Bilobed Mass Research Articles

A Bilobed Schwannoma in Roof of Orbit: A Rare Case Report

In this paper, we report a case of bilobed schwannoma, presented in the roof of orbit arising from supraorbital nerve. A 62-year male presented with a nontender mass in superior part of orbit and eccentric proptosis. Visual acuity and rest of ocular examination were normal. CT scan and MRI orbit revealed an extraconal homogenous bilobed mass, of size 3.5 to 2.5 cms in roof of orbit. Fine needle aspiration cytology was done, which was suggestive of schwannoma a peripheral nerve tumor. Successful surgical excision of intact bilobed schwannoma was done with careful separation and preservation of supraorbital nerve from which it was originated. Postoperative period was uneventful though rare, less than 1%, schwannoma can present as painless mass in the orbit and proptosis. Treatment of choice is surgical excision of intact tumor to prevent recurrence and preservation of peripheral nerve from which it arises.

Masses in the Oral Cavity

A 36+1-week female newborn has masses arising from the oral cavity. ### Prenatal History ### Birth History Figure 1. Photograph at 2 days of age shows a large mass arising from the infant’s oral cavity. Two smaller masses also in the oral cavity are obscured by the larger mass. Figure 2. Side view of the mass. ### Physical Examination Initial examination revealed an appropriate-for-gestational-age female infant. Aside from the large mass protruding from her oral cavity, she did not appear dysmorphic. A careful oropharyngeal examination revealed that the firm, nontender, 3x4-cm, multilobulated, pedunculated mucosal mass arose from the left maxillary alveolus on a vascular stalk (Fig. 3). A separate 2x2-cm bilobed mass arose from the left mandibular alveolus but did not protrude out of …

Supracoronary approach for keratoma removal in horses: Two cases

Summary Two competitive horses were presented for examination of chronic lameness; one associated with a hoof-wall deformity, the other with a firm mass over the dorsal pastern region. Radiographs revealed moderately radiopaque masses associated with both deformities. The lesions were characterised ultrasonographically as noninvasive, well-circumscribed heterogeneous masses. Computed tomographic examination of the second case revealed a well-defined, partially mineralised, bi-lobed mass with associated bony resorption of the underlying middle phalanx. Both patients were anaesthetised and the keratomas surgically removed via approaches 1–2 cm proximal to the coronary bands. Both horses were stall-sound 2 days after surgery and returned successfully to an equal level of competition by 8 months. A supracoronary approach is a viable alternative to partial or complete hoof wall resection for the removal of nonsolar keratomas from the foot of a horse.

Chondromyxoid fibroma of the nasal septum: Case report and review of literature

Chondromyxoid fibroma (CMF) is a rare bone tumor, accounting for less than 0.5% of all bone tumors, with a predilection for lower extremity bone metaphyses. Involvement of the head and neck is extremely rare, with only 3 cases reported in the nasal septum in world literature. This is a case report of a CMF in the nasal septum of a 49-year-old woman with a 6-month history of congestion. MRI showed a bilobed mass originating from the nasal septum. Histologic and immunoperoxidase staining as well as electron microscopic studies were performed. A literature review was performed. The patient underwent a midface-degloving approach for surgical resection. The final pathology was prototypic of CMF. The patient was disease-free 16 months postoperatively. CMF is a rare, benign neoplasm occasionally occurring in the head and neck. Surgical resection is often curative. CMF must be differentiated from chondrosarcoma, given the substantial differences in treatment.

Orbital Schwannoma With Fluid–Fluid Levels on MRI

A 40-year-old man presented with a progressively growing left orbital mass producing proptosis. Orbital MRI revealed a large bilobed mass that was isointense with respect to the extraocular muscles on T1-weighted images and demonstrated heterogenous contrast enhancement. T2-weighted images revealed a markedly heterogenous internal appearance with fluid-fluid levels. The mass was completely excised in one piece. Histopathologically, the encapsulated tumor consisted mostly of spindle-shaped tumor cells with elongated nuclei forming bundles without obvious mitosis. Richly cellular areas were consistent with the Antoni A pattern, and more hypocellular edematous areas were consistent with the Antoni B pattern. Hemorrhagic and cystic areas were seen within the tumor. The tumor cells stained diffusely positive with S-100 protein. Findings were consistent with the diagnosis of orbital schwannoma. Fluid-fluid levels are usually seen in some vascular and bone tumors and soft tissue lesions. Fluid-fluid levels have previously been reported to occur in intracranial but not in orbital schwannomas. This case demonstrates that orbital schwannoma can also display fluid-fluid levels on MRI, which were thought to be due to intralesional hemorrhage in this case.

Prenatal Sonographic Diagnosis of a Perineal Lipoma

Received March 8, 2010, from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (J.R.W., M.G.P., M.C., A.C.), Division of Pediatric Surgery, Department of Surgery (B.M.), and Department of Radiology (S.W.), Maine Medical Center, Portland, Maine USA. Manuscript accepted for publication March 9, 2010. Address correspondence to Joseph R. Wax, MD, Maine Medical Partners Women’s Health, 887 Congress St, Suite 200, Portland, ME 04102 USA. E-mail: waxj@mmc.org primagravid patient underwent an obstetric ultrasound examination at a gestational age of 31 weeks 5 days for a fundal height less than expected. The pregnancy was dated by a 15week sonogram, and the fetus had a known 46,XX karyotype following amniocentesis performed because of an increased risk for trisomy 21 by maternal serum screening. The fetal anatomy was sonographically normal at 18 weeks’ gestation. Sonography revealed a normally grown fetus (1746 g, 43rd percentile) surrounded by a normal amniotic fluid volume. A 2.3 ×1.4-cm lobulated right labial and perineal mass was observed (Figures 1 and 2). A review of the 18-week study confirmed a normal perineum at that time. Color and power Doppler interrogation showed no flow within the lesion. The likely diagnosis was a lipoma, for which the patient was counseled and referred for pediatric surgical consultation. The pregnancy was followed weekly, with the mass showing stable dimensions and appearance. A healthy neonate weighing 3150 g with 1and 5minute Apgar scores of 8 and 9, respectively, was delivered vaginally at 39 weeks’ gestation. The neonate had normal bowel and bladder function with physical examination notable only for the 5 ×4 ×3-cm bilobed mass arising from the right perineum extending to the right labium minora and introitus (Figure 3). Magnetic resonance imaging performed on the second day of life showed a signal intensity consistent with fat, no enhancement with gadolinium contrast, and a 1.7-cm vascular pedicle extending cephalad to the right lateral vagina, lower rectum, and anus (Figure 4). At 1 month of age, the mass was locally excised without complications (Figure 5). Histologic examination of the specimen showed mature adipose tissue interspersed with collagenous bands, leading to the diagnosis of a fibrolipoma.

Structure of the central nervous system of a juvenile acoel, Symsagittifera roscoffensis

The neuroarchitecture of Acoela has been at the center of morphological debates. Some authors, using immunochemical tools, suggest that the nervous system in Acoela is organized as a commissural brain that bears little resemblance to the central, ganglionic type brain of other flatworms, and bilaterians in general. Others, who used histological staining on paraffin sections, conclude that it is a compact structure (an endonal brain; e.g., Raikova 2004; von Graff 1891; Delage Arch Zool Exp Gén 4:109-144, 1886). To address this question with modern tools, we have obtained images from serial transmission electron microscopic sections of the entire hatchling of Symsagittifera roscoffensis. In addition, we obtained data from wholemounts of hatchlings labeled with markers for serotonin and tyrosinated tubulin. Our data show that the central nervous system of a juvenile S. roscoffensis consists of an anterior compact brain, formed by a dense, bilobed mass of neuronal cell bodies surrounding a central neuropile. The neuropile flanks the median statocyst and contains several types of neurites, classified according to their types of synaptic vesicles. The neuropile issues three pairs of nerve cords that run at different dorso-ventral positions along the whole length of the body. Neuronal cell bodies flank the cords, and neuromuscular synapses are abundant. The TEM analysis also reveals different classes of peripheral sensory neurons and provides valuable information about the spatial relationships between neurites and other cell types within the brain and nerve cords. We conclude that the acoel S. roscoffensis has a central brain that is comparable in size and architecture to the brain of other (rhabditophoran) flatworms.

Atypical Imaging Features of Bilateral Achilles Tendon Xanthomatosis

History A 60-year-old man presented to the emergency room with chest pain and dizziness. Bilateral lower extremity masses with superimposed cellulitis were incidentally discovered. On the right leg, there was a single rounded mass above the heel; the mass extended cephalad from the Achilles tendon insertion. On the left leg, there was a larger bilobed mass that extended from the Achilles tendon insertion to the lower calf. On both legs, cellulitis that extended approximately several centimeters beyond the margins of the masses was seen. Physical examination also revealed multiple subcutaneous nodules in the dorsa of both hands, in several fingers (Fig 1), and overlying the elbows and knees. No inflammation was seen. The patient’s blood-lipid level was normal, and he was not taking any cholesterol-lowering medications at the time of admission. At admission, the patient’s serum uric acid level was slightly elevated, but 24-hour urine-urate levels were normal.

Adult obstructive sleep apnea related to nasopharyngeal obstruction: a case of retropharyngeal lipoma and pathogenetic considerations

Cervico facial lipomas are relatively rare and only a few of them affect retropharyngeal space. Because of their slow growth rate, they can reach large size before causing respiratory disturbances and surgery is the treatment of choice. We present a case of 73-year-old female patient with severe obstructive sleep apnea [Apnea Hypopnea Index (AHI) = 43; mean SaO2 = 84%; lowest SaO2 = 60%; time of sleep with SaO2<90% = 35%]. Computed tomography scan showed a low attenuation bilobed retropharyngeal mass (5 x 2 x 2.5 cm) compatible with lipoma, extending from the nasopharynx to the superior bound of the oropharynx (at the level of C2-C3 passage). Removal of the tumor cured the obstructive sleep apnea; the sleep study at 1 month follow-up showed the normalization of the somnographic parameters (AHI = 12; lowest SaO2 = 76%; mean SaO2 = 95%; time of sleep with SaO2<90% = 4%).

A THYMIC CARCINOID IN A BENGAL TIGER (PANTHERA TIGRIS)

An 18-yr-old Bengal tiger (Panthera tigris) presented with acute onset hind limb paresis. Radiographic and ultrasonographic imaging revealed a caudal abdominal aortic thrombus and a cranial mediastinal mass. Necropsy confirmed aortic thrombosis. Necrotizing enteritis and multifocal renal thrombosis were also noted. The cranial mediastinum contained a bilobed mass that histologically and ultrastructurally was consistent with a carcinoid.

An unusual right-sided endocarditis: A case report of eustachian valve endocarditis

1. Case report Eustachian valve is a remnant of the right sinus venosus valve that directs blood flow in the fetal circulation from the vena cava through the foramen ovale into the left atrium. The persistence of this valve in an adult is uncommon. We describe the case of eustachian valve endocarditis in a 70 year-old woman who had chronic atrial fibrillation on anticoagulation and recent percutaneous coronary intervention after a myocardial infarction. Echocardiogram then showed severe left ventricular dysfunction. The eustachian valve was not visualized. She currently presented with acute right hypochondrium pain, nausea, and leucocytosis. Acute cholecystitis was diagnosed and she had open cholecystectomy performed. The gall bladder pus grew Klebsiella pneumoniae sensitive only to amikacin and imipenem. Post-operatively, she developed new fever with severe hypotension requiring centralvenousmonitoringviaarightinternaljugularcatheter. She further developed congestive heart failure 4 days later. Cardiac auscultation did not reveal new murmurs, whilst chest X-ray confirmed pulmonary congestion. Transthoracic echocardiogram (TTE) (Fig. 1) showed preserved left ventricular function, moderate mitral regurgitation, and a mobile mass in right atrium. Transesophageal echocardiogram (TEE) (Fig. 2) confirmed a large bilobed mobile mass attached to the eustachian valve tip. As the international normalized ratio (INR) remained at therapeutic level throughout this period, and no thrombus was sighted in the left atrial appendage, eustachian valve endocarditis was diagnosed. She was given 5 weeks of intravenous ceftriaxone and imipenem. Two out of six bottles of blood culture returned positive for multi-resistant K. pneumoniae. She had complete response to the antibiotics and was dischargedwell.

Incidental, Early Diagnosis Of Urinoma By F-18 FDG PET/CT

An F-18 FDG positron emission tomography/computed tomography (PET/CT) scan was performed for staging purposes in a 51-year-old asymptomatic man 3 weeks after hand-assisted laparoscopic surgery (HALS) for colorectal cancer. The whole-body F-18 FDG PET/CT demonstrated a left retroperitoneal hyperintense focus of F-18 FDG. The degree of radioactivity was comparable with the bladder, suggesting a urine collection. A CT/IVP obtained after the PET/CT study found a left hydronephrosis and a dilated ureter to the visible level of the bilobed fluid mass. The urinoma was subsequently drained percutaneously. Follow up with CT scan of the abdomen and pelvis showed no reaccumulation of urine. A PET/CT performed 5 months later was negative for retroperitoneal reaccumulation of urine. With PET alone, a hypermetabolic retroperitoneal focus of FDG may have been interpreted as lymphadenopathy if a contemporaneous CT was not available. The integrated PET and CT displayed the structural and functional aspects of the fluid collection, correctly indicating a urine collection.

Cerebello-Pontine angle (CPA) lymphoma with perineural extension into the middle fossa: case report

Background Tumors of the cerebello-pontine angle are most commonly schwannoma and meningioma. Primary central nervous system (CNS) lymphoma usually presents deep within the cerebral hemispheres, occasionally is found in the cerebellum, and rarely occurs in the cerebello-pontine angle. We report a rare case of primary CNS lymphoma involving the right cerebello-pontine angle and the middle cranial fossa mimicking a tentorial meningioma. Methods A 21-year-old woman presented with right sided hearing loss and a facial droop. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed, followed by cerebral angiography to assess vascularity. Results Imaging revealed a bilobed mass involving the right cerebello-pontine angle and middle fossa. The labyrinthine segment of the facial nerve canal was enlarged, and some bony erosion was seen along the petrous bone anteriorly. The mass was hypointense on both T1 and T2-weighted MRI and exhibited heterogenous enhancement. It was distinctly hypovascular on angiography. At surgery, a B-cell lymphoblastic lymphona was found that infiltrated along the 7 th and 8 th nerve complexes into the internal auditory canal. Conclusion Imaging and surgery disclosed a cerebello-pontine lymphoma with perineural extension along the 7 th nerve to reach the middle cranial fossa. Because of the unusual imaging characteristics of this tumor, as well as special considerations with respect to treatment, preoperative consideration of this entity is important in planning direct surgical biopsy rather than an extensive resection.

Benign prostatic hyperplasia mimicking bladder tumor

An 82-year-old man presented with transfusion-dependent gross hematuria. Abdominal and pelvic computed tomography identified a 9 × 5-cm, heterogeneous, solid, intravesical mass extending from the base of the bladder to the dome (Fig. 1), which was radiographically suspicious for a primary bladder malignancy. Examination under anesthesia revealed a mobile supraprostatic mass, and cystoscopic evaluation showed a large, bilobed solid mass. Cystoscopic biopsies confirmed benign prostatic hyperplasia. The patient underwent suprapubic prostatectomy. At surgery, two large intravesical adenomas were seen arising from each lateral lobe. The patient recovered uneventfully and was discharged on postoperative day 4 with complete resolution of the gross hematuria. The specimen weight was 215 g.

Polycystic kidney disease in goldfish (Cusrassius auratus)

Abstract Thirty percent of 60 goldfish in an outside pond showed progressive development of swollen abdomens and floatation problems. The occasional fish was found dead. Necropsy of an affected fish showed an abdomen almost filled with a large bilobed ventral mass comprised of masses of cysts filled with clear fluid. On histopathological examination, this mass appeared to be composed of large cystic spaces lined by a single flattened epithelium. Occasional remnants of normal kidney tissue were seen withen the mass.

Abdominal aortic aneurysm in childhood. A noninvasive approach to the diagnosis.

A case of an abdominal aortic aneurysm in a 9 year old Black male is reported.Abdominal roentgenograms, intravenous urograms and upper gastrointestinal series showed a bilobed calcified mass in the retroperitoneal space without defining the organ of origin.This case illustrates the usefulness of noninvasive techniques such as sonography and radioisotope angiography in determining the vascular origin of an unusual mass in a child. The principal purpose of arteriography was to rule out unsuspected lesions in other arteries.Although the pathologic findings were somewhat equivocal, the clinical information strongly suggested that this represented a mycotic aneurysm.

PATHOLOGY RESULTING FROM CHRONIC PARAFFIN EAR PLUGS: METHODOLOGICAL PROBLEM IN AUDITORY DEPRIVATION RESEARCH.

Two studies (1, 2 j have reported effects of early auditory deprivation on later behavior. Results support the principle that early sensory deprivation is followed by a deficit in ability to use information presented in the affected sense modality. Their methods of inducing auditory deprivation entail the possibility of damage to the ear. Physical examinations of the ears or the usual kinds of hearing tests by which damage could have been detected were not reported. If some degree of hearing loss occurred because of damage to ear structures, this fact would alter the interpretation of their results. The present study was designed to determine whether damage to the ear of an adult cat may result from plugging the external ear canal, when this is done by careful procedures similar to those employed by Wolf. Cat E: Gelfoam pledgets were positioned against the tympanic membranes and melted paraffin was introduced, filling the external canal on each side. Forty-two days after the initial procedure, S was examined with the aid of an operating microscope. The left external canal was completely blocked by a solid plug of paraffin found deep within the canal. Beneath the plug a mass of granulation tissue was encountered. Removal of this mass was difficult. A central fistula with granulation tissue growing through it was found when the tympanic membrane was finally cleared. The right external ear canal contained a similar solid plug of paraffin, deeply situated. The right drum was not visualized, but one middle ear ossicle was seen. The left and right bullae were examined and both were found to contain the typical greyish thin pus of otitis media. Cat F : Melted paraffin was slowly introduced into each external ear canal, filling the canals down to the tympanic membrane and a portion of the bowl of the pinna. Four days later the left ear plug loosened and fell out. Melted paraffin was reintroduced and a single nylon suture was taken over each pinna in an effort to stabilize the plugs. Fortythree days after the initial procedure this subject was examined. A small, soiid, obliterative plug of paraffin was removed from the right ear canal. Below this a large, bilobed mass of granulation tissue was found penetrating through the tympanic membrane an(] malleus. The right middle ear was examined and appeared otherwise normal. The paraffin plug was missing from the ieft canal. The tympanic membrane and middle ear appeared normal. The buliae were normal on both sides. The obvious implication is that plugging the ears with paraffin for a period of weeks is not a promising method for creating an uncomplicated reversible hearing impairment in Ss. It should not be inferred that the ears of the rats studied by Wolf or Gauron and Becker were necessarily damaged. Since peripheral damage ?7zay result from chronic ear plugs, researchers should take cognizance of this possibility.

The neuromotor system of Euplotes

The fibrillar system of ciliate protozoöns was described by Sharp for Diplodinium, by Yocom for Euplotes. An integrated fibrillar system in the flagellate Giardia was described by Kofoid and Christiansen and for Trichonympha and Trichomitus by Kofoid and Swezy. The designation neuromotor apparatus has been given to this integrated organ system of the Protozoa, on the basis of morphological considerations and anatomical relations. Experimental proof of the conductile function of certain elements in this system has been accomplished in Euplotes by microdissection with the Barber apparatus. With this instrument actuating quartz microscalpels it has been possible to cut selected fibrils and determine the effects of the cutting and subsequent regeneration upon the previously analyzed stereotyped behavior of this organism. Euplotes patella is a hypotrichous ciliate protozoon about 100-150 microns in length. Its neuromotor system consists of a small bilobed central mass, the motorium, at the corner of the cytostome. From this a fiber runs anteriorly and to the left at the base of the membranelles the full length of the adoral zone connecting with the bases of these motor organs. An extensive fibrillar lattice-work in the anteriorly projecting oral lip appears to be connected with this fiber. Running posteriorly from the motorium five distinct fibers diverge posteriorly, one each to the five posteriorly located anal cirri. No such fibers pass to the other thirteen cirri, but radiating fibrils from the base of each disappear in the adjacent cytoplasm. There is thus an integrated fibrillar system connecting the presumably sensory anterior lip, the powerful motor oral membranelles and the five major cirri of the ventral surface most active in the walking and swimming movements of the animal.