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The Journal of Obstetrics and... Sep 2018To describe the clinical findings and urogenital symptoms associated with sacral perineural cysts (Tarlov cysts).
AIM
To describe the clinical findings and urogenital symptoms associated with sacral perineural cysts (Tarlov cysts).
METHODS
A retrospective chart review including 65 female patients with Tarlov cysts was completed. Clinical findings were collected from a database of subjects seen in our institution's urogynecology and neurosurgery clinics between 2004 and 2015. A statistical analysis was performed to test for any correlation between cyst size or location, and patient symptoms or examination findings.
RESULTS
Tarlov cysts were most commonly located from S2 to S3 (73%), and ranged in size from 1 to 2 cm (55%). Frequently reported symptoms included lower back pain (83%, 95% confidence interval [CI] 0.71-0.91), lower extremity radiculopathy (75%, CI 0.63-0.85), positional pain (62%, CI 0.50-0.73), urinary urgency (54%, CI 0.41-0.66) and urinary frequency (48%, CI 0.35-0.61). Common urodynamic findings included an early sensation of filling (70%), involuntary detrusor contractions (33%), urethral instability (33%) and stress urinary incontinence (33%). A statistical analysis comparing cyst size and location to clinical findings was significant for a correlation between an S2 location and central nervous system symptoms (P = 0.02), larger cyst size and urinary dysfunction (P = 0.05) and smaller cyst size and an early sensation of filling (P = 0.05).
CONCLUSION
Patients with symptomatic sacral Tarlov cysts frequently report pain and neuropathy related to the lower back, pelvis and urogenital system. As compared to the general population, urinary urgency and urodynamic findings associated with urgency were more frequent in our patient sample. These findings suggest that Tarlov cysts may have a clinically significant impact on urogenital function.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Low Back Pain; Middle Aged; Pelvic Pain; Radiculopathy; Retrospective Studies; Tarlov Cysts; Urination Disorders
PubMed: 29974579
DOI: 10.1111/jog.13711 -
Medicine Sep 2022Uro-originated epidermoid cysts, especially located in the upper urinary tract are rare and only 4 cases of epidermoid cyst occurring in the upper urinary tract have...
RATIONALE
Uro-originated epidermoid cysts, especially located in the upper urinary tract are rare and only 4 cases of epidermoid cyst occurring in the upper urinary tract have been reported worldwide so far. In the previous cases, the cysts were diagnosed as tumors and organs were removed.
PATIENT CONCERNS AND DIAGNOSIS
We report a case of epidermoid cyst in ureter in a 48-year-old female patient admitted to the local hospital suffering from paroxysmal pain in the right hypochondriac for 8 years.
INTERVENTIONS AND OUTCOMES
She underwent right ureteroscopy in order to rule out the possibility of urinary epithelial carcinoma. The tumor was pathological diagnosed as a benign ureterocyst epidermoid. Postoperatively, the patient showed good recovery. During the 24-month follow-up period, the patient remained well and free of complications.
CONCLUSION
This case illustrates that benign epidermoid cysts can appear in the ureter, although it is extremely rare. It also indicates that perioperative examinations must be exhaustive to avoid the further injury to the patients.
Topics: Epidermal Cyst; Female; Humans; Middle Aged; Ureter
PubMed: 36123920
DOI: 10.1097/MD.0000000000030254 -
La Pediatria Medica E Chirurgica :... Oct 2021The caecum is one of the rarest sites of intestinal duplication cysts. The most common symptomatology includes vomiting, abdominal pain, abdominal distention, palpable...
The caecum is one of the rarest sites of intestinal duplication cysts. The most common symptomatology includes vomiting, abdominal pain, abdominal distention, palpable mass and rectal bleeding. Most of the duplications are diagnosed within the first two years of life, including prenatal diagnosis. Only few cases of caecal duplication have been reported in the literature up to the present day. We are going to present a case of a five-years old girl with caecum duplication who reached our ward due to abdominal distension with no other symptoms.
Topics: Abdominal Pain; Cecum; Child, Preschool; Cysts; Digestive System Abnormalities; Female; Humans; Vomiting
PubMed: 34672177
DOI: 10.4081/pmc.2021.246 -
European Journal of Medical Genetics Jan 2022Cutaneous neurofibromas (cNF) are one of the hallmarks of neurofibromatosis 1 (NF1). The number of cNFs varies between individuals from a few to hundreds or even...
Cutaneous neurofibromas (cNF) are one of the hallmarks of neurofibromatosis 1 (NF1). The number of cNFs varies between individuals from a few to hundreds or even thousands and increases throughout adult life. cNFs cause a significant disease burden to adult patients and constitute an unmet need for therapy, since they may cause itch and pain and, being conspicuous and unsightly, stigmatize the patient. There is a lack of reports on how the outcome of various treatment options are perceived by the patients. Here we describe a technique for cNF removal using CO laser, and report how patients experience the procedure. Questionnaires were sent to patients who had had CO laser surgery in the French Referral Center for Neurofibromatoses, and in the Turku University Hospital, Finland, to retrospectively evaluate the patients' global satisfaction of the procedure, treatment indications, and reasons for withdrawal from treatment, if this was the case. The number of returned questionnaires was 233/473 in France and 23/27 in Finland. The results showed that the most important indications for cNF removal were esthetic, and pain and itch caused by the tumors. In general, the procedure was well tolerated, and the degree of satisfaction was 8-10 on a scale from 0 to 10. For those 30% who discontinued the tumor removal program, the main reasons were organizational constraints, a non-satisfactory esthetic result, too many cNFs to treat, or problems with healing. Thus, the CO laser method is well tolerated but does not fully answer to the needs of the patients. Since medical treatment is not yet available, we encourage the use of laser removal of cNFs as a feasible method to decrease the tumor burden of the patients.
Topics: Adult; Aged; Carbon Dioxide; Female; Humans; Lasers, Gas; Male; Middle Aged; Neurofibroma; Patient Reported Outcome Measures; Patient Satisfaction; Retrospective Studies; Skin Neoplasms; Surveys and Questionnaires; Young Adult
PubMed: 34768015
DOI: 10.1016/j.ejmg.2021.104386 -
Neuro-oncology Apr 2022Non-invasive differentiation between schwannomas and neurofibromas is important for appropriate management, preoperative counseling, and surgical planning, but has...
BACKGROUND
Non-invasive differentiation between schwannomas and neurofibromas is important for appropriate management, preoperative counseling, and surgical planning, but has proven difficult using conventional imaging. The objective of this study was to develop and evaluate machine learning approaches for differentiating peripheral schwannomas from neurofibromas.
METHODS
We assembled a cohort of schwannomas and neurofibromas from 3 independent institutions and extracted high-dimensional radiomic features from gadolinium-enhanced, T1-weighted MRI using the PyRadiomics package on Quantitative Imaging Feature Pipeline. Age, sex, neurogenetic syndrome, spontaneous pain, and motor deficit were recorded. We evaluated the performance of 6 radiomics-based classifier models with and without clinical features and compared model performance against human expert evaluators.
RESULTS
One hundred and seven schwannomas and 59 neurofibromas were included. The primary models included both clinical and imaging data. The accuracy of the human evaluators (0.765) did not significantly exceed the no-information rate (NIR), whereas the Support Vector Machine (0.929), Logistic Regression (0.929), and Random Forest (0.905) classifiers exceeded the NIR. Using the method of DeLong, the AUCs for the Logistic Regression (AUC = 0.923) and K Nearest Neighbor (AUC = 0.923) classifiers were significantly greater than the human evaluators (AUC = 0.766; p = 0.041).
CONCLUSIONS
The radiomics-based classifiers developed here proved to be more accurate and had a higher AUC on the ROC curve than expert human evaluators. This demonstrates that radiomics using routine MRI sequences and clinical features can aid in differentiation of peripheral schwannomas and neurofibromas.
Topics: Humans; Machine Learning; Magnetic Resonance Imaging; Neurilemmoma; Neurofibroma; Retrospective Studies
PubMed: 34487172
DOI: 10.1093/neuonc/noab211 -
Gynecologic and Obstetric Investigation 2023Approximately 17-44% of women diagnosed with endometriosis have ovarian endometriomas (cysts). Although ovarian endometriomas may adversely affect quality of life and...
OBJECTIVES
Approximately 17-44% of women diagnosed with endometriosis have ovarian endometriomas (cysts). Although ovarian endometriomas may adversely affect quality of life and work performance, the associations among patient characteristics, cyst size, and pain in women with endometriosis have not yet been reported. Thus, the objective of this study was to assess the association among age, cyst size, and pain in women with ovarian endometriomas.
DESIGN
This was a retrospective secondary analysis of pooled data from six randomized clinical trials on the use of low-dose estrogen/progestogen drugs for endometriosis.
PARTICIPANTS/MATERIALS, SETTING, AND METHODS
Data on 491 patients enrolled in four randomized and two nonrandomized trials between 2003 and 2017 were pooled. None of the participants had undergone surgical treatment before trial participation. We examined differences in dysmenorrhea score, menstrual pain score, analgesic score, and pelvic pain, as measured using a visual analog scale (VAS), by age and endometrioma size.
RESULTS
The mean dysmenorrhea, menstrual pain, and analgesic scores were 4.2, 2.2, and 2.0, respectively. The mean VAS for pelvic pain was 55, which decreased significantly with an increase in age. Age was not associated with endometrioma size, including volume and maximum diameter, or dysmenorrhea score. Additionally, endometrioma volume and maximum diameter were not associated with menstrual pain, analgesic score, or pelvic pain.
LIMITATIONS
The details of past treatment history were not available; therefore, these could not be considered in the analysis. Additionally, the assessment of pain is heavily influenced by psychological factors, making it difficult to assess the true extent of pain.
CONCLUSIONS
Endometrioma size was not associated with dysmenorrhea or pelvic pain measured using the VAS.
Topics: Humans; Female; Endometriosis; Dysmenorrhea; Progestins; Retrospective Studies; Quality of Life; Pelvic Pain; Estrogens; Cysts; Analgesics
PubMed: 37952524
DOI: 10.1159/000534666 -
Clinical Imaging Nov 2022To assess the value of preoperative 3D-FIESTA and MR angiography (MRA) in endoscopic resection of epidermoid cysts presenting with trigeminal neuralgia (TN).
PURPOSE
To assess the value of preoperative 3D-FIESTA and MR angiography (MRA) in endoscopic resection of epidermoid cysts presenting with trigeminal neuralgia (TN).
METHODS
3D-FIESTA and MRA were performed before neuroendoscopy in 32 cases of epidermoid cysts with TN, and the tumors were grouped into types A, B, C, and D according to the relationship between the tumor and adjacent nerves and arteries (Hitoshi Kobata's classification). Evaluation of the neuroendoscopic resectability of different types of tumors, included gross total tumor removal (GTR), subtotal tumor removal (STR), and partial tumor removal (PTR). During the 5-year follow-up, symptoms were assessed based on facial pain relief using the Barrow Neurological Institute (BNI) score.
RESULTS
The coincidence rate between MRI classification of the tumor and the operation was 100%. Type B tumors were the most common (18/32, 56.3%). Type A tumors showed the highest resectability (9/9, 100%), followed by type B tumors (14/18, 77.8%). Moreover, microvascular decompression was performed in all 4 cases of type C and 1 case of type D tumors. During follow-up, 23 patients showed marked improvement in symptoms (15, 8 of BNI I or II), 8 cases showed partial improvement (BNI III), and only 1 case of type C tumor was associated with poor facial pain relief, which recurred 5 years later (BNI IV).
CONCLUSIONS
Preoperative high-resolution MR can accurately analyze the relationship between epidermoid cysts and adjacent nerves and arteries. It could act as a powerful tool in the evaluation of tumor resectability and the prognosis of surgery.
Topics: Angiography; Epidermal Cyst; Facial Pain; Humans; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Neuroendoscopy; Treatment Outcome; Trigeminal Neuralgia
PubMed: 35973272
DOI: 10.1016/j.clinimag.2022.08.006 -
Thorax Jul 1971Thirty-two mediastinal neural tumours were seen in the East Anglian Regional Thoracic Surgical Unit at Cambridge between October 1952 and July 1970. The descending order... (Review)
Review
Thirty-two mediastinal neural tumours were seen in the East Anglian Regional Thoracic Surgical Unit at Cambridge between October 1952 and July 1970. The descending order of frequency was neurofibroma, ganglioneuroma, neurilemmoma, neurofibrosarcoma, and neuroblastoma. The literature relating to these tumours is reviewed and the pathological and clinical complications encountered in this series and in the literature are described.
Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Deglutition Disorders; Female; Ganglioneuroma; Horner Syndrome; Humans; Hypertension; Infant; Infant, Newborn; Lung Diseases; Lung Neoplasms; Male; Mediastinal Neoplasms; Mediastinum; Meningocele; Middle Aged; Neoplasm Regression, Spontaneous; Neoplasms, Nerve Tissue; Neurilemmoma; Neuroblastoma; Neurofibroma; Neurofibromatosis 1; Neurologic Manifestations; Osteoarthropathy, Secondary Hypertrophic; Pain; Paraganglioma, Extra-Adrenal; Pheochromocytoma; Sex Factors; Vitamin B 12
PubMed: 4327710
DOI: 10.1136/thx.26.4.392 -
Gastroenterologie Clinique Et Biologique 2010
Topics: Abdominal Pain; Adult; Cholangiography; Cholecystectomy; Choledochal Cyst; Humans; Male
PubMed: 20537486
DOI: 10.1016/j.gcb.2010.03.011 -
Neurology Feb 2023Internal neurofibromas, including plexiform neurofibromas (PNF), can cause significant morbidity in patients with neurofibromatosis type 1 (NF1). PNF growth is most...
BACKGROUND AND OBJECTIVES
Internal neurofibromas, including plexiform neurofibromas (PNF), can cause significant morbidity in patients with neurofibromatosis type 1 (NF1). PNF growth is most pronounced in children and young adults, with more rapid growth thought to occur in a subset of PNF termed distinct nodular lesions (DNL). Growth behavior of internal neurofibromas and DNL in older adults is not well documented; yet knowledge thereof is important for patient risk stratification and clinical trial design. The primary objective of this study was to evaluate the long-term growth behavior of internal neurofibromas in adults with NF1. Secondary objectives were to correlate tumor growth behavior with patient-specific, tumor-specific, and patient-reported variables.
METHODS
In this prospective cohort study, internal neurofibromas were identified on coronal short TI inversion recovery sequences on baseline and follow-up whole-body MRIs (WBMRIs). Tumor growth and shrinkage were defined as a volume change ≥20%. The association between tumor growth and patient-specific (baseline age, sex, and genotype), tumor-specific (morphology, location, DNL presence on baseline WBMRI, and maximum standardized uptake value on baseline PET imaging), and patient-reported variables (endogenous and exogenous hormone exposure, pain intensity, and quality of life) was assessed using the Spearman correlation coefficient and Kruskal-Wallis test.
RESULTS
Of 106 patients with a baseline WBMRI obtained as part of a previous research study, 44 had a follow-up WBMRI. Three additional patients with WBMRIs acquired for clinical care were included, generating 47 adults for this study. The median age during baseline WBMRI was 42 years (range 18-70). The median time between WBMRIs was 10.4 years. Among 324 internal neurofibromas, 62.8% (56% of PNF and 62.1% of DNL) shrank spontaneously without treatment and 17.1% (17.9% of PNF and 13.8% of DNL) grew. Growth patterns were heterogeneous within participants. Patient-specific, tumor-specific, and patient-reported variables (including endogenous and exogenous hormone exposure) were not strong predictors of tumor growth.
DISCUSSION
Internal neurofibroma growth behavior in older adults differs fundamentally from that in children and young adults, with most tumors, including DNL, demonstrating spontaneous shrinkage. Better growth models are needed to understand factors that influence tumor growth. These results will inform clinical trial design for internal neurofibromas.
Topics: Child; Young Adult; Humans; Aged; Adolescent; Adult; Middle Aged; Neurofibromatosis 1; Follow-Up Studies; Prospective Studies; Quality of Life; Neurofibroma, Plexiform; Neurofibroma; Magnetic Resonance Imaging
PubMed: 36332985
DOI: 10.1212/WNL.0000000000201535