Giant cell tumors histologically have

Giant cell tumors histologically have a predominance of large multinucleated giant cells that are dispersed in spindle-shaped stroma cells. However, other types of tumors are also rich in giant order S63845 such as chondroblastomas, aneurysmal bone cysts, and giant-cell reparative granulomas. This feature makes determining a correct pathological diagnosis difficult. Because of the scarcity of temporal GCT case reports, the precise therapeutic roles of the extent of surgery and adjuvant therapies remain unestablished. A complete surgical excision is generally the gold standard of treatment. According to previous articles in the medical literature, the local recurrence rate varies widely from 7% to 60% and depends on the extent of surgery (e.g., en bloc resection or curettage only). For good local control, a wide local excision is preferred as the first step. However, en bloc resection for a cranial GCT is often difficult and may cause cosmetic or neurologic deficits. The role of postoperative radiation is still controversial. In some series, adjuvant radiotherapy reportedly produces good local control (from 80% to 90%). Some scientists believe, however, that radiation may induce a future malignant transformation. Giant cell tumors of the temporal bones are rare. Even with currently available imaging tools, it remains difficult to differentiate an osteolytic cranial lesion involving the temporal bone from other more common neoplasms. A wide surgical excision can provide good local control. However, en bloc resection of a temporal GCT is difficult. Adjuvant radiotherapy for the residual tumor after the subtotal resection produced significant tumor regression for 14 months in our patient. Long-term follow up will be required to evaluate the final outcome of our patient.
The incidence of appendiceal diverticulitis in pathologic specimens is 0.004–2.1%. It was reported first in 1893 by Kelynack, and it is rare in younger patients. Appendiceal diverticulitis presents as right lower quadrant pain and is an uncommon entity in younger populations. Although encountered infrequently, its possibility must be considered in the differential diagnosis of abdominal pain, especially in cases of adult patients. Since its clinical presentation can be different from the classical picture of acute appendicitis, it is important that surgeons be aware of this condition. Patients with appendiceal diverticulitis are four times more likely to have a perforation, resulting in a 30-fold increase in mortality compared with simple appendicitis. In present studies, the incidence of appendiceal diverticulosis has been reported to be 0.88% in appendectomy specimens, which is similar to the results of previous reports. In addition, it has been associated with a high perforation rate of 70% (in 7 of 10 patients). It is difficult to diagnose preoperatively despite careful examination of the clinical symptoms, even with high-resolution ultrasound or computer tomography scans. To add to our concern, several studies have indicated that appendiceal diverticulosis is associated with appendiceal neoplasia. A tumor occurs when cells in the appendix become abnormal and multiply without control. Tumors may be benign (noncancerous), or malignant (resulting in appendix cancer—also termed appendiceal cancer). Once the diagnosis of appendiceal diverticular disease has been established, we recommend resection; however, some investigators doubt the potential benefit of prophylactic appendectomy.