Concurrent Lesions Research Articles

Lymphoscintigraphy of draught horses with chronic progressive lymphoedema

Early diagnosis of chronic progressive lymphoedema (CPL) may result in more effective interventions and provide a basis for further investigation of whether early diagnosis could be used as a means of eliminating potential genetic influences by cessation of breeding from affected individuals. Lymphoscintigraphy may be useful in draught horses to differentiate early lesions of CPL from other conditions in the pastern region. Forelimbs of 2 normal and 5 CPL-affected draught horses were evaluated with lymphoscintigraphy. Lymphoscintigraphy showed clearly the presence of interstitial fluid stasis and delayed lymphatic drainage in the affected extremities of diseased animals in contrast to normal animals of these breeds. The rate of decreased clearance of a particulate radiopharmaceutical from the tissues was related positively to the severity of clinical signs. Our findings support the hypothesis that lymph stasis is probably responsible for the progressive swelling and concurrent skin lesions observed in association with CPL in draught horses. Lymphoscintigraphy should also prove useful in diagnosis of CPL in draught horses, even in the mild stages of the disease; such early diagnosis may result in more effective intervention.

Gingival Enlargement in Neurofibromatosis Type 1: A Case Report and Literature Review

The purpose of this article is to describe a rare case of neurofibromatosis1 (NF1) of the gingiva and a review of the current literature. Neurofibromatosis1 (NF1) of the gingiva is an uncommon cause of gingival enlargement. The disease is clinically characterized by epidermal melanosis, nevi, and flabby skin or bone malformations; in addition, the lesions may undergo malignant transformation. Involvement of the gingiva with or without concurrent skin lesions has been reported only occasionally. A 40-year-old male patient with a history of NF1 came to us with a chief complaint of enlargement of the gums. Clinical examination revealed diffuse gingival enlargement with no signs of inflammation. The characteristic skin lesions associated with NF1 were also present. A gingival specimen was sent for biopsy. Based on the history, clinical, and histological findings, NF1 was established as the cause of the gingival enlargement. NF1 may affect the gingival tissue; considering the neurological complications and malignant potential, NF1 must be diagnosed early and monitored regularly. The clinician should be aware of clinical and histopathological findings of NF1 considering the fact that the condition has malignant potential.

Asymptomatic Cervical or Thoracic Lesions in Elderly Patients who Have Undergone Decompressive Lumbar Surgery for Stenosis

Study DesignA retrospective study.PurposeTo evaluate the prevalence and risk factors of asymptomatic cervical or thoracic lesions in elderly patients who have undergone surgery for lumbar spinal stenosis.Overview of LiteratureConcurrent multiple spinal lesions have been reported in many studies with a varied prevalence, and described the characteristics of the disease and its treatment options. However, the cervical or thoracic lesions without apparent symptoms in patients with symptomatic lumbar stenosis had not been evaluated.MethodsA total of 101 elderly patients (aged 65 or more), who had undergone surgery for lumbar spinal stenosis from January 2005 to December 2005, were enrolled in this study. All patients underwent lumbar magnetic resonance imaging (MRI) along with T2-weighted cervical and thoracic sagittal MRI prior to surgery. The concurrent cervical or thoracic lesions were classified according to the disease entity, and the severity of the lesions was graded from grade 0 (no lesion) to grade 4 (any lesion compressing the cord with a signal change). The prevalence of concurrent cervical and thoracic lesions was then analyzed. In addition, the risk factors for the development of concurrent lesions were evaluated, and the risk factors affecting the severity of the concurrent lesion were analyzed individually.ResultsSeventy-seven (76.2%) and 30 (29.7%) patients had a concurrent cervical and thoracic lesion, respectively. Twenty-six patients (25.7%) had both a cervical and thoracic lesion. There was a positive correlation between the symptom duration of lumbar stenosis and the prevalence of both cervical (p = 0.044) and thoracic (p = 0.022) lesions.ConclusionsThe incidence of asymptomatic cervical or thoracic lesions is apparently high in elderly patients who have undergone surgery for lumbar spinal stenosis, particularly in those with longer symptom duration. This highlights the need for a preoperative evaluation of the cervical and thoracic spine in these patients.

Parasitic Infections in Solid Organ Transplant Recipients

Parasitic Infections in Solid Organ Transplant Recipients

Is there just one lesion? The need for whole body skin examination in patients presenting with non‐melanocytic skin cancer

In patients presenting with non-melanoma skin cancer (NMSC) the frequency of concurrently presenting tumours is poorly documented. Whole body skin examination is recommended but in a recent survey of Australian General Practitioners and skin cancer clinics doctors it was infrequently performed. The aim of this study was to examine the incidence of concurrent skin cancer at initial presentation and therefore to examine the need for whole body skin examination for NMSC presentations. One hundred consecutive patients with a referral diagnosis indicative of NMSC were examined. Data was analysed as to the referring doctor's diagnosis, whole body skin examination findings and histology of excised lesions. Epidemiological data was obtained by patient questionnaire. One hundred patients, 41 males and 59 females, with a mean age of 70 years (range 39-91 years) underwent whole body skin examination. Sixty-seven per cent of patients were found to have additional lesions requiring treatment, 46% sin cancers (30 patients basal cell carcinomas, five squamous cell carcinomas, seven basal and squamous cell carcinomas, two lentigo maligna, two adenexal tumours) and 21% solar keratoses. Thirty-four of the additional lesions detected were in areas covered by clothing. Sixty-eight patients had a past history of skin cancer excision. In the Australian patient population, the need for whole body skin examination is essential to avoid missing concurrent lesions. Ongoing surveillance is also essential as these patients have a high risk of developing future NMSC.

Simultaneous Appearance of Multiple Evanescent White Dot Syndrome and Multifocal Choroiditis Indicate a Common Causal Relationship

Purpose: To report simultaneous occurrence of multiple evanescent white dot syndrome (MEWDS) and multifocal choroiditis (MFC) in the same eye of a 33-year-old Caucasian woman.Methods: Review of clinical and fluorescein angiographic features of a patient who presented with decreased visual acuity and was followed for 3 months.Results: Patient presented with concurrent lesions of MEWDS and MFC occurring in the same eye. During the follow-up period MEWDS lesions resolved and MFC lesions evolved into chorioretinal scars.Conclusions: Simultaneous development of MEWDS and MFC may indicate a possible common causal entity.

The cardiovascular response of normal rats to dual lesion of the subfornical organ and area postrema at rest and to chronic losartan

The subfornical organ (SFO) and the area postrema (AP), two of the sensory circumventricular organs (CVO), are known to play a role in the chronic central control of blood pressure. In previous studies in which these regions were independently lesioned, the chronic hypotensive effects of the AT 1 receptor blocker losartan (10 mg/kg/day) were attenuated by ~ 15 mm Hg. In the present study, we sought to investigate the effect of concurrent lesion of both the SFO and the AP on the cardiovascular effects of chronic losartan infusion in order to test the hypothesis that a greater attenuation of the hypotensive effects of losartan would be observed in rats with dual lesions. To do so, arterial pressure and heart rate responses to 10-day infusion of losartan were compared in sham rats and those with dual lesions of the AP and SFO. Two important findings resulted from this study. First, dual lesion rats exhibited a sustained and significant decrease in resting blood pressure (83 ± 1 mm Hg vs. 104 ± 1 mm Hg, respectively) and heart rate (356 ± 3 bpm vs. 398 ± 6 bpm, respectively) compared to sham animals. Secondly, rats with concurrent lesion of both the AP and the SFO demonstrated a significantly attenuated response to losartan compared to sham animals but showed no greater attenuation of losartan's chronic hypotensive effects than animals with lesion of either the SFO or the AP (∼ 15 mm Hg). Although these results do not support the stated hypothesis, they do suggest redundancy and compensatory roles of the AP and SFO in basal cardiovascular control.

Higher expression levels of 14-3-3σ in ductal carcinoma in situ of the breast predict poorer outcome1

The protein 14-3-3sigma is involved in the regulation of cellular processes such as apoptosis, cell cycle progression and proliferation. Disruption of protein expression has been implicated in a number of malignancies. Here we examine the expression pattern of 14-3-3sigma in breast cancer and specifically consider whether expression in ductal carcinoma in situ (DCIS) lesions is predictive of disease outcome. We examined 14-3-3sigma protein expression and localization using immunohistochemical staining on a high-density tissue microarray consisting of 157 invasive breast cancer patients. Statistical analyses were used to assess the correlation of 14-3-3sigma expression with clinico-pathological parameters and patient outcome. We observed a statistically significant increase in 14-3-3sigma protein expression in ductal hyperplasia, DCIS, and invasive ductal carcinoma (IDC) as compared normal glandular epithelium. In IDC, lower expression of 14-3-3sigma tended to predicted poorer survival time while in DCIS lesions, there was a stronger correlation between relatively higher levels of 14-3-3sigma predicting shorter survival time. Further, of patients who had concurrent DCIS and IDC lesions, those that exhibited a decrease of 14-3-3sigma expression from DCIS to IDC had significantly shorter survival time. Our findings indicate that 14-3-3sigma expression may be a useful prognostic indicator for survival in patients with breast cancer with an elevated 14-3-3sigma in earlier disease predicting a less favorable disease outcome. To our knowledge this is the first published study associating 14-3-3sigma protein expression with breast cancer survival.

Use of Magnetic Resonance Angiography to Predict Long-Term Outcomes of Ischemic Stroke Patients with Concurrent Stenoses in Hong Kong

Purpose: To determine the long-term outcome of ischemic stroke patients with concurrent intracranial and extracranial atherosclerosis using magnetic resonance angiography. Methods: A prospective cohort of patients in Hong Kong with acute ischemic stroke was studied with magnetic resonance angiography of the brain and carotid duplex. All patients were followed up regularly for the development of recurrent stroke, cardiac events, or death. Results: Totally 343 patients with acute ischemic stroke were included, of whom 104 (30%) had concurrent intracranial and extracranial lesions. The follow-up period was up to 76 months (mean 44.5 months). Overall, 55 patients (15.5%) died of any cause and 91 patients (26.5%) suffered a further nonfatal vascular event. The overall 5-year cumulative rates of mortality, restroke and poor outcomes (combined death and further vascular events) were 18, 27 and 37%, respectively. In patients with concurrent lesions, these rates were 31, 41 and 51%, respectively. The corresponding rates were 13, 22 and 31% in patients without concurrent lesions. The risks were highest in the first year after stroke. More deaths (log rank, 16.3; p = 0.0001), restrokes (log rank, 9.71; p = 0.002) and poor outcomes (log rank, 13.87; p = 0.0001) were found among patients with concurrent lesions. The presence of concurrent vascular lesions, advanced age, smoking, hyperlipidemia and previous history of stroke were independent predictors of poor outcomes. Conclusions: The long-term prognosis of ischemic stroke patients with concurrent atherosclerosis of intracranial and extracranial vessels is poor. They are at high risk of further vascular events or death.

Towards Identification of Hereditary DNA Mismatch Repair Deficiency: Sebaceous Neoplasm Warrants Routine Immunohistochemical Screening Regardless of Patient's Age or Other Clinical Characteristics

Although the significance of immunohistochemical detection of DNA mismatch repair proteins and/or microsatellite instability testing in identifying patients at risk for germline deficiency in DNA mismatch repair genes is well established in colorectal carcinomas, the proper use of such techniques in sebaceous neoplasms, another tumor type that has been implicated in patients with hereditary DNA mismatch repair deficiency, has not been clearly defined. In this study, we stratified a series of 27 patients with 1 or more sebaceous neoplasms based on the pattern of immunohistochemical expression of MLH1, MSH2, MSH6, and PMS2, and comparatively analyzed their clinical and pathologic characteristics, including tumor-infiltrating lymphocytes and peritumoral lymphocytic response as determined by immunohistochemical staining for CD3. The study tissue samples included 30 sebaceous carcinomas, 14 sebaceous adenomas, and 7 sebaceous hyperplasias, along with 8 concurrent nonsebaceous lesions from 6 patients. Overall, 12 of the 27 (44%) patients showed abnormal IHC staining with mismatch repair proteins in their sebaceous tumors, the most commonly seen abnormality being concurrent loss of MSH2 and MSH6 (8/12, 67%). Sebaceous adenomas and carcinomas occurring in the same patients showed an identical staining pattern, as did hereditary nonpolyposis colorectal cancer-related nonsebaceous tumors in the same patients. When compared with cases that had normal expression of the mismatch repair proteins, cases with abnormal expression tended to be younger (median age, 56.5 y vs. 68 y), more likely to involve sites outside the head and neck (9/12 vs. 0/15), and more likely to have synchronous or metachronous visceral malignancies (8/12 vs. 3/15) and a positive family history. Furthermore, sebaceous tumors with abnormal expression had significantly higher CD3-positive tumor-infiltrating lymphocytes and peritumoral lymphocytic response. Thus, all these factors (age less than 60 y, involvement of nonhead and neck sites, visceral malignancy, family history fulfilling at least Bethesda guidelines, and lymphocytic infiltration) bore informative value in predicting abnormal expression of DNA mismatch repair proteins. However, their sensitivity was only modest, being 58%, 75%, 67%, 78%, and 75%, respectively. On such a premise, given that sebaceous neoplasms are only infrequently encountered, and that immunohistochemistry is easily available and reasonably reliable, we recommend that, when there exists a desire to identify hereditary DNA mismatch repair deficiency, routine immunohistochemical detection of DNA mismatch repair proteins be performed in all sebaceous neoplasms regardless of patient's age or other clinical characteristics.

Primary Aortic Myxofibrosarcoma Mimicking Thrombus

Aortic sarcoma is a rare vascular malignancy. We report a case of primary aortic myxofibrosarcoma mimicking thrombus. This neoplasm demonstrated no contrast enhancement on computed tomography or magnetic resonance imaging and was clinically suspected to represent a large thrombus, although aortic primary neoplasm was considered in the differential diagnosis on the basis of imaging. Biopsies of the aortic lesion and a concurrent brain lesion were consistent with the diagnosis of aortic myxofibrosarcoma with brain metastasis. This report highlights overlapping imaging features between primary aortic sarcoma and vascular thrombus and the importance of considering neoplastic conditions in the differential diagnosis of large intravascular soft tissue lesions.

Management of associated glioma and arteriovenous malformation – the priority is the glioma

The conjunction of a glioma with an arteriovenous malformation (AVM) is exceptionally rare. We report the case of a malignant pleomorphic xanthoastrocytoma located on the vicinity of an untreated AVM that was removed without interference with the AVM. The question posed by such concurrent lesions is which to manage first. It appears more logical to treat the tumour first because of the elevated incidence of associated high-grade gliomas.

Positron Emission Tomography/Computed Tomography after Immunocytochemical and Clonal Diagnosis of Intraocular Lymphoma with Vitrectomy Cell Blocks

The purpose of this study is to report the role of whole-body 2-[(18)F] fluoro-2-deoxy-D-glucose (FDG) positron emission tomography fused with computed tomography (PET/CT) after immunocytochemical and clonal diagnosis of intraocular lymphoma with vitrectomy cell blocks. Eleven patients with intraocular lymphoma were involved in this study: 6 patients presented with vitreous opacity in both eyes and 5 patients presented with unilateral involvement. The concurrent retinal lesions were present in 6 eyes of 5 patients. Brain lymphoma was diagnosed in 7 of the 11 patients : simultaneous with eye lesions in one patient, following the eye lesions in 3, and prior to the eye lesions in 3. Vitrectomy was done in 17 eyes of the 11 patients, and vitrectomy cell blocks were processed for immunocytochemical staining and clonality analysis by polymerase chain reaction amplification of the immunoglobulin heavy chain gene. The 7 most recent patients were evaluated with fluorodeoxyglucose whole-body PET/CT. Immunocytochemical staining of vitrectomy cell blocks in all patients showed large cells which were positive for CD20 and Ki-67 but negative for CD3, consistent with diffuse large B-cell lymphoma. The size and sequence of amplified fragments of the immunoglobulin heavy chain gene were different between the lesions of both eyes in one patient while they were the same in another patient. PET/CT after the diagnosis by vitrectomy revealed abnormal uptake in the cerebellum of two patients, in the eye as a recurrent lesion of one patient, and in both eyes as residual retinal lesions of one patient. In conclusion, PET/CT could be considered as a method to confirm brain lymphoma or as a reference for initiating additional therapy in the case of eye recurrence or residual lesions after vitrectomy. The clonality of lymphoma cells was variable between the lesions in both eyes.

Synchronous Colorectal Cancer

Purpose: Synchronous colorectal cancer is clinically significant because there is a chance to miss concurrent lesions. The aim of this study is to investigate the clinical features of synchronous colorectal cancer. Methods: Retrospectively, the records of 4,494 colorectal cancer patients who underwent a potentially curative resection for colorectal cancer from September 1994 to December 2005 were reviewed. Synchronous colorectal cancer was defined according to the following two criteria: 1) two or more colorectal cancers had to be found simultaneously in the same patient and 2) each of the tumors had to be distinctly separated by an intact bowel wall. Results: Synchronous colorectal cancer was diagnosed in 114 patients (2.5%). Synchronous colorectal cancer shows different features compared with single colorectal cancer. Synchronous colorectal cancer occurs at a older age, occurs more frequently in the colon, has a bigger size, and has more polyps. There was no difference of stage based on survival rate between synchronous and single colorectal cancer patients. The preoperative diagnosis rate of synchronous colorectal cancer was 74.6%. Eleven (9.6%) synchronous colorectal cancer patients underwent a total colectomy, and there were no significant differences in survival or complications compared with the other group. Conclusion: Synchronous colorectal cancer is difficult to diagnose preoperatively. Early postoperative examination for synchronous colorectal cancer is required, especially in patients who did not have a complete preoperative evaluation.

Clonality and HPV Infection Analysis of Concurrent Glandular and Squamous Lesions and Adenosquamous Carcinomas of the Uterine Cervix

Ueda, Y; Miyatake, T; Okazawa, M; Kimura, T; Miyake, T; Fujiwara, K; Yoshino, K; Nakashima, R; Fujita, M; Enomoto, T Author Information

Type IV Thoracoabdominal Aneurysm Repair: Predictors of Postoperative Mortality, Spinal Cord Injury, and Acute Intestinal Ischemia

Our purpose was to identify preoperative and intraoperative predictors of early mortality, spinal cord injury, or acute intestinal ischemia after repair of type IV thoracoabdominal aneurysm (TAA IV) as a basis for optimizing surgical indications and techniques. From January 1991 to June 2006 we operated on 171 patients for TAA IV. There were 149 men (87.1%) and 22 women (12.9%), with a mean age of 65.0 +/- 10.9 years (range 23-82). The underlying etiology was degenerative aneurysmal disease in 143 patients (83.6%). Twenty-two patients (12.8%) underwent emergent operation. Comorbidity included coronary disease in 72 patients (45.6%) including 39 who had undergone a revascularization procedure, arterial hypertension in 121 (70.1%), chronic obstructive pulmonary disease in 81 (47.4%), and chronic kidney insufficiency in 58 (33.9%). Seventy-six patients (44.4%) presented concurrent lesions involving at least one visceral artery. Spinal cord arteriography was performed in 91 patients (53.2%). In 25 cases (27.5%) arteriographic findings demonstrated the need for revascularization of the Adamkiewicz artery due to location of the ostium at or below the T12 level. Repair was carried out with cross-clamping only in 160 cases (93.6%). Partial cardiopulmonary bypass was used in 11 patients (6.4%). A total of 23 patients (13.4%) died postoperatively. The cause of death was acute intestinal ischemia in nine cases, multiple organ failure in seven, coagulation disorder in three, cardiac complications in two, and stroke in two. Spinal cord injury occurred in eight patients (4.7%) including two who died. According to univariate analysis, the significant predictors of early death were age over 70 years, degenerative aneurysmal disease, coronary artery disease, chronic renal insufficiency or visceral artery lesions, operator, duration of intestinal ischemia and use of a "complex" surgical technique. Although the only significant predictor of spinal cord injury was duration of digestive ischemia, an almost significant trend (p < 0.1) was observed for coronary artery disease, coronary bypass, and renal insufficiency. The significant predictors of acute intestinal ischemia were kidney insufficiency and visceral artery lesions, but coronary artery disease and previous coronary bypass were almost significant (p = 0.06). Frequent association of TAA IV with arteriosclerotic disease in elderly patients presenting coronary artery disease and chronic kidney insufficiency partly explains why early postoperative mortality remains high. The incidence of spinal cord injury suggests that preoperative spinal cord arteriography is mandatory for prevention. The frequency of intestinal ischemia is more problematic, but a better understanding of the underlying mechanism should enable development of preventive strategies.

Clonality and HPV Infection Analysis of Concurrent Glandular and Squamous Lesions and Adenosquamous Carcinomas of the Uterine Cervix

We analyzed the clonality and human papillomavirus (HPV) infection status of concurrent glandular and squamous lesions and adenosquamous carcinomas of the uterine cervix to clarify their histogenesis. The glandular and squamous components were clonally different from each other in 7 informative concurrent lesions. HPV was episomal in 2 polyclonal glandular dysplasias (GDs). HPV was in a mixed integrated-episomal form in a monoclonal GD, an adenocarcinoma in situ, and an adenocarcinoma. Both tumor components were monoclonal in origin in 6 adenosquamous carcinomas, with identical patterns of X-chromosomal inactivation and types and physical status of HPV. These results imply that the concurrent glandular and squamous lesions are formed separately, whereas adenosquamous carcinoma is more likely to be a combination tumor of monoclonal origin, and that integration of HPV has an important role in the progression from polyclonal GD through monoclonal expansion to adenocarcinoma in situ and adenocarcinoma.

Oral manifestations as predictors of immune suppression in a HIV-/AIDS-infected population in south India

The objectives of the study are to evaluate the relationship between common HIV-related oral lesions and absolute CD4+ count, age, gender, and medication used and to assess the sensitivity, specificity, positive and negative predictive value of oral manifestations for low absolute CD4+ counts. HIV-positive patients, 200, from south India were selected, whose absolute CD4+ counts were determined within 2 weeks of oral examination. Sociodemographic data was obtained using a structured questionnaire. Oral manifestations were diagnosed according to presumptive criteria of EEC-clearinghouse classification (1993). Four or more concurrent oral lesions were statistically significant with low CD4+ counts <200 cells/mm3 (P = 0.005). The highest and lowest mean CD4+ cell counts were seen in individuals with linear gingival erythema (LGE; 172.5 cells/mm(3)) and pseudomembranous candidiasis (PC; 87 cells/mm(3)), respectively. Smoking, age (<35 years), and males had a positive association with oral hairy leukoplakia (OHL; P < 0.05). Patients with CD4+ counts < 200 cells/mm(3) were associated with 15 times greater risk of PC and four times at greater risk for occurrence of any oral manifestation. Concurrent oral manifestations (>or=4) were good predictors (80-100%) of severe immune suppression. In most resource poor countries where facilities for undertaking CD4+ counts are not available, the presence of concurrent oral manifestations may be used as an indicator of deteriorating immune status.

Assessment of necropsy findings in sled dogs that died during Iditarod Trail sled dog races: 23 cases (1994–2006)

To describe the character and frequency of causes of death and associated lesions in long-distance racing sled dogs. Retrospective case series. 23 dogs. Medical records of dogs that died during or soon after competition in the Iditarod Trail sled dog races (1994 through 2006) were examined for fi ndings of gross necropsy and histologic evaluation of tissue samples. From the data, descriptive and comparative statistics were obtained. Recognized causes of death included aspiration of gastric contents (n = 4), aspiration pneumonia (4), acute blood loss secondary to gastric ulceration (3), and sled dog myopathy (2). A cause of death was not established for 7 dogs. Prevalent lesions among the study population included rhabdomyolysis (n = 15), enteritis (10), gastritis (10), aspiration pneumonia (8), and gastric ulceration (8). All dogs with aspiration pneumonia had concurrent gastric mucosal lesions. Subjective biventricular cardiac hypertrophy was evident in most dogs; other lesions detected frequently included centrilobular hepatic fibrosis, gastric dilatation, and mild cardiac myodegeneration and necrosis. Unexpected death is a rare event among conditioned sled dogs during competition in endurance races. Potentially life-threatening conditions of dogs that are associated with periods of long-distance physical exertion include aspiration pneumonia, gastric mucosal lesions, and severe rhabdomyolysis. Dogs that develop clinical signs suggestive of these conditions should be excluded from strenuous activities. Epidemiologic investigations are required to clarify the risk for death associated with these lesions in dogs competing in endurance races.

Epidermoid cysts associated with thoracic meningocele

Intraspinal tumours of cutaneous origin associated with various spinal dysraphisms have been well documented in the literature. However, the metachronous development of intra- and extra-medullary tumours in conjunction with dorsal meningocele is rare. The authors report a patient with a thoracic dorsal meningocele and congenital intradural extramedullary epidermoid tumour. The patient developed an intramedullary epidermoid growth 12 years later. Subtotal resection of the tumour predisposed to a later recurrence. Meningocele is not always an isolated clinical entity but the concurrent occult lesions are usually veiled by the more conspicuous surface anomaly. Thorough magnetic resonance imaging of the whole neural axis helps to identify associated pathologies. Delicate intradural exploration by a microsurgical approach is necessary to achieve appropriate treatment.