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Renal angiomyolipomas hemorrhage is associated with their size and vascular constitution. The effects of sirolimus on different components of angiomyolipomas was analyzed in patients with tuberous sclerosis complex, sporadic lymphangioleiomyomatosis and multiple sporadic angiomyolipomas. Thirty angiomyolipomas from 14 patients treated with sirolimus were retrospectively evaluated. A Hounsfield-unit threshold was used to classify angiomyolipomas in fat-rich, fat-poor and intermediate-fat tumors, and to categorize tumor compartments in fat rich, fat poor, intermediate fat and highly vascularized. Diameter variations were measured to assess the effects on aneurysmatic/ectatic vascular formations. Volume reduction following treatment with sirolimus was higher in fat-poor than fat-rich angiomyolipomas. Tumor reduction was mainly determined by decrease of the fat-poor and highly-vascularized compartments while the volume of the fat-rich compartment increased. Broad liposubstitution was observed in some tumors. A median reduction of 100% (75 to 100) in the diameter of aneurysmatic/ectatic vascular structures was observed. Our study showed that sirolimus reduces the size of angiomyolipomas by decreasing primarily their highly-vascularized and fat-poor compartments. This effect is associated with a remarkable reduction of tumoral aneurysms/ectatic vessels, revealing the likely mechanism responsible for the risk-decreasing effect of mTOR inhibitors on angiomyolipoma bleeding. These findings support the role of mTOR in the development of angiomyolipoma blood vessels.

PIK3CA-related overgrowth spectrum is caused by mosaicism mutations in the PIK3CA gene. These mutations, which are also observed in various types of cancer, lead to a constitutive activation of the PI3K/AKT/mTOR pathway, increasing cell proliferation. Heat shock transcription factor 1 (HSF1) is the major stress-responsive transcription factor. Recent findings indicate that AKT phosphorylates and activates HSF1 independently of heat-shock in breast cancer cells. Here, we aimed to investigate the role of HSF1 in PIK3CA-related overgrowth spectrum. We observed a higher rate of proliferation and increased phosphorylation of AKT and p70S6K in mutant fibroblasts than in control cells. We also found elevated phosphorylation and activation of HSF1, which is directly correlated to AKT activation. Specific AKT inhibitors inhibit HSF1 phosphorylation as well as HSF1-dependent gene transcription. Finally, we demonstrated that targeting HSF1 with specific inhibitors reduced the proliferation of mutant cells. As there is currently no curative treatment for PIK3CA-related overgrowth spectrum, our results identify HSF1 as a new potential therapeutic target., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Most patients with phosphoinositide-3-kinase, catalytic, alpha polypeptide (PIK3CA)-related overgrowth spectrum become symptomatic early in life and need treatment before puberty. Recently, the specific inhibition of PIK3CA pathways has been proposed as a therapeutic option for these patients improving their surgical options and quality of life. Alpelisib, a specific alpha fraction inhibitor, has shown promising results., Case: A 17-year-old girl presented with severe involvement of her external genitalia with a combined vascular malformation in the context of congenital, lipomatous, overgrowth, vascular malformations, epidermal nevi and spinal/skeletal anomalies and/or scoliosis syndrome, needing frequent blood transfusions for anemia due to vaginal bleeding and use of a crutch for walking. After failure of treatment with rapamycin, compassionate treatment with alpelisib was started with excellent response., Summary and Conclusion: PIK3CA inhibitors might become a new option of treatment for PIK3CA-related overgrowth spectrum patients., (Copyright © 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Introduction: CLOVES syndrome is characterized by lipomatous overgrowth associated with vascular malforma tions, representing a diagnostic and a therapeutic challenge. Rapamycin, an mTOR inhibitor, has proved to be a good therapeutic option in some vascular anomalies. In this article, we report two ca ses of CLOVES syndrome with good response to oral rapamycin treatment., Objective: To report the outcome of two patients with CLOVES syndrome treated with oral rapamycin., Clinical Cases: Case 1: A three-year-old female preschooler with CLOVES syndrome and history of repeated hospita lizations due to severe infections resulting from macrocystic lymphatic malformations and due to thrombotic episodes. The patient evolved with poor quality of life, multiple hospitalizations, surgical risk and progression of the lesions, therefore, oral rapamycin was indicated. After six months of treatment, clinical and radiological reduction in the size of the lipomatous and lymphatic masses, cutaneous lymphorrhea absence and a significant improvement of her quality of life were observed, without requiring new hospitalizations. Case 2: a ten-year-old female schooler with CLOVES syndro me, who developed scoliosis and deterioration of her motor skills, becoming wheelchair-dependent. Oral rapamycin was indicated, showing improvement in her physical capacity, independence and au tonomy, and absence of lymphorrhea after four months of treatment., Conclusion: We propose oral rapamycin for the treatment of patients with CLOVES syndrome who present with complications and deterioration in the quality of life as a result of the disease.

CLOVES syndrome (congenital lipomatous overgrowth, vascular malformations, epidermal naevi, scoliosis/skeletal and spinal syndrome) is a genetic disorder that results from somatic, mosaic gain-of-function mutations of the PIK3CA gene, and belongs to the spectrum of PIK3CA-related overgrowth syndromes (PROS). This rare condition has no specific treatment and a poor survival rate. Here, we describe a postnatal mouse model of PROS/CLOVES that partially recapitulates the human disease, and demonstrate the efficacy of BYL719, an inhibitor of PIK3CA, in preventing and improving organ dysfunction. On the basis of these results, we used BYL719 to treat nineteen patients with PROS. The drug improved the disease symptoms in all patients. Previously intractable vascular tumours became smaller, congestive heart failure was improved, hemihypertrophy was reduced, and scoliosis was attenuated. The treatment was not associated with any substantial side effects. In conclusion, this study provides the first direct evidence supporting PIK3CA inhibition as a promising therapeutic strategy in patients with PROS.

Background: Back mice, or episacroiliac lipoma, represent a potentially treatable cause of low back pain that may be under-recognized in clinical practice. Despite being well characterized based on clinical history and physical examination findings, implementation of appropriate treatment may be delayed or missed based on a lack of familiarity with the diagnosis., Objectives: In this case report and literature review, we describe a 47-year-old woman with history of persistent low back pain who presented with a pain exacerbation consistent with a back mouse. The history, epidemiology, clinical characteristics, differential diagnosis, potential mechanisms for pain, and treatment options for back mice were then reviewed., Study Design: Case report and literature review., Setting: Academic university-based pain management center., Results: Studies included one randomized clinical trial, 4 cross-sectional studies, 8 case reports or series, and 16 other publications prior to 1967., Limitations: A single case report., Conclusions: Firm, rubbery, mobile nodules that are located in characteristic regions of the sacroiliac, posterior superior iliac, and the lumbar paraspinal regions may represent fatty tissue that has herniated through fascial layers. When painful, these back mice may be confused with other causes of low back pain. In particular, the presence of point tenderness may mimic myofascial pain, and reports of radicular pain may imitate herniated nucleus pulposus. However, back mice may be distinguished from other entities based on findings from the history and physical examination such as absence of neurological deficit. Treatment consisting of injection of local anesthetic into the nodule with or without corticosteroid followed by repeated, direct needling has been reported to relieve pain in many case reports. The one clinical trial comparing injection of local anesthetic to normal saline, which did not include repeated needling, found only mild and transient benefit in the treatment group.

Patients with phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome and germline mutations in PTEN frequently develop lipomatosis, for which there is no standard treatment. Rapamycin was shown to reduce the growth of lipoma cells with heterozygous PTEN deficiency in vitro, but concomitantly induced an upregulation of AKT phosphorylation. Since it was shown that resveratrol stabilizes PTEN, we asked whether co-incubation with resveratrol could suppress the rapamycin-induced AKT phosphorylation in PTEN-deficient lipoma cells. Resveratrol incubation resulted in decreased lipoma cell viability by inducing G1-phase cell cycle arrest and apoptosis. PTEN expression and AKT phosphorylation were not significantly changed, whereas p70S6 kinase (p70S6K) phosphorylation was reduced in PTEN-deficient lipoma cells after resveratrol incubation. Rapamycin/resveratrol co-incubation significantly decreased viability further at lower doses of resveratrol and resulted in decreased p70S6K phosphorylation compared to rapamycin incubation alone, suggesting that resveratrol potentiated the growth inhibitory effects of rapamycin by reducing p70S6K activation. Both viability and p70S6K phosphorylation of primary PTEN wild-type preadipocytes were less affected compared to PTEN-deficient lipoma cells by equimolar concentrations of resveratrol. These results support the concept of combining chemopreventive natural compounds with mammalian target of rapamycin (mTOR) inhibitors to increase the efficacy of chemotherapeutic drugs for patients suffering from overgrowth syndromes.

Episacral lipoma is a small, tender subcutaneous nodule primarily occurring over the posterior iliac crest. Episacral lipoma is a significant and treatable cause of acute and chronic low back pain. Episacral lipoma occurs as a result of tears in the thoracodorsal fascia and subsequent herniation of a portion of the underlying dorsal fat pad through the tear. This clinical entity is common, and recognition is simple. The presence of a painful nodule with disappearance of pain after injection with anaesthetic, is diagnostic. Medication and physical therapy may not be effective. Local injection of the nodule with a solution of anaesthetic and steroid is effective in treating the episacral lipoma. Here we describe 2 patients with painful nodules over the posterior iliac crest. One patient complained of severe lower back pain radiating to the left lower extremity and this patient subsequently underwent disc operation. The other patient had been treated for greater trochanteric pain syndrome. In both patients, symptoms appeared to be relieved by local injection of anaesthetic and steroid. Episacral lipoma should be considered during diagnostic workup and in differential diagnosis of acute and chronic low back pain.

Lipomas are common benign tumours of fat cells. In most cases, surgical excision is curative and simple to perform; however, such a procedure requires general anaesthesia and may be associated with delayed wound healing, seroma formation and nerve injury in deep and intramuscular tumours. The objective of this study was to evaluate treatment of subcutaneous, subfascial or intermuscular lipomas using intralesional steroid injections in dogs. Fifteen dogs presenting with lipomas were selected for treatment with ultrasound-guided intralesional injection of triamcinolone acetonide at a dose of 40 mg/mL. Nine subcutaneous and subfascial tumours showed a complete regression. The other lipomas decreased in diameter, achieving, in some cases, remission of discomfort and regression of lameness. Steroid injection was a relatively safe and effective treatment for lipomas in dogs; only six dogs experienced polyuria/polydipsia for about 2 weeks post-treatment.

Central precocious puberty (CPP) is fairly common in girls. In most girls, the etiology for the CPP is unknown. Among the more rare causes of CPP in girls are central nervous system tumors and hamartomas. Osteolipoma of the tuber cinereum, which is the most commonly diagnosed at autopsy, has been reported as a cause of CPP. We describe an 8-year-old girl with central precocious puberty in whom MRI demonstrated a lesion compatible with osteolipoma. Her symptom was breast development that begun at age 7 years and 9 months. Her case history, laboratory studies and imaging are presented. Her puberty was rapidly progressive. She was treated successfully with a GnRHa (Triptorelin 3.75 mg IM q 4 weeks). Her case brings to the forefront the need to perform an MRI in children with rapidly progressing puberty.

Treatment options are limited for classic nevus lipomatosus superficialis, in which clustered lesions present over a large area. We present a case of nevus lipomatosus superficialis that showed clinical and histological improvement after treatment with intralesional phosphatidylcholine and sodium deoxy-cholate., (© 2011 Wiley Periodicals, Inc.)

Aim: The aim of this study was to evaluate the efficacy of isoproterenol and prednisolone in the treatment of subcutaneous lipomas., Methods: The first experiment evaluated in vitro lipolysis induced by isoproterenol 10(-6) M alone and across a range of prednisolone concentrations to determine the optimal dose to maximize lipolysis. The second experiment evaluated lipolysis in a lipoma and subcutaneous fat by in vivo microdialysis in five subjects to isoproterenol 10(-6) M with and without prednisolone 10(-6) M. These five subjects and five additional subjects had a lipoma treated five times a week for 4 weeks in a 4-cm grid with 0.2 ml injections of 10(-6) M isoproterenol and 10(-6) M prednisolone. Lipoma size was followed monthly for 1 year or until surgical removal., Results: Prednisolone increased in vitro lipolysis to isoproterenol and 10(-6) M was the optimal concentration of both drugs. Lipomas responded with less lipolysis to isoproterenol than subcutaneous fat during microdialysis, and prednisolone treatment increased lipolysis in both lipomas and subcutaneous fat. Injection treatment of the lipomas decreased their volume 50%. All but one lipoma grew after treatment. Eight of the 10 subjects elected for surgical treatment, and the histology of the lipomas was normal fat tissue., Conclusions: Prednisolone and isoproterenol in combination increased lipolysis, and injections of the combination into lipomas decreased their volume 50% over 4 weeks. Eight of the 10 subjects elected for surgical removal., (© 2011 Blackwell Publishing Ltd.)

A new treatment variation in the spectrum of aesthetic medicine has been investigated worldwide since 2004: so-called injection lipolysis. Advances in knowledge regarding the efficacy and mechanism of action have been achieved especially in Germany because most users are found in Germany when compared on an international level. The reason for this is that the combination of phosphatidylcholine and deoxycholic acid as active substances has been approved for i.v. treatment of fat embolisms. It is thus readily available, but the subcutaneous injection of the drug Lipostabil N® is considered as off-label use. Meanwhile injection lipolysis has become an integral component for many in the practice of aesthetic medicine. The international association of physicians performing lipolysis in the so-called NETWORK-Lipolysis (with more than 2,000 members worldwide) has in particular called for the development of internationally recognized treatment standards and protocols. When the indication for its use adheres to strict criteria and the physicians applying the method have participated in intensive training, subcutaneous injection of phosphatidylcholine/deoxycholic acid represents a meaningful addition to the scope of minimally invasive aesthetic medicine.

Because thyrolipoma (adenolipoma of thyroid) and thyrolipomatosis (diffuse lipomatosis of thyroid) are distinctively rare conditions with only few cases reported in the literature, we are reporting 5 additional cases. All the 5 patients were adult females, with ages from 38 to 79 years, who presented with thyroid masses. Four of the patients had normal thyroid function tests and one had mild hypothyroidism. All patients received partial or total thyroidectomy. The thyroid specimens showed either circumscribed yellow-tan masses (cases 1, 2, and 3) or diffuse yellow-brown discoloration (cases 4 and 5). Histologic examination revealed abundant mature fat infiltrating the affected thyroid tissue in 3 distinct patterns: (1) fat infiltration limited to follicular adenomas (thyrolipoma); (2) fat diffusely infiltrating throughout the thyroid gland (thyrolipomatosis); or (3) fat infiltration involving both follicular adenoma and their surrounding thyroid tissue. Because of the rarity of thyroid fat-containing lesions, confusion in differential diagnosis may occasionally occur. It is important to be aware during frozen section that these lesions may present as extrathyroidal nodules, which can be radioactive on intraoperative scan for parathyroid glands. In addition, a papillary thyroid carcinoma was also identified in one case of thyrolipomatosis. All patients recovered well after surgery and there has been no recurrence of the lesions after 1 to 24 years of clinical follow-up. In summary, we are reporting 5 rare cases of thyrolipoma and thyrolipomatosis with distinct histologic patterns. Previously reported cases of thyrolipomatosis were reviewed and analyzed with the current cases.

The patient was a 65-year-old male, who had been performed partial resections of the colon (descending colon cancer and rectal cancer: Stage IIIa). Multiple hepatic metastases were observed 1 year and 10 months after the operation. Hepatic arterial infusion chemotherapy was started, and a complete response for liver metastases had been continuing for 2 years. On the seventh month after the hepatic arterial infusion chemotherapy was started, a lipoma-like tumor of approximately 10 cm was found under the diaphragm on the left side. The tumor was suspected to be a lipoma on imaging and it had a tendency for enlargement. Two years and two months after hepatic arterial infusion chemotherapy was begun, the patient was hospitalized for excision of the tumor. Intraoperative findings indicated that there was a 3.5 cm mass in the greater omentum in addition to the aforementioned tumor under the left diaphragm. Both masses were excised. The histopathological findings showed that the tumor under the left diaphragm was composed of adipose tissue with coagulative necrosis. The existing adipose tissue was thought to have necroses and had become encapsulated. Similar findings were obtained for the mass in the greater omentum. Contrast study using a port system revealed stenosis of hepatic artery and defluxion of contrast medium into splenic artery and inferior phrenic artery. We speculated that the lipoma-like tumor was formed by the angitis with the change of the drug distribution.

Background: Injections with Lipostabil, a phosphatidylcholine (PDC) containing substance, have become a popular technique to treat localized fat accumulation and lipomas for aesthetic reasons. Despite its frequent use, the mechanism of action of PDC and histological changes of treated fat tissue still remain unclear. To investigate the histological changes of lipomas after treatment with PDC., Methods: In all, fourteen lipomas (n = 14) in five patients presenting with multiple lipomas were treated with intralesional injections of PDC (Lipostabil, Nettermann, Germany). Histological changes with immunohistochemical analysis of the inflammatory process were evaluated 4, 10, 24, 48 h, 10 days, 30 days and 60 days after lipolysis., Results: Between 4 and 48 h after injection, histology shows a lobular neutrophilic infiltrate with partially destroyed fat cells. At day 10 the inflammatory process is accompanied by an infiltration of T-lymphocytes. After 60 days formation of macrophages with foam cells are visible, accompanied by thickened septa and capsula., Conclusion: Lipolysis with PDC results in a distinct inflammatory reaction of affected fat tissue, similar to factitial panniculitis. Early destruction of fat cells may suggest the involvement of detergent or osmotic mechanisms in the process.

Phosphatidylcholine, a lecithin extracted from soy beans, is able to lower serum cholesterol to some extent. When applied intralesionally within fat tissues, it is supposed to act as a "fat burner" and reduce undesired fat deposits. We applied intralesionally phosphatidylcholine within a lipoma of a young patient. To evaluate the volume of the lipoma sonographic imaging was performed before treatment and one month after the third application. Only a partial reduction of the lipoma could be achieved, and increased echographic density could be observed after the third intralesional application of phosphatidylcholine. Surgical excision was performed. Histologic examination showed focal fibrosis, inflammatory reaction with granulomatous features, and presence of pseudomembranous degeneration of fat tissue. Off-label intralesional use of phosphatidylcholine as "fat burner" for the reduction of aesthetically disturbing lipomas should be considered only on a case-to-case basis after careful consideration of possible undesired effects similar to those described in our patient.

Background: Surgery of multiple lipomas, as in patients with familial multiple lipomatosis, is often limited by poor aesthetic outcome owing to extensive scarring. For this reason, phosphatidylcholine (PDC) has been widely used to treat areas of localized fat accumulation. However, no reports of lipoma therapy with intralesional application of PDC, that is, injection lipolysis, have been published to date., Objective: To investigate whether injection lipolysis with PDC is an effective therapeutic option for patients with multiple lipomas., Methods: Thirty lipomas in 10 patients were sonographically measured prior to treatment. Four injections at intervals of 6 to 8 weeks were done. Sonographic measurements of lipoma size were repeated before each injection. Side effects, a pain score using a visual analogue scale, and patient satisfaction were noted. In one lipoma, histologic changes after lipolysis are described., Results: After four injections, a significant reduction in size of 45.8% was achieved. No complete elimination was seen in any lipoma. Histology showed a mild granulomatous septal panniculitis. Hematoma occurred in eight cases (27%). Four patients described pain on pressure for 3 days after injection. No severe side effects or systemic reactions were observed., Conclusion: Although surgery is the gold standard for lipoma therapy, injection lipolysis with PDC can also significantly reduce lipoma size. Complete elimination was not observed in any lipoma. Given that this was a short-term study, long-lasting therapeutic effects and possible recurrence of lipoma cannot be evaluated.

Background: Lipomas are benign neoplasms of mature fat cells. Current treatments are invasive and carry the risk of scarring. Injections of phosphatidylcholine solubilized with deoxycholate, a bile salt, have been used to reduce unwanted accumulations of fat. Recent in vitro and ex vivo investigations indicate that deoxycholate alone causes adipocyte lysis., Objective: We sought to report our experience treating lipomas using subcutaneous deoxycholate injections., Methods: A total of 6 patients presenting with 12 lipomas were treated with intralesional injections of sodium deoxycholate (1.0%, 2.5%, and 5.0%) at intervals of 2 to 20 weeks. Tumor size, cutaneous reactions, and patients' subjective responses were recorded before and after treatment., Results: All lipomas decreased in size (mean area reduction, 75%; range, 37%-100%) as determined by clinical measurement (with ultrasound confirmation in one lipoma) after an average of 2.2 treatments. Several lipomas fragmented or became softer in addition to decreasing in volume. Adverse effects, including transient burning, erythema, and local swelling, were associated with higher deoxycholate concentrations but resolved without intervention. There was no clear association between deoxycholate concentration and efficacy., Conclusions: Our clinical experience supports our laboratory investigations demonstrating that deoxycholate, rather than phosphatidylcholine, is the active ingredient in subcutaneously injected formulas used to treat adipose tissue. This small series suggests that low concentration deoxycholate may be a relatively safe and effective treatment for small collections of fat. However, controlled clinical trials will be necessary to substantiate these observations.

Phosphatidylcholine was initially used in emergencies and in the treatment of atheroma plaques in cardiac diseases. Recently, it has also been used in the treatment of localized fat deposits. We report on the authors' clinical experience of the use of 250 mg/ml phosphatidylcholine injections in the treatment of subcutaneous fat deposits, showing the clinical response and side-effects. Volunteers received phosphatidylcholine injections in several areas of localized fat deposits, with a minimum interval of one week and mean interval of 15 days between applications. Laboratory tests were performed during the period of the drug use. Clinical results reflect that phosphatidylcholine was efficacious in reducing the fatty pads in the treated areas, with few side effects. From the authors' point of view, the off-label use of phosphatidylcholine in the treatment of fatty pads and small areas of localized fat is safe, low cost, and effective.

The forty-years experience of treatment of 125 patients with thymic gland tumors was summarized, in 113 of them thymoma was revealed. In the disease of I-II stages the five-year survival index had constituted 75.6%, and in III-IV stages the method of choice is combined treatment, after which the five-years survival index does not exceed 31.2%. It is necessary to perform additional studying of factors, influencing the result of treatment of the thymic gland tumor.

Objective: To determine a solution capable of discerning adipose versus nervous tissue, to aid in surgical separation of the adipose tissue which appears to be visually indistinguishable from nervous tissue in lipomyelomeningoceles (LMMs)., Methods: The following solutes (in normal saline) were investigated, both at 25 and 37 degrees C: beta-carotene, vitamin D, vitamin E, lecithin, hydrogen peroxide, lipase, protease, hyaluronidase, partially purified collagenase, purified collagenase, trypsin, trypsin plus purified collagenase and non-solute-containing saline (control). Each solution was applied to a pediatric lipoma to determine gross effects over a period of approximately 30 min. If a solution appeared to affect the adipose tissue grossly, studies of functional in vivo sensory evoked and spontaneous potentials using that particular solution were conducted upon sheep spinal cord, nerve roots, dura and peripheral nerve. Additionally, histological studies were conducted to determine the effect of that solution upon adipose tissue, spinal cord, myelin, dura and nerve roots., Results: Of all solutions investigated, partially purified collagenase type 1 (T1C; Lot M0M4322, Code CLS-1, Worthington Biochemical Corporation, Lakewood, N.J., USA) at 37 degrees C was the most successful in grossly altering the consistency and appearance of adipose tissue. This change was more apparent over 20-30 min following application of the solution to the adipose tissue. Solutions not containing T1C did not show appreciable results; purified collagenase plus trypsin did not appear comparable or superior to T1C. No significant histological or functional change was noted when comparing the spinal cord, nerve rootlets, myelin, dura or peripheral nerve from the T1C-treated group versus normal (untreated) control groups., Conclusion: T1C appears to be a potentially effective solution for application during LMM surgery in the acute setting, and such use of an adjunct solution may significantly aid in the safe surgical resection of LMMs. Pending further research, this technique may be applied for other indications which require discernment or alteration of adipose versus nervous tissue., (Copyright 2002 S. Karger AG, Basel)

Cerebellar liponeurocytoma is a rare tumor of the posterior fossa that has many morphological similarities to medulloblastoma and neurocytoma. Recently the World Health Organization working group for classification of central nervous system neoplasms adopted the term "cerebellar liponeurocytoma" to provide a unified nomenclature for a tumor variously labeled in the literature as lipomatous medulloblastoma, lipidized medulloblastoma, medullocytoma. neurolipocytoma, lipomatous glioneurocytoma, and lipidized mature neuroectodermal tumor of the cerebellum. The rarity of this tumor and paucity of pertinent information regarding its biological potential and natural history have resulted in the application of various treatment modalities. It is suggested in the available literature that these lesions have a much more favorable prognosis than typical medulloblastomas, and that adjuvant therapy for liponeurocytoma need not be as extensive as that administered for medulloblastomas.

Introduction: In recent years there has been increasing interest in isolated trigeminal sensory neuropathy. We present a case with an unusual association of this neuropathy and a fatty tumour of Meckel's cavum., Clinical Case: A 24 year old man consulted for occasional episodes (during the previous two months) of dysesthesia of the right maxillary region. These were self-limiting and lasted only a few minutes. There was no lacrimation, apparent trigger factor, conjunctival injection or reduction in level of consciousness. There were no abnormal findings either on general or on full neurological examination. On cranial CT there was no signal from the tip of the right petrous temporal bone, but no space-occupying lesion nor pathological uptake of contrast material. On cranial MR there was an extra-axial lesion in the superior part of the tip of the right petrous temporal bone of 2 x 2 cm, localized to Meckel's cavum and right cavernous sinus, with a small lobule in the right lateral part of the prepontine cisterna., Conclusions: Trigeminal sensory neuropathy has been described in association with different connective tissue disorders, infections of the central nervous system, vascular dilatations and very varied types of tumours, particularly meningioma. The commonest site for lesions related to this clinical condition is the posterior fossa. A tumour in Meckel's cavum is rarely found in relation to this diagnosis, and from our review of the literature, involvement of fatty tumours seems to be rare.

Lipoblastomatosis is a locally infiltrative tumor of embryonic fat. We describe the MR appearance of cervical lipoblastomatosis with epidural extension. The initial MR study showed features of a soft-tissue mass; a subsequent MR examination, performed after chemotherapy, depicted the lesion as a typical lipoma of high signal intensity on T1-weighted images and of intermediate signal on T2-weighted sequences.

Intracranial lipoma is a rare condition, and it is usually asymptomatic. We describe a 67 year old woman who developed blurred vision, diplopia, left sided oculomotor palsy, and ipsilateral ptosis during steroid treatment for giant cell arteritis. These symptoms were considered to be associated with aggressive giant cell arteritis, and the steroid dose was raised. Surprisingly, the symptoms increased, and further examination revealed an intracranial lipoma situated in the Meckel's cave. During tapering of the steroids her symptoms gradually improved. This is the first report demonstrating that steroids may induce hypertrophy of the fat tissue in the intracranial lipoma, causing compression of the cranial nerves passing through the cavernous sinus thereby mimicking the ocular symptoms sometimes associated with aggressive giant cell arteritis.

Lipoma arborescens is a villous lipomatous proliferation of the synovial membrane characterized by chronic and painless synovial effusion. The aetiology is unknown. It has to be included in the differential diagnosis of chronic monoarticular disease in childhood. Magnetic resonance imaging provides a highly efficient tool for the diagnosis of this very rare condition. This is indeed the fourth paediatric case reported. Rather than resorting to the often inconvenient surgical synovectomy commonly recommended, we chose to treat the knee of this 13-yr-old boy with intra-articular osmic acid.

The authors report two rare cases of intracranial lipomas recognized in CT of the head. The tumours were situated in the corpus callosum in one case, and in the posterior fossa in the other case. Both cases were thought unsuitable for surgical intervention, and one of the patients was given only anticonvulsant treatment.

With the aim of exterminating small (up to 3--4 cm. in diameter), single or multiple subcutaneous fat tumors (lipoma etc.) the author suggests to use transcutaneous injections of solutions possessing necrotizing properties (10% calcium chloride, 96% alcohol, formalin) into the tumor instead of its surgical removal. The injection should be done under local anesthesia, slowly, the amount of solution not exceeding 0.5--1 of the volume of the tumor. The necrotherapy has been used for 4 years upon 14 patients (32 tumors); besides, the author made 12 self-injections. In 3 cases a repeated injection was required. There were no complications or recurrences.

Ten dogs were selected for treatment of SC lipomas (n = 18) with intratumor injection of 10% calcium chloride. At 6-month follow-up, 4 tumors had regressed completely and 14 were less than 50% of their original size. Skin necrosis overlying treated tumors developed in 3 dogs.

Self-medication of rheumatic complaints in the upper arm, by one woman, and of a lipoma on the thigh, by another, with pure laurel oil caused within two weeks severe contact dermatitis and swellings far from the point of application. Sesquiterpene lactone, contained within laurel oil, proved to be the cause of the induced contact allergy. Since the acquired specific hypersensitivity of the eczema type is directed primarily against the alpha-methylene group of the lactone, cross-reactions were observed against a large number of other plans which are botanically unrelated but contain substances of a similar class. Those allergic to laurel oil should therefore avoid many cosmetics, articles of hygiene, foods, drinks and medicinal preparations which contain herbs, as well as gardening, certain cut flowers and perfumes, especially those of the family Compositae. The present trend "back to nature" makes further sensitizations against laurel oil likely. This would seem to justify the inclusion of these substances among the group of potentially harmful environmental and occupational products.

The use of subselective renal artery embolotherapy with absolute alcohol, using balloon occlusion to prevent backflow, is described in treating three hemorrhaging angiomyolipomas in two patients with tuberous sclerosis. Embolotherapy was chosen to treat the extensive hemorrhage and to spare the normal renal parenchyma. Literature reports of this treatment are reviewed, indicating it is one of the best methods for achieving a safe, permanent, and complete ablation.

A metastatic ovarian lipid cell tumor was treated with BV-CAP chemotherapy following cytoreductive surgery and VAC chemotherapy for persistent disease found at second-look laparotomy before disease progression was noted. Serum Dihydrotestosterone (DHT) levels correlated with disease status during all phases of treatment, as did serum testosterone (T) to a lesser degree. Measurement of these two hormones may provide additional useful information on the response of patients with subclinical metastatic disease to post-operative therapy.