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We report a case of a 50-year-old woman with traumatic dissection of the right common carotid artery secondary to attempted suicidal hanging. Initial examination showed marks of strangulation on the neck, facial edema, and multiple conjunctival petechiae accompanied by difficulty in breathing and loss of consciousness. She gradually recovered except for her left upper limb weakness. Rehabilitation, with a diagnosis of left brachial plexus injury, was started. Two years later, she occasionally felt numbness of the left upper extremity. On her second admission, a bruit was heard on the right side of her neck. Neurological examination did not reveal any change. CT scan showed atrophic changes. Angiography demonstrated approximately 80% stenosis of the right common carotid artery which was thought to be responsible for the attacks of numbness. Right carotid endarterectomy was performed. Histological findings revealed dissection of the medial layer of the arterial wall. Complaints of numbness disappeared postoperatively, and angiography showed good patency at a follow-up examination. We conclude that the stenosis of the common carotid artery was not due to atherosclerosis but due to the dissection as a result of hanging.

We treated three cases of inflammatory granulomas extending from the sphenoid sinus to the cavernous sinus. Case 1 was that of a 36-year-old male with diplopia and right ptosis. Case 2 was that of a 40-year-old male with frontal headache. Case 3 was that of a 70-year-old female with left impaired vision and frontal headache. In the first case, MRI demonstrated a mass lesion extending from the right half of the sphenoid sinus to the cavernous sinus and retropharyngeal space. In the second case the granuloma extended from the right cavernous sinus to the right retroorbital space. In the last case, MRI demonstrated diffuse Gd-DTPA enhancement of the left cavernous sinus and the left half of the sphenoid sinus. In all cases an operation was performed using the sublabial rhinoseptal approach, and the tumor in the sphenoid sinus was removed. Histological examination revealed an inflammatory granuloma in all 3 cases. In the first case the clinical symptoms improved following administration of glucocorticoids. In the second case the mass in the cavernous sinus decreased in size postoperatively. In the last case, the clinical symptoms gradually improved with administration of antibiotics after surgery. Granuloma of the cavernous sinus is difficult to diagnose, but when a similar pathological lesion coexists in the sphenoid sinus, a definitive diagnosis can be easily made via the sublabial rhinoseptal approach.

Ectopic pituitary adenomas are very rare and only 17 cases have been reported. In this paper we present a case of large pituitary adenoma originating in the suprasellar region. A 26-year-old man was admitted to our clinic with a chief complaint of headaches. Neurological examination revealed slight disorientation and bilateral choked disk. Hormonal study revealed that the serum prolactin level was 3300ng/ml and serum growth hormone level was 29.5ng/ml. Computed tomography showed a large mass in the suprasellar region extending upward to the third ventricle and backward to the pons. T1-weighted MR imaging revealed that the intensity of the mass was the same as that of the cerebral cortex and the pituitary gland was showing high intensity in the pituitary fossa. The tumor was radically removed via the transpetrosal transtentorial approach. Histologically, the tumor was a prolactin-growth hormones producing pituitary adenoma. The literature was reviewed and the origin of the tumor was discussed.

Although meningiomas have been regarded as one of the benign brain tumors, cases showing clinically malignant behavior have been reported. For the purpose of detecting the possibility of predicting different biological behavior in meningiomas, eleven meningiomas were studied with the aid of flow cytometric (FMC) and cytogenetic techniques. Morphologically two cases were diagnosed as syncytial meningiomas and nine as transitional meningiomas. The former included one case (#5) of "syncytial poorly structured meningioma" (Zang et al.). In the FCM study seven out of eleven cases showed diploid (2C) or near diploid modal peaks with small amounts of tetraploid DNA (4C) cells. The remaining four cases had larger cell populations at 4C. Cytogenetically cells corresponding to 2C and near 2C peaks were also proved to be composed of diploid or hypodiploid cells in all of the eight cases studied. Chromosomal analyses revealed normal karyotypes in three. The remaining five hypodiploid cases had common chromosomal aberrations in G22, including missing chromosome 22 in four cases and 22 q-deletion in one. Nine cases grown in culture were also studied by FCM and were able to be maintained in culture from 14 days to 5 months. Close to the terminal stage of culture, most of the cases in culture tended to have higher cell population at 4C and the appearance of cells even at 8C (polyploidization). Similar changes were also obtained in cultured human fibroblast and seem not to be specific to this benign tumor. These results are discussed with reference to the previous reports from the point of view of patterns of FCM histograms from surgical specimens, degree of hypodiploidy, morphological behavior. Further studies, especially relating to basic cell kinetics are needed before clinical application can be made.