The higher rate of GSD related surgery in

The higher rate of GSD-related surgery in the diabetic group compared with the control group may indicate a different presentation of pain symptoms between the two groups, which might be explained by diabetic neuropathy. Diabetic rats exhibited sluggish sensory nerve conduction and a high pain threshold. Evidence has indicated that hyperglycemia may result in changes to the gastric motor and sensory functions, suggesting that any impaired sensory functioning might be related to the dysfunctional control of blood glucose in diabetic patients. Therefore, diabetic patients are likely to be less sensitive to their pain symptoms, and this seems to delay GSD diagnosis until acute and severe cholecystitis develops. This eventually leads to a higher incidence of cholecystectomy in diabetic patients than in nondiabetic controls.
Conclusion
Introduction Meningiomas are common in nonglial intracranial Quercetin dihydrate tumors and account for 13–26% of primary intracranial tumors, whereas cystic meningiomas are rare and account for only 1.6–10% of all meningiomas. Appropriate diagnosis of brain tumor is crucial not only for formulating an appropriate treatment plan, but also in prognosis and chemoradiotherapy. Differential diagnosis varies with astrocytoma, metastatic tumor, ganglioglioma, pleomorphic xanthoastrocytoma, and neuroblastoma. We report a case of a patient with left frontal cystic meningioma, and a mural nodule mimicking hemangioblastoma and lacking the typical characters of meningioma.
Case Report A 37-year-old female, a hepatitis B carrier with no other systemic disease, visited the emergency department because of involuntary right-side limb movement, without loss of consciousness. The patient did not report other episodes of discomfort, such as headache, giddiness, nausea, or vomiting. The patient was suspected to have intracranial lesion; thus, brain computed tomography (CT) was conducted. The CT revealed a large (4.6 cm × 3.0 cm × 4.0 cm) left frontal mass lesion with a cystic component and perifocal edema. Brain magnetic resonance imaging (MRI) through gadolinium enhancement revealed cerebrospinal fluid enrichment within the septated cyst, a centrally located enhancing mural nodule measuring 1.27 cm × 0.73 cm, and perifocal edema (Figure 1). Suspecting supratentorial hemangioblastoma, the tumor was approached through the supine position. A cystic tumor with xanthochromic content was observed after a left frontal craniotomy and dura take-up suture (Figure 2). The grayish tumor was centrally located, away from the cystic component. A cytological study of the fluid within the cyst was conducted. Owing to the suspicion of hemangioblastoma and the lack of cystic wall thickening, gross removal of the tumor without the cystic component was performed with microscopic assistance. A cytology report showed no malignant cells, and a permanent pathology report showed a skull-invading meningothelial meningioma, World Health Organization Grade II (Figure 3A and B). The patient recovered uneventfully postoperation without subsequent neurological sequelae, and a subsequent follow-up was performed.
Discussion Meningiomas are the most common intracranial nonglial brain neoplasms. Cystic meningiomas are rare and lack an appropriate diagnostic method. According to the relationship between tumors, two classification systems, provided by Nauta et al and Rengachary et al, are applied for cystic meningioma. Based on the classification provided by Rengachary et al, cystic meningiomas can be classified as intratumoral and peritumoral cystic meningiomas. Nauta et al classified cystic meningiomas into four categories according to the relationship between the cystic cavity and the tumoral mass, as follows: Type I, centrally located intratumoral cyst; Type II, peripherally located intratumoral cyst; Type III, peritumoral cyst in the adjacent parenchyma; and Type IV, peritumoral cyst between the tumor and the adjacent parenchyma. The patient had Type III cystic meningioma, according to the classification provided by Nauta et al, and peritumoral cystic meningioma, according to the classification provided by Rengachary et al.