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The Natural History and Treatment Guidelines of Cerebellar Liponeurocytoma—A Case Report

Open Journal of Modern Neurosurgery 2011年第2期1卷 10-16页

作者： Or Cohen-Inbar euvgeni vlodavsky Menashe Zaaroor 不详

Background and Importance: Lipomatous medulloblastoma (cerebellar liponeurocytoma) is a rare cerebellar tumor, with only twenty-nine cases reported, considered a distinct variant of medulloblastoma. The few cases described support an indolent nature for this tumor. We aim at defining the optimum treatment strategy and long-term behavior for this tumor entity. Clinical presentation: A 74 years old male presented on September 2010 complaining of mild dizziness and headache slowly progressing over a few months. This gentleman was operated on at our department some 18 years ago for a right cerebellar hemispheral lesion, defined as a liponeurocytoma. This patient received no adjuvant treatment. Current magnetic resonance imaging (MRI) studies disclosed a right hemispheral cerebellar mass, locally recurrent in the original surgical tumor bed. Gross total resection of the tumor was accomplished through a suboccipital craniotomy, with complete resection of the lesion. The histopathological diagnosis was defined as cerebellar liponeurocytoma. No adjuvant therapy was given as initially, after the first operation. Currently, the patient is alive, fully alert with minimal neurological deficits, Barthel index 90, Kernofsky performance status of 90 and with no evidence of disease on neuroimaging. Conclusion: This patient portrays this tumor’s natural history after surgical intervention with no adjuvant treatment, being the longest reported follow-up and recurrence. This distinct variant of medulloblastoma appears to have a uniquely favorable prognosis, even without adjuvant therapy. A complete surgical resection with close follow-up seems both sufficient and prudent.

关键词： Natural History Cerebellar Liponeurocytoma Recurrence in 18 Years

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Autoimmune pancreatitis misdiagnosed as a tumor of the head of the pancreas

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World Journal of Gastrointestinal Surgery 2012年第7期4卷 185-189页

作者： Eran Brauner Jesse Lachter Offir Ben-Ishay euvgeni vlodavsky Yoram Kluger Department of General Surgery B Rambam Health Care Campus31096 HaifaIsrael Department of Gastroenterology Rambam Health Care Campus31096 HaifaIsrael Department of Pathology Rambam Health Care Campus31096 HaifaIsrael

Autoimmune pancreatitis can mimic pancreatic cancer in its clinical presentation, imaging features and laboratory parameters. Differentiating between those two entities requires implementation of clinical judgment and experience along with objective parameters that may suggest either condition. Few strategies have been proposed for the surgeon to implement when facing borderline cases. The following case is an example of a clinical scenario compatible with an accepted algorithm for diagnosis of pancreatic cancer, which eventually proved wrong. We present a 75-year-old patient who was admitted for obstructive jaundice. Imaging features were highly suggestive for pancreatic cancer as was the carbohydrate antigen 19-9 (CA 19-9) level, leading to a decision for surgery. Pathological examination revealedautoimmune pancreatitis. Though no frank carcinoma was found, premalignant ductal changes of pancreatic intraepithelial neoplasia (PanIN)Ⅰand PanIN Ⅱ were discovered throughout the pancreatic duct. Caution is advised when relying on the combination of highly suggestive radiology features and elevated levels of CA 19-9 in the diagnosis of pancreatic cancer. When the tissue diagnosis is not conclusive, obtaining IgG4 and antinuclear Ab levels is advised, to rule out the rare possibility of autoimmune pancreatitis. Patients with autoimmune pancreatitis should be followed carefully as precancerous lesions may accompany the benign disease and the correlation of these two entities has not been ruled out.

关键词： Autoimmune pancreatitis Carbohydrate antigen 19-9 Pancreatic cancer Pancreatic intraepithelial neoplasia

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