalpinx cysts combined with adnexal torsion and reviewed the literature to help improve the diagnosis of the disease.Case reportsThe first patient was an 11-year-old girl with left lower abdominal pain for 5 days and fever with nausea and vomiting for 3 days, who was found to have a cystic pelvic mass on preoperative imaging and was diagnosed intraoperatively and postoperatively on pathology as having a left tubal mesosalpinx cyst combined with adnexal torsion. The second patient was a 13-year-old girl with right lower abdominal pain for 16 h and a palpable mass in the lower and middle abdomen on examination, which was hard and tender to palpate. Preoperative imaging revealed a large cystic mass in the right adnexal region, and intraoperative and postoperative pathology revealed a right tubal mesosalpinx cyst combined with adnexal torsion.ConclusionsTubal mesosalpinx cysts combined with adnexal torsion are rare causes of acute lower abdominal pain. Early diagnosis and timely surgery are necessary to ensure ovarian and tubal function. Accurate preoperative imaging diagnosis is challenging, and MRI is a beneficial supplement to ultrasound and CT examinations, providing more objective imaging information and reducing the incidence of adverse outcomes.

Risk factors for pathological upgrading and noncurative resection in patients with gastric mucosal lesions after endoscopic submucosal dissection

BackgroundThe pathological results obtained from endoscopic forceps biopsy (EFB) do not always align with the findings of postoperative endoscopic submucosal dissection (ESD). Furthermore, as ESD becomes more widespread, the number of noncurative endoscopic cases increases; thus, an accurate preoperative diagnosis and an appropriate treatment method are crucial. The purpose of this study was to explore the risk factors for postoperative pathological upgrading and noncurative resection and to gather experience in clinical and pathological diagnosis.MethodsFrom March 2016 to November 2023, 292 ESD specimens were collected from 262 patients with gastric mucosal lesions. Clinicopathological information, the coincidence rate of pathological diagnosis between EFB and ESD specimens, and risk factors related to noncurative resection were analyzed retrospectively.ResultsThe overall upgraded pathological diagnosis rate between EFB and ESD was 26.4%. The independent predictors for the upgraded group included proximal stomach lesions, lesion size > 2 cm, surface ulceration, and surface nodules. Twenty of the 235 early gastric cancer (EGC) patients underwent noncurative ESD resection. Multivariate analysis showed that undifferentiated carcinoma and tumor infiltration into the submucosa were significantly associated with noncurative resection.ConclusionBiopsy cannot fully represent the lesions of gastric intraepithelial neoplasia (GIN). When a suspected epithelial dysplasia is suspected, a careful endoscopic examination should be conducted to evaluate the lesion site, size, and surface characteristics to ensure an accurate diagnosis. Noncurative endoscopic resection is associated with undifferentiated carcinoma and submucosal infiltration. Clinicians must be familiar with these predictive factors for noncurative resection and select the appropriate treatment for their patients.

Incidental discovery of unilateral hydronephrosis unveiling psoas major desmoid-type fibromatosis in a 24-year-old male: A case report with a 5-year follow-up.

Desmoid-type fibromatosis (DTF), also known as aggressive fibromatosis, is a rare neoplasm originating from the fascial or musculoaponeurotic tissues. While benign and characterized by slow growth, it exhibits local aggressiveness and lacks specific clinical characteristics. However, in a considerable percentage of patients, it could be asymptomatic and discovered by accident during routine clinical examinations. Only a few cases of DTF arising from the psoas major muscle have been reported in the medical literature. A 24-year-old male, asymptomatic and without significant personal or family medical history, was diagnosed with grade 2 hydronephrosis by abdominal ultrasonography during a routine physical examination. This diagnosis was made 15 days after undergoing uncomplicated open-heart surgery to repair an atrial septal defect. Intravenous pyelogram revealed hydronephrosis with dilation of the pelvicalyceal system. Ureteroscopy ruled out any intrinsic lesions of the ureter. Contrast-enhanced computed tomography identified a 3.5 × 2 × 5.2 cm mass in the retroperitoneum, closely associated with the psoas muscle and enveloping the ureter adjacent to the iliac artery. Postoperative pathological analysis confirmed a definitive diagnosis of sporadic DTF. The patient underwent exploratory abdominal surgery, during which the tumor was resected without any intraoperative complications. After close monitoring over a 5-year follow-up period, which included periodic physical examinations, magnetic resonance imaging, and ultrasonography, no local recurrence was detected. Achieving an accurate preoperative diagnosis presents a challenge in cases involving retroperitoneal tumors originating from the psoas major muscle and encasing the ureter. However, the insertion of a double J stent is deemed a crucial step in the surgical process, facilitating the dissection and isolation of the ureter from the tumor while preserving kidney function.

Ứng dụng của test chọc tháo dịch não tủy trong chẩn đoán và điều trị giãn não thất áp lực bình thường nguyên phát: ca lâm sàng

Normal Pressure Hydrocephalus (NPH) is a clinical syndrome characterized by gait disturbance, cognitive decline, and urinary incontinence accompanied by ventricular enlargement without increased intracranial pressure. NPH is a diagnosis of particular note as it differs from other neurodegenerative disorders such as Alzheimer’s and Lewy body disease. Symptoms may improve if diagnosed and treated promptly. Clinical symptoms of the disease were first described by Salomon Hakim and R.D. Adam in 1965, though they are common but not specific enough. Additionally, age-related ventricular enlargement and periventricular white matter damage are found in various conditions, both in normal individuals and in other cognitive decline disorders (vascular cognitive impairment, Alzheimer’s), making early diagnosis challenging. Treatment of NPH mainly relies on surgical intervention with ventriculoperitoneal shunting, with accurate preoperative diagnosis being crucial for success.Lumbar puncture (LP) can be considered the most important procedure to demonstrate the underlying pathophysiology of NPH, which is normal pressure hydrocephalus. High-volume lumbar tap test (LTT) is a relatively simple and effective method when clinical-radiological suspicion is present: it helps to distinguish NPH from other conditions with ventricular enlargement and aids in predicting the success of ventriculoperitoneal shunting surgery. The clinical case presented below illustrates the value of LTT in the definitive diagnosis of NPH at the Department of Neurology and Alzheimer’s Disease - National Geriatric Hospital.

Intracranial Cysts: A Single-Institution Experience With 27 Surgically Managed Cases.

Introduction Intracranial cysts (ICs) are rare pathologies that are often found incidentally during radiological examinations. They may appear in various brain regions and are categorized as normal, congenital, traumatic, or tumor-associated variants. ICs can be asymptomatic or cause symptoms, such as headaches, visual impairments, or seizures, depending on their size and location. Severe complications include obstructive hydrocephalus, loss of consciousness, and intracranial bleeding. Surgical excision is the most accepted type of management in most ICs. Objectives This study aimed to evaluate 27 surgically managed ICs in a tertiary hospital focusing on their clinical, radiological, histopathological, surgical outcomes, and prognosis to enhance understanding and management of these rare, benign cysts. Methodology This retrospective cohort study included 27 surgically managed ICs with pathological confirmation in King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia, from May 2016 to May 2023. All extracranial and nonsurgically managed cysts have been excluded from this study.Data on demographics, clinical presentations, radiological features, surgical outcomes, and follow-up were retrospectively extracted and analyzed. MRI and CT scans were reviewed to determine cyst characteristics. Surgical outcomes and postoperative complications were recorded. Data were collected via Google Forms and analyzed using the JMP Pro software. Ethical approval was obtained from King Abdullah International Medical Research Center, Jeddah, Saudi Arabia. Results The study included 27 ICs: 11 (40.74%) colloid cysts, six (22.22%) epidermoid cysts, five (18.51%) adamantinomatous craniopharyngiomas, two (7.40%) neuroepithelial cysts, and one each of Rathke's cleft cyst (3.70%), xanthogranuloma (3.70%), and dermoid cyst (3.70%). All 27 cases were surgically managed (100.00%), with gross total resection achieved in 14 (51.85%) cases.Only 12 cases (44.44%) did not develop any surgical complications. Twenty-two cases (81.48%) experienced an improvement in the preoperative presenting symptoms. During the follow-up, only three cases (11.11%) had evidence of recurrence. Conclusion This study analyzed 27 ICs of various histopathological types. Each type showed distinct clinical and radiological features. Surgical management generally improved preoperative symptoms with low mortality and recurrence rates, although complications were common. Identifying specific radiological features is crucial for an accurate preoperative diagnosis and optimal surgical outcomes.

Imaging features of pediatric meningiomas: emphasis on unusual locations.

This article aims to analyze pediatric meningioma's imaging characteristics, especially those in unusual locations. Pediatric patients with pathologically confirmed meningiomas at our hospital from January 2010 to January 2024 were enrolled. Meningiomas located in the cerebral convexity, parasagittal falcine region, anterior skull base, middle skull base, sphenoid ridge, cerebellopontine angle (CPA), olfactory groove, or juxtasella were considered in usual locations. Meningiomas found in other areas were considered in unusual locations. Clinical information, pathology results, and imaging features of pediatric meningiomas in usual and usual locations were analyzed and compared. A total of 18 patients (19 meningiomas) were enrolled, including 14 males and 4 females, with an average age of 14years (ranging from 6 to 18years). A total of 12 (63.2%) meningiomas were in the unusual location, including four (33.3%) were intraparenchymal, four (33.3%) were intraventricular, two (16.7%) were intraosseous, one (8.3%) case was in the paranasal sinus, and one (8.3%) was intraspinal. The meningiomas in unusual locations usually lacked the meningeal tail sign, and the misdiagnosis rate on preoperative imaging was significantly higher than that of meningiomas in usual locations. Pediatric meningiomas are prone to occur in unusual locations. When they occur in usual locations, they often lack typical radiographic features of meningiomas, leading to potential misdiagnosis before surgery. Recognition of the imaging characteristics of meningiomas in unusual locations in children may facilitate accurate preoperative imaging diagnosis.