RESUMEN
OBJECTIVE: Preoperative differentiation between primary central nervous system lymphoma (PCNSL) and high grade astrocytoma (HGA) on conventional magnetic resonance imaging (MRI) can be difficult and even impossible. However, differentiation is important to guide therapeutic strategy. Several authors have reported the leakage pattern in dynamic susceptibility-contrast (DSC)-MRI in PCNSL. It describes the shape of the signal intensity curve which does not return to the baseline after the first pass of the bolus of contrast agent but crosses above it and sometimes even slopes up. In this retrospective study, our goal was to define the sensitivity and specificity of this sign. MATERIAL AND METHODS: Patients with first ever diagnosed PCNSL and HGA who were treatment naive and received DSC-MRI were included. In all patients, a histological specimen was available. Patients did not receive corticosteroids prior to imaging and were HIV negative. The presence of a leakage pattern was assessed by two neuroradiologists working in consensus and correlated with the histological diagnosis. RESULTS: Nine patients with PCNSL (2 women, 7 men, age 59 ± 10 years) and 14 patients with HGA (3 women, 11 men, age 58 ± 17 years) were included. Six of the patients with PCNSL exhibited a leakage pattern, while only two patients with HGA did (P = 0.0227, Fischer's exact test). Sensitivity was 0.67, and specificity was 0.86. DISCUSSION: Although the leakage pattern does not prove PCNSL, it is an important diagnostic clue and can be easily assessed.
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Astrocitoma/diagnóstico , Neoplasias del Sistema Nervioso Central/diagnóstico , Medios de Contraste , Linfoma/diagnóstico , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Astrocitoma/epidemiología , Astrocitoma/patología , Neoplasias del Sistema Nervioso Central/epidemiología , Neoplasias del Sistema Nervioso Central/patología , Diagnóstico Diferencial , Femenino , Humanos , Linfoma/epidemiología , Linfoma/patología , Imagen por Resonancia Magnética/normas , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
We present a case of a bilateral vasoproliferative tumor of the retina in a young man. The first symptom was visual impairment due to vitreous hemorrhage. The right eye showed small tumors which were successfully treated by repeated cryocoagulation, photocoagulation and bevazicumab injection. The tumor in the left eye was larger and eventually led to a painful secondary glaucoma. After enucleation, this tumor was examined histologically and immunohistochemically. The clinical and histological differential diagnoses and therapeutic options are discussed.
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Neoplasias de la Retina/patología , Neovascularización Retiniana/patología , Criocirugía , Diagnóstico Diferencial , Enucleación del Ojo , Angiografía con Fluoresceína , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/patología , Glaucoma de Ángulo Abierto/cirugía , Humanos , Coagulación con Láser , Masculino , Oftalmoscopios , Papiledema/diagnóstico , Papiledema/patología , Papiledema/cirugía , Reoperación , Retina/patología , Neoplasias de la Retina/diagnóstico , Neoplasias de la Retina/cirugía , Neovascularización Retiniana/diagnóstico , Neovascularización Retiniana/cirugía , Ultrasonografía , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/patología , Hemorragia Vítrea/cirugía , Adulto JovenRESUMEN
OBJECTIVES: It is well known that cerebral cavernous malformations (CCMs) present with variable degrees of contrast enhancement on routine magnetic resonance imaging (MRI) studies. This is attributed to the presence of a low flow vascular architecture in these lesions. The aim of this preliminary study was to determine whether an additional reason for the different degree of contrast enhancement could be the degree of internal thrombosis. MATERIAL AND METHODS: Fourteen consecutive patients with surgically removed CCMs were included. In all patients, standard preoperative MRI (1.5 Tesla, T1 weighted images without and with contrast agent, slice thickness 5 mm, 0.1 mmol gadolinium/kg body weight, and delay â¼5 minutes) and a histological specimen were available. The degree of contrast enhancement (none, little, moderate, and marked) was rated by two independent neuroradiologists blinded to the results of histopathology. The degree of internal thrombosis (none, little, moderate, and marked) was rated by a neuropathologist blinded to the results of MRI. RESULTS: Contrast enhancement was visible in six (43%) CCMs (Cohen's κ = 0.76 or substantial). The degree of contrast enhancement was not dependent on the degree of internal thrombosis (P = 0.1, Fisher's exact test) and did not correlate with it (r = 0.06, P = 0.83, Pearson's correlation coefficient). CONCLUSION: The flow characteristics of CCMs seem to be the main factor contributing to the degree of contrast enhancement while the degree of internal thrombosis does not influence their contrast affinity.
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Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/patología , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/patología , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Medios de Contraste , Femenino , Gadolinio , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVES: The suppressor gene maspin (Serpin B5) is a promising candidate for future treatment. We have examined the messenger RNA (mRNA) and protein expression of maspin in normal breast tissue, breast cancer primaries, brain metastases and breast cancer cell lines. Results were compared to hormone receptor expression and proliferation index. METHODS: Maspin mRNA expression was examined by real-time polymerase chain reaction in fresh frozen human samples and breast cancer cell lines MCF-7, T47-D and MDA-MB-231. Maspin protein, estrogen and progesterone receptor expression as well as Ki-67 proliferation index were detected by immunohistochemistry from 16 patients with breast cancer primaries and breast cancer brain metastases. RESULTS: In relation to normal breast tissue, maspin mRNA expression was decreased in primary tumors and again decreased in brain metastases. Normalized C(T) values were 1 (normal tissue), 0.3 (primary tumors) and 0.13 (brain metastases). Immunohistochemistry revealed same tendencies. In comparison to poorly invasive breast cancer cell lines, maspin mRNA expression was decreased in highly invasive and metastatic 231-parental cell lines. In contrast, maspin mRNA expression was increased in 231-brain, and it was not detectable in 231-bone. Patients with maspin-positive primary tumors showed longer survival. DISCUSSION: This finding adds maspin to the list of metastasis suppressor genes possibly involved in the formation of breast cancer brain metastases.
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Neoplasias Encefálicas/secundario , Neoplasias de la Mama/patología , Receptores de Estrógenos/biosíntesis , Serpinas/biosíntesis , Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/análisis , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/terapia , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/terapia , Línea Celular Tumoral , Terapia Combinada , Craneotomía , Femenino , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Antígeno Ki-67/biosíntesis , ARN Mensajero/análisis , Receptores de Progesterona/biosíntesis , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
With magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), we tried to get more pre-operative information in patients with suspicious meningioma concerning the histologic diagnosis especially regarding WHO Grades I and II meningiomas. Apart from the known spectra and metabolites such as choline, creatine and N-acetyl-aspartate (NAA), recent publications have shown that lactate is often found in necrotic tumor tissue. Within a 2 year period, 39 patients with an intracranial meningioma were studied with MRS. In 62.5% of histologic atypical meningiomas (WHO Grade II), a lactate peak could be demonstrated in the pre-operative MRS. Interestingly, also patients with multiple meningiomas show different spectra of their tumors.
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Espectroscopía de Resonancia Magnética/métodos , Neoplasias Meníngeas/diagnóstico , Meninges/patología , Meningioma/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/metabolismo , Diagnóstico Diferencial , Femenino , Humanos , Ácido Láctico/análisis , Ácido Láctico/metabolismo , Imagen por Resonancia Magnética/métodos , Masculino , Neoplasias Meníngeas/clasificación , Neoplasias Meníngeas/metabolismo , Meninges/metabolismo , Meninges/fisiopatología , Meningioma/clasificación , Meningioma/metabolismo , Persona de Mediana Edad , Invasividad Neoplásica/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos XRESUMEN
Cavernous hemangiomas are most commonly found within the subcortical neural parenchyma near the fissura Rolandi, in the basal ganglia, or in the brain stem. Because of advancing neuro-imaging technology and thus resulting in a higher incidence of cavernous hemangiomas they have rising impact in neurosurgery. We present two unusual cases of extra-axial cavernous hemangiomas: one located at the frontal falx, the other within the bone of the right frontal bone. We discuss these and other cases in the literature with respect to the more common differential diagnoses and the appropriate therapy regimen for cavernous hemangiomas in these locations.
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Duramadre/patología , Hueso Frontal/patología , Lóbulo Frontal/patología , Hemangioma Cavernoso del Sistema Nervioso Central/diagnóstico por imagen , Hemangioma Cavernoso del Sistema Nervioso Central/fisiopatología , Adulto , Vasos Sanguíneos/patología , Vasos Sanguíneos/fisiopatología , Fosa Craneal Media/diagnóstico por imagen , Fosa Craneal Media/patología , Fosa Craneal Media/fisiopatología , Diagnóstico Diferencial , Duramadre/irrigación sanguínea , Duramadre/diagnóstico por imagen , Hueso Frontal/irrigación sanguínea , Hueso Frontal/diagnóstico por imagen , Lóbulo Frontal/fisiopatología , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/fisiopatología , Meningioma/diagnóstico por imagen , Meningioma/fisiopatología , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos XRESUMEN
The authors report a rare case of metastatic atypical meningioma WHO grade II involving the dorso-lateral region of the cervical spine and causing spinal cord compression in a 76-year-old man. The patient was treated surgically in June 1998 for an atypical parasagittal meningioma in the right frontal lobe. Local recurrence with extension to the left hemisphere required surgical treatment in January 2000, and in December 2000 recurrence caused paraplegia of the lower extremities and paresis of the left arm. A 3 (rd) operation was carried out in January 2001, followed by radiotherapy with a total dose of 45 Gy. The patient presented again in March 2003 because of pain in the neck and a progredient new paresis and paresthesia of the right arm. Computed tomogram of the cervical spine showed a large tumor with compression of the spinal cord. MRI was not possible due to a pacemaker which had been implanted in the meantime. Surgical subtotal removal of the tumor via hemilaminectomy of the 3 (rd) and 4 (th) cervical vertebrae was performed. After decompression of the cervical spine the paresis of the right arm improved, the paraplegia of the legs and the left arm, existing since December 2000, remained unchanged. Histological findings of the cranial lesions and the metastatic lesion had a similar appearance and were compatible with atypical meningioma (WHO grade II).
Asunto(s)
Neoplasias Encefálicas/patología , Meningioma/patología , Neoplasias de la Columna Vertebral/secundario , Anciano , Terapia Combinada , Humanos , Imagen por Resonancia Magnética , Masculino , Meningioma/complicaciones , Meningioma/cirugía , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Procedimientos Neuroquirúrgicos , Paraplejía/etiología , Compresión de la Médula Espinal/etiología , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/cirugíaRESUMEN
OBJECTIVE: The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation. METHODS: From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with histologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated. RESULTS: Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0 years vs 66.5 years, P < 0.05). There was a significantly higher number of hematomas > or = 30 ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, subarachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH. Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features of CAA-related ICH included lobar distribution affecting mainly the lobar superficial areas, lobulated appearance, rupture into the subarachnoid space, and secondary IVH from the lobar hemorrhage. More specifically, multiplicity of hemorrhage, bilaterality, and repeated episodes also strongly suggest the diagnosis of CAA. Multiple hemorrhages, defined as 2 or more separate hematomas in multiple lobes, accounted for 17.1% in CAA-related ICH. CONCLUSION: There are certain features in CAA on CT and MRI and in clinical settings. To some extent, these features may contribute to distinguishing CAA from HTN related ICH.
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Angiopatía Amiloide Cerebral/diagnóstico , Angiopatía Amiloide Cerebral/epidemiología , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiología , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/epidemiología , Medición de Riesgo/métodos , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Causalidad , Angiopatía Amiloide Cerebral/clasificación , Hemorragia Cerebral/clasificación , China/epidemiología , Comorbilidad , Diagnóstico Diferencial , Femenino , Humanos , Hipertensión Intracraneal/clasificación , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
A case of myofibrosarcoma (IMT) of the brain and lung as well as the spinal cord is described. A 29-year-old male patient presented with fever (40 degrees C), malaise, vomitus, meningism and leukocytosis. Computer tomography identified a bleeding in the left frontal lobe. A bleeding angioma was suspected and an operation was performed. The histological examination could not reveal an exact diagnosis. Eight months after complete recovery from the first bleeding, the patient had a second intracranial temporo-occipital bleeding on the right side which has been removed operatively. A new lesion was seen in the left parietal white matter of the brain. A growing cavernoma was suspected and resection of the lesion was planned. Pre-operatively the patient suffered from hemoptysis and fever. The X-ray of the chest showed a pulmonary lesion in the left lower lobe. In the CT of the chest a large tumor in the left lower lobe of the lung and additionally a cystic structure in the mediastinum was seen. The histological examination of this tumor identified an inflammatory myofibroblastic tumor (IMT). The left parietal lesion has been resected after the thoracic operation. The brain lesions were estimated to be metastases of the IMT of the lung. In the further clinical history the patient developed a large spinal cord metastasis of the thoracic spine. The metastatic development of the tumor reported in this case is unusual. The current therapy of these tumors consists of complete tumor resection and further clinical controls. However, due to the localization and the extension of some lesions in the present case, the complete resection has not been possible. There is no proven role of chemotherapy and radiation therapy. The patient died due to the pulmonary deterioration.
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Neoplasias del Sistema Nervioso Central/secundario , Fibrosarcoma/secundario , Neoplasias Pulmonares/patología , Neoplasias de Tejido Muscular/secundario , Adulto , Neoplasias del Sistema Nervioso Central/fisiopatología , Neoplasias del Sistema Nervioso Central/cirugía , Diagnóstico Diferencial , Fibrosarcoma/fisiopatología , Fibrosarcoma/cirugía , Hemangioma Cavernoso del Sistema Nervioso Central/patología , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/fisiopatología , Imagen por Resonancia Magnética , Masculino , Neoplasias de Tejido Muscular/fisiopatología , Neoplasias de Tejido Muscular/cirugía , Tomografía Computarizada por Rayos XRESUMEN
We report on two patients with ossifying fibroma of the anterior skull base with intracranial extension. A psammomatoid ossifying fibroma was removed from a 29 year old female patient, and in a 37 year old female patient a cemento ossifying fibroma was removed. The main clinical symptom in both cases was headache. Surgery took place after diagnosis and therapy in an interdisciplinary operation with ENT colleagues. The ossifying fibroma is a benign neoplasm mainly affecting the maxilla and mandible. Complete removal is better than a curettage of the tumor.
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Fibroma Osificante/diagnóstico , Seno Frontal , Imagen por Resonancia Magnética , Neoplasia Residual/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de la Base del Cráneo/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Diagnóstico Diferencial , Endoscopía , Femenino , Fibroma Osificante/patología , Fibroma Osificante/cirugía , Seno Frontal/patología , Seno Frontal/cirugía , Humanos , Neoplasia Residual/patología , Neoplasia Residual/cirugía , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/cirugía , Reoperación , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Base del Cráneo/cirugíaRESUMEN
Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos) is a rare space occupying lesion of the posterior fossa with some typical neuroradiological features which can be better diagnosed in the MRI era. This is the major CNS manifestation of Cowden disease. In recent years more publications underlined the association of these hamartomatous lesions. We add another patient with a dysplastic gangliocytoma of the cerebellum who also had a thyroid adenoma and fulfilled the criteria of having Cowden disease.A problem of surgical removal of these tumors is missing the borderline between tumor and healthy cerebellum tissue so that incomplete removal of the tumor is not rare. Surgical removal of these tumors in an open MRI unit would be a good indication.
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Neoplasias Cerebelosas/diagnóstico , Neoplasias Cerebelosas/patología , Ganglioneuroma/diagnóstico , Ganglioneuroma/patología , Adulto , Neoplasias Cerebelosas/cirugía , Cerebelo/patología , Cerebelo/cirugía , Diagnóstico Diferencial , Ganglioneuroma/cirugía , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
BACKGROUND: The clinical course of glioblastoma multiforme is characterised by invasive growth and regular recurrence. Many genetic alteration have been identified in the genesis of the disease. However, information about immunohistochemical expression in recurrent lesions is sparse. OBJECTIVES: To determine (1) whether the p53/mdm2/EGFR/msh2 expression pattern differs in initial v recurrent glioblastoma multiforme; (2) whether a possible change in expression correlates with prognostic variables (progression-free survival time, total survival time); and (3) whether chemotherapy in addition to surgery and radiotherapy influences the p53/mdm2/EGFR/msh2 expression profile. METHODS: 27 patients were studied. They met the following criteria: histologically confirmed diagnosis of glioblastoma multiforme (WHO IV); total tumour resection at initial craniotomy; at least one re-craniotomy for glioblastoma multiforme recurrence; age 21 years or older. All underwent radiotherapy of at least 54 Gy, and 17 received additional chemotherapy. Immunohistochemical staining of initial tumours and recurrences was done with the following monoclonal antibodies: anti-p53 (DO-1), anti-mdm2 (IF-2), anti-EGFR (H11), and anti-msh2 (AB-1). RESULTS: In comparison with the initial tumour, recurrent lesions were characterised by reduced expression of p53 (p < 0.0001) and msh2 (p = 0.0012), while the numbers of mdm2 (p = 0.02), EGFR (p < 0.0001), and msh2 positive specimens (p < 0.0001) were reduced. Chemotherapy was associated with reduced msh2 expression (p < 0.0001). Immunohistochemical variables were not associated with patient survival. CONCLUSIONS: There are significant differences in the p53/mdm2/EGFR/msh2 expression patterns in initial v recurrent glioblastoma multiforme. There may be interactions between chemotherapy and changes in the msh2 expression.
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Neoplasias Encefálicas/genética , Proteínas de Unión al ADN , Genes erbB-1/genética , Genes p53/genética , Glioblastoma/genética , Proteínas Nucleares , Proteínas Proto-Oncogénicas/genética , Adulto , Anciano , Anticuerpos Monoclonales/inmunología , Anticuerpos Antineoplásicos/inmunología , Neoplasias Encefálicas/inmunología , Neoplasias Encefálicas/patología , Femenino , Genes erbB-1/inmunología , Genes p53/inmunología , Glioblastoma/inmunología , Glioblastoma/patología , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Proteína 2 Homóloga a MutS , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Proteínas Proto-Oncogénicas/inmunología , Proteínas Proto-Oncogénicas c-mdm2RESUMEN
OBJECTIVE: Glioblastoma multiforme (GBM) is a major cause of morbidity and mortality in neurosurgical patients. Despite the overall poor prognosis a range in survival times exists. Many approaches have been undertaken to define patient subgroups based on molecular changes. The aim of this study was to assess a possible correlation between the immunohistochemical p53, Mdm2, EGFR and Msh2 expression and age. METHOD: 143 patients (77 male, 66 female) were included in this retrospective study who underwent craniotomy for newly-diagnosed GBM between May 1994 and February 2000. For statistical analysis, patients were separated into three age groups: 1. < 40 years, 2. 40-60 years, 3. > 60 years. Immunohistochemical staining (IHC) was performed using anti-p53 (clone DO-1), anti-Mdm2 (clone IF-2), anti-EGFR (clone H11) and anti-Msh2 antibodies (clone AB-1). The results were compared with the Ki67/MIB-1 proliferation index (Ki67 PI) and patient survival. FINDINGS: P53 protein expression was significantly decreasing with advanced age (p < 0.05) whereas EGFR and Mdm2 expression was increasing (p < 0.05; p=0.01). Msh2 expression was unrelated to age. Multivariate analysis revealed Msh2 protein expression as a significant predictor of prolonged survival (p=0.004) whereas p53, Mdm2 and EGFR were not associated with patient survival. P53, Mdm2, EGFR and Msh2 expression was not associated with the Ki67 PI. INTERPRETATION: Our results support the hypothesis that in GBM patients a complex relationship exists between the p53, Mdm2 and EGFR expression and age. Msh2 expression is not related to age. Notably, nuclear Msh2 expression turned out to be an independent prognostic indicator.
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Proteínas de Unión al ADN , Genes erbB-1/genética , Genes p53/genética , Glioblastoma/metabolismo , Proteínas Nucleares , Proteínas Proto-Oncogénicas/biosíntesis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento/metabolismo , Disparidad de Par Base , División Celular , Niño , Preescolar , Craneotomía , Reparación del ADN , Femenino , Glioblastoma/cirugía , Humanos , Inmunohistoquímica , Lactante , Antígeno Ki-67 , Masculino , Persona de Mediana Edad , Proteína 2 Homóloga a MutS , Pronóstico , Proteínas Proto-Oncogénicas/genética , Proteínas Proto-Oncogénicas c-mdm2 , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
Between 1955 and 1963, millions of children and adults were exposed to SV40-contaminated poliovirus vaccines. The oncogenic potential of this polyomavirus was revealed when intracerebral inoculation of SV40 into newborn hamsters resulted in the development of ependymomas and choroid plexus papillomas. Subsequently, SV40-like sequences were repeatedly detected in human ependymomas with broadly ranging incidence rates of 7-90%. Most epidemiological studies, however, have not described an increased occurrence of ependymomas. To gain more data on this controversial issue, this study examined 62 archived ependymal tumours from 31 children and 31 adults who underwent surgery between 1990 and 1999. Only three (5%) of the tumours--including 24 classical, 20 anaplastic, and 12 myxopapillary ependymomas; one subependymoma; and five ependymoblastomas--revealed subgenomic SV40 sequences. None of the ependymomas in patients born between 1920 and 1960 demonstrated SV40-like sequences. The positive tumours represent 7% of grade II and III ependymomas (two paediatric and one adult tumour). DNA sequencing of the PCR product revealed identical sequences of SV40 in the positive ependymal tumours. Compared with the results from other countries, this incidence rate is relatively low. Therefore, it seems likely that significant differences between individual countries exist regarding the prevalence of SV40-positive ependymomas. These differences may reflect different degrees of exposure to SV40-contaminated polio vaccine.
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Ependimoma/virología , Virus 40 de los Simios/aislamiento & purificación , Adolescente , Adulto , Anciano , Niño , Preescolar , ADN Viral/análisis , Contaminación de Medicamentos , Ependimoma/epidemiología , Alemania/epidemiología , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Vacunas contra Poliovirus , Reacción en Cadena de la Polimerasa/métodosRESUMEN
INTRODUCTION: It is commonly felt that cerebral amyloid angiopathy (CAA) related intracerebral hemorrhage (ICH) can be distinguished from hypertension (HTN)-related ICH by certain typical features on computerized tomography (CT) and magnetic resonance imaging (MRI). The purpose of this study was to investigate the performance of clinicians who were asked to differentiate between CAA and HTN based on hemorrhage pattern interpretation and to assess the feasibility of such classification. METHODS: The admission scans from 83 patients who were admitted to our service with an acute ICH were presented to 5 clinicians in a randomized and blinded fashion (1 junior, and 1 senior neurosurgical resident, 1 attending neurosurgeon, and 2 neurosurgeon-neuroradiologists). There were no patients who received oral anticoagulants other than low-dose aspirin, or who suffered from vascular malformations or tumors. Scans from 41 patients with a histologically proven diagnosis of CAA and from 42 patients with a clear history of HTN were investigated. Hematoma evacuation was done in all CAA patients and in 59% of HTN patients (n = 25). RESULTS: The overall average classification accuracy was 66.8% (range: 62.7-69.9). For correct HTN classification it was 69.5% (range: 64.3-81), and 63.9% for CAA, respectively (range: 48.9-75.6). There were negligible differences in classification accuracy among all observers. Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74 vs. 66.5 years, p < 0.05). There was a significantly higher number of hematomas >30 ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglionic hemorrhage was seen in CAA, but in 40.5% in HTN. Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Two patients (4.9%) with CAA, and 7 patients with HTN (16.7%) presented with cerebellar hematomas. CONCLUSIONS: Three of 10 scans were not correctly diagnosed regardless of the examiner's level of training. This calls into question the reliability of classifying the underlying pathological condition based on hemorrhage pattern interpretation on CT or MRI. The definite diagnosis of CAA- versus HTN-related hemorrhage requires a histopathological confirmation and should not be based solely on hemorrhage pattern interpretation.
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Angiopatía Amiloide Cerebral/diagnóstico , Angiopatía Amiloide Cerebral/fisiopatología , Hemorragia Intracraneal Hipertensiva/diagnóstico , Hemorragia Intracraneal Hipertensiva/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Encéfalo/fisiopatología , Diagnóstico Diferencial , Método Doble Ciego , Femenino , Hematoma/diagnóstico por imagen , Hematoma/patología , Humanos , Interpretación de Imagen Asistida por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Though Malignant peripheral nerve sheath tumours (MPNST) are a rare entity accounting for 5-10% of soft-tissue sarcomas they are an important differential diagnosis to benign tumours of the peripheral nervous system regarding treatment and prognosis. METHOD: We present our experience with eight patients who underwent surgery for MPNST at the Department of Neurosurgery between 10/1990 and 9/1999. The median age was 37 years [range: 13-64], the male/female ratio was 1:1. Two patients suffered from Neurofibromatosis type 1. Paraffin embedded tumour specimens were immunohistochemically stained for S-100, p53 and Ki67/MIB-1. FINDINGS: The most frequent initial symptoms were local swelling and pain followed by irritation of cranial nerves and spinal ataxia. Four tumours were localised at the head & neck region, three were found in the extremities and one tumour was located on the trunk. All patients underwent surgery with curative intent, but total resection, defined by negative surgical margins, was achieved in only 3 cases. All of these developed local recurrence with a mean disease free survival time of 10.6 months. In five cases, adjuvant radiation was given. During follow up, three patients developed distant metastases located in the lung, liver and subcutaneous tissue. Five out of eight patients died during follow-up with a mean survival time of 11.6 months after diagnosis. Results of immunohistochemical staining were as followed: S-100 (7/8), p53 (7/8). The Ki67/MIB-1 proliferation index was detectable in all tumour samples, it differed from 10-30%. INTERPRETATION: MPNST is a rare and fatal diagnosis in neurosurgery with high risk of local recurrence and occurence of distant metastases. Though mulitimodal therapy including surgical resection and adjuvant radiotherapy including brachytherapy is available, the prognosis remains dismal. Modern clinical studies and the development of effective chemotherapy is needed in order to gain control of the disease.
Asunto(s)
Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/cirugía , Recurrencia Local de Neoplasia/mortalidad , Neoplasias de la Vaina del Nervio/mortalidad , Neoplasias de la Vaina del Nervio/cirugía , Neoplasias de la Médula Espinal/mortalidad , Neoplasias de la Médula Espinal/cirugía , Neoplasias Torácicas/mortalidad , Neoplasias Torácicas/cirugía , Adolescente , Adulto , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Vaina del Nervio/diagnóstico , Neoplasias de la Médula Espinal/diagnóstico , Tasa de Supervivencia , Neoplasias Torácicas/diagnósticoRESUMEN
Brain oedema is usually associated with intracranial meningiomas in about 50-66%. As underlying causes, different factors like localisation, vascular supply, angiogenic growth factors and histological subtypes are discussed, and its existence is probably multifactorial. We present 11 patients with the rare subtype of secretory meningiomas. Brain oedema was observed in 82%. These tumours are localised mainly at the frontal convexity and at the sphenoid ridge. All 11 patients were female so that hormonal factors also may play a role in the production of peritumoural oedema. The postoperative outcome was good and no recurrences were seen during follow-up.
Asunto(s)
Edema Encefálico/etiología , Neoplasias Meníngeas/complicaciones , Meningioma/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Antígeno Carcinoembrionario/análisis , Femenino , Glucógeno/análisis , Humanos , Neoplasias Meníngeas/química , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/metabolismo , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/ultraestructura , Meningioma/química , Meningioma/diagnóstico por imagen , Meningioma/metabolismo , Meningioma/cirugía , Meningioma/ultraestructura , Persona de Mediana Edad , Mucina-1/análisis , Proteínas de Neoplasias/análisis , Reacción del Ácido Peryódico de Schiff , Radiografía , Receptores de Progesterona/análisis , Estudios RetrospectivosRESUMEN
Granular-cell tumour is a rare suprasellar space occupying lesion, which usually presents with visual deterioration, endocrine deficits or headache. We present two women with extraordinarily large tumours, measuring 3.8 and 4.0 cm in diameter. In both cases the tough, vascular tumour could be removed only subtotally.
Asunto(s)
Tumor de Células Granulares/diagnóstico , Neurohipófisis , Neoplasias Hipofisarias/diagnóstico , Anciano , Femenino , Tumor de Células Granulares/diagnóstico por imagen , Tumor de Células Granulares/patología , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Hipofisarias/patología , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Secretory meningiomas are a rare histological subtype of these benign intracranial tumors. Few reports have been published regarding their tendency to develop peritumoral edema. METHODS: Between July 1994 and February 1999, 11 patients with secretory meningiomas underwent operations in the Department of Neurosurgery, University of Kiel, Kiel, Germany. The clinical notes and radiological data (computed tomographic and magnetic resonance imaging scans) were reviewed. Immunohistochemistry was used to examine the expression of carcinoembryonic antigen and epithelial membrane antigen as well as progesterone and estrogen receptors. RESULTS: Secretory meningiomas were found in 11 (5%) of 214 patients with intracranial meningiomas who were operated on in that period. All 11 patients were women. These patients' mean age was 65 years (range, 51-87 yr). The localization of these tumors was at the convexity in seven patients, at the sphenoid ridge in two patients, and in the olfactory groove and petroclival region in one patient each. Two meningiomas had no edema surrounding them, two meningiomas had a small amount of edema, two had moderate edema, and five had severe edema. No recurrences were observed during the mean follow-up period of 26 months (range, 8-65 mo). Immunohistochemically, all tumors contained pseudopsammoma bodies and reacted with epithelial membrane antigen and carcinoembryonic antigen. The MIB-1 antibody staining index showed a mean of 2% (range, 0-7%). CONCLUSION: Secretory meningiomas are rare tumors, and they are mainly localized at the frontal convexity and the sphenoid ridge. They are surrounded by more edema than usual. The preponderance of female patients with this presentation is striking. The expression of carcinoembryonic antigen and epithelial membrane antigen is a characteristic feature of secretory meningiomas. These meningiomas are also positive for progesterone receptors, which has been shown to be a good prognostic factor.