ABSTRACTS OF PAPERS PRESENTED AT THE 73RD RESEARCH MEETING OF THE MEDICAL RESEARCH CENTRE OF BOMBAY HOSPITAL ON MONDAY,10TH JANUARY 2000, 2.30 PM IN THE SP JAIN CAFETERIA (CONVENOR DR. HL DHAR)
1 INTRA-SELLAR TUBERCULOMA - AN UNUSUAL CASE
Pradnya S Gaitonde, Daya K Manghani, Darab K Dastur
Pituitary tuberculomas, mimicking adenomas are very unusual. We describe a rare case of a patient with an exclusively intrasellar mass, and who presented with severe headaches and loss of libido. The lesion was approached transsphenoidally and pathological examination revealed a typical granulomatous reaction, suggesting tuberculoma. This was confirmed on immunohistochemical preparations which showed lymphocytes to be positive for Leucocyte Common Antigen (LCA) and large mononuclears to be positive for Macrophage Factor (MF). Complete removal was achieved and the patient started post-operative anti-tuberculous therapy.
2.MULTIPLE VASCULAR MALFORMATION PRESENTED AS MULTIORGAN BLEED
Harish Parekh, Atul Tapadia, BS Singhal
A 30 year old lady presented with acute onset of headache, giddiness and abnormal posturing of both upperlimbs on 26.10.99. She was hospitalised and treated conservatively. During a part of work up and investigation, she was found to have small hypointense lesion in right cerebellar region on T2WI in MRI brain, which was considered to be an infarct. She improved with conservative treatment but similar event repeated on 23.11.99. At this time, she had acute headache with recurrent episodes of vomiting and became unconscious for short duration. At this time repeated imaging of brain was done, revealed large fresh haemorrhage which was dissected into ventricular system. Then she was referred to Bombay Hospital. After admission to Bombay Hospital she was further investigated and was found to have following. Coagulation profile was normal. Routine CBC/ESR/SMA 12+2/renal profile was normal. Stool C/M shows occult blood.
X-ray chest shows sharply circumscribed spherical mass in right lower zone located beneath the hilum. SubsequentHRCT chest shows nodular peripheral enhancement within the lesion suggesting a cavernoma and multiple similar lesions were seen in both lungs.
DSA (Digital subtraction angiography) L1v5 showed a small angioma fed by posterior meningeal branch of right vertebral artery with an early draining vein drains into focula at the site of haemorrhage. During hospitalisation, over next few days she developed acute abdominal pain and her haemoglobin dropped down to very low level as compared to previous value so she was further investigated.
CT Scan and ultrasonography of abdomen revealed large perinephric collection bilaterally with a vascular malformation in both the kidney. So she was taken for (treatment) endovascular coiling (DSA guided). On 25th day of admission she became drowsy and developed left sided hemiplegia. At this time CT scan brain done, reveals large fresh subcortical haemorrhage in right frontal lobe with considerable mass effect. Presently she is under Rx in ICU.