Approach to orbital tumours. Based on a study of orbital tumours in Ceylon.
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We describe three patients with malignant peripheral nerve tumours in the orbit and review the existing literature on these rare lesions.
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Anatomic sections of the superior aspect of the anterior mediastinum reveal that normal structures can cause indentations upon the adjacent lung. On lateral chest films, the soft-tissue density of the anterior superior mediastinal structures contrasts with that of the normal lung, revealing a normal, undulating configuration of the anterior superior mediastinum. We have termed this the "vascular incisura," analogous to the cardiac incisura of the left lung seen inferiorly. An appreciation of normal variations within this space is essential when evaluating pathologic alterations.
Magnetic resonance imaging is the method of choice for evaluating patients with a nontraumatic brachial plexopathy. Although there is a wide range of disease processes that may cause a brachial plexopathy, radiation fibrosis, primary and metastatic lung cancer, and metastatic breast cancer account for almost three-fourths of the causes. Radiation fibrosis, the most common cause in our series, may occur several months to years after the completion of therapy. Findings of radiation fibrosis include (a) thickening and diffuse enhancement of the brachial plexus without a focal mass and (b) soft-tissue changes with low signal intensity on both T1- and T2-weighted images. Lung cancer arising in the lung apex may invade the lower portion of the brachial plexus. Many tumors may metastasize to the brachial plexus, causing a brachial plexopathy. Breast cancer is the most likely to metastasize because major lymphatic drainage routes for the breast course through the apex of the axilla.
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We present a patient with an intramuscular pelvic arteriovenous malformation that was initially diagnosed as a tumor of the sciatic nerve sheath. Endovascular embolization, attempted as a preoperative maneuver, was complicated by diffuse pulmonary emboli and death. To our knowledge, this is the first such reported case. Its presentation here broadens the differential diagnosis of sciatic nerve sheath tumors, emphasizes the diagnostic and management issues of masses presenting as peripheral nerve tumors, and provides clinicopathological evidence regarding the cause of neurological symptoms.
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