RESUMO
Meningioma (MGM) is the most common type of intracranial tumor in adults. The validation of novel prognostic biomarkers to better inform tumor stratification and clinical prognosis is urgently needed. Many molecular and cellular alterations have been described in MGM tumors over the past few years, providing a rational basis for the identification of biomarkers and therapeutic targets. The role of receptor tyrosine kinases (RTKs) as oncogenes, including those of the ErbB family of receptors, has been well established in several cancer types. Here, we review histological, molecular, and clinical evidence suggesting that RTKs, including the epidermal growth factor receptor (EGFR, ErbB1), as well as other members of the ErbB family, may be useful as biomarkers and therapeutic targets in MGM.
Assuntos
Meningioma/metabolismo , Receptores Proteína Tirosina Quinases/metabolismo , Biomarcadores Tumorais , Receptores ErbB/genética , Receptores ErbB/metabolismo , Humanos , Meningioma/fisiopatologia , Proteínas Oncogênicas v-erbB/genética , Proteínas Oncogênicas v-erbB/metabolismo , Fosforilação , Prognóstico , Receptores Proteína Tirosina Quinases/fisiologia , Receptor ErbB-2/metabolismo , Transdução de Sinais , Tirosina/metabolismoRESUMO
BACKGROUND: Stabbing headache (SH) is considered as a pure primary headache, but according to a few clinical observations it could also be secondary. Over the past decades, we have been observing the complaint of SH in patients with intracranial vascular and neoplastic lesions. OBJECTIVE: To describe a series of patients with intracranial lesions who experienced SH. METHODS: This is a cross-sectional, retrospective study of 34 patients with intracranial lesions associated with SH, admitted at Hospital das Clínicas, Federal University of Pernambuco, Brazil. RESULTS: In this series of 34 patients [29 women, 44 ± 12 years (mean ± SD)] with secondary SH, the causes were intracranial neoplasms (n = 31), cerebral aneurysms (n = 2), or arteriovenous malformation (n = 1). Pituitary tumor (n = 18), meningioma (n = 6), and vestibular schwannomas (n = 4) were the most prevalent types of intracranial neoplasms. All these lesions had intimate contact with the dura mater, including an oligodendroglioma, the only intra-axial tumor in the series. A characteristic in the secondary SH is the crescendo pattern (12/34, 35%), progressing from infrequent attacks to recurrent crises occurring several times a day. The SH lasted from 5 days to 60 months (15 ± 18 months, mean ± SD) until the correct diagnosis [16/34 (47%) of the patients ≤6 months]. The SH was triggered by the movement of the head (5/34, 15%) or Valsalva maneuver (1/34). After surgery, suppression of the SH was observed. In a few of the patients to whom dexamethasone was prescribed, the SH subsided within a few days. CONCLUSION: This study was able to identify clinical red flags associated with intracranial lesions and secondary SH, for example, recent onset of SH, exclusively unilateral (ipsilateral) at the same location, crescendo pattern, triggered by head movements, or Valsalva maneuver.
Assuntos
Fístula Arteriovenosa/complicações , Neoplasias Encefálicas/complicações , Transtornos da Cefaleia Secundários/etiologia , Transtornos da Cefaleia Secundários/fisiopatologia , Aneurisma Intracraniano/complicações , Malformações Arteriovenosas Intracranianas/complicações , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/patologia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Estudos Transversais , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Introducción: Los tumores cerebrales a veces tienen una presentación clínica compleja y atípica en sus inicios, en dependencia de su localización, lo que puede confundirse con trastornos de la esfera psiquiátrica. Objetivo: Describir un caso clínico interpretado como una psicosis por su sintomatología cuyo diagnóstico resultó un glioblastoma multiforme de alta malignidad. Caso clínico: Mujer de 35 años que comienza desde hace varios meses con trastornos de la conducta, síntomas depresivos, irritabilidad y conflictos en el hogar. Se instala un cuadro de depresión profunda que no mejora con tratamiento farmacológico impuesto por psiquiatría y se decide tratamiento electroconvulsivo, después del cual cae en estado de coma con elementos de hipertensión intracraneal y focalización neurológica. La tomografía de urgencia evidencia un tumor intracraneal, con áreas de necrosis, infiltración y desplazamiento de estructuras adyacentes y signos de hipertensión intracraneal. Al realizar intervención microquirúrgica fallece. La necropsia reveló glioblastoma multiforme de alta malignidad con focos de necrosis y de hemorragias. Conclusiones: La depresión y manifestaciones de trastornos mentales pueden tener causa orgánica, un hecho que debe considerarse en el contexto clínico. La historia clínica bien obtenida, la evaluación psicopatológica y las técnicas de imágenes en la actualidad son herramientas fundamentales en la precisión diagnóstica(AU)
Introduction: Brain tumors sometimes have a complex and atypical clinical presentation at the beginning, depending on their location, which can be mistaken for psychiatric disorders. Objective: To describe a clinical case interpreted as a psychosis for its symptoms and whose diagnosis was a highly malignant glioblastoma multiforme. Clinical case: This is the case of a 35-year-old woman who, several months ago, started to present behavioral disorders, depressive symptoms, irritability, and conflicts at home. Clinical signs of deep depression onset, which does not improve with pharmacological treatment prescribed by the psychiatry specialist; electroconvulsive treatment is decided, after which she falls into a coma with elements of intracranial hypertension and a neurological focus. The emergency tomography shows an intracranial tumor, with necrotic areas, infiltration, and displacement of adjacent structures, as well as signs of intracranial hypertension. When microsurgical intervention is performed, she died. The necropsy revealed highly malignant glioblastoma multiforme with necrosis focuses and hemorrhage. Conclusions: Depression and manifestations of mental disorders may have an organic cause, a fact that must be considered in the clinical setting. A well-obtained clinical history, psychopathological evaluation, and imaging techniques are currently essential tools for an accurate diagnosis(AU)
Assuntos
Humanos , Feminino , Transtorno Bipolar/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Glioblastoma/diagnóstico por imagem , Hipertensão Intracraniana/diagnósticoRESUMO
Introduction Meningiomas are the most common primary intracranial tumors, accounting for up to 35% of the neoplasms in this category. Approximately 1020% of these neoplasms are histologically atypical, and the lymphoplasmacyte-rich meningioma (LPM) corresponds to a very rare subtype of meningioma that is characterized histopathologically by massive infiltrates of inflammatory cells. The case described in the present study is the sixth case of an intraventricular LPM found in the literature and the first case considering the location in the third ventricle. Case Description A 21-year-old male without previous comorbidities sought medical attention due to visual impairment (complaining of intermittent visual blur) for 2 months. A magnetic resonance imaging of the brain confirmed the presence of a well-delimited solid mass in the third ventricle of 3.0 2.3 cmwith a cystic component that extended itself inferiorly and distorted the visual pathway anatomy. Neurosurgeons decided to access the lesion using an interhemispheric transcallosal approach with a transforaminal access, and the lesion was resected completely. The patient has an ambulatorial endocrinological follow-up and is neurologically stable 6 months after the procedure. No new visual deficits were noted. Conclusion Lymphoplasmacyte-rich meningioma is a very rare intracranial tumor, and the involvement of the third ventricle make this case unique.
Assuntos
Humanos , Masculino , Adulto , Terceiro Ventrículo/cirurgia , Terceiro Ventrículo/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/patologia , Meningioma/diagnóstico por imagemRESUMO
Background: Anaplastic ependymoma is a rare primary intracranial neoplasm in dogs and cats, which originates fromependymal cells that line the ventricular system of the brain and spinal cord. Normally, this neoplasm occurs as a single,expansive mass that develops mainly in the lateral ventricles, and neurological changes are due to local tissue impairmentand peritumoral tissue compression. This article reports a case of anaplastic ependymoma in a dog treated at the VeterinaryHospital of the Federal University of Mato Grosso do Sul (UFMS), emphasizing and describing the neurological signsand histopathology of this tumor.Case: This article reports the case of a 11-year-old mongrel dog with a history of butting its head against obstacles, ofcompulsive walking, and altered proprioception of the right side limbs. The condition evolved to positional strabismus ofthe left eye, left lateral deviation of the head, vertical nystagmus, decreased level of consciousness, and constant lateraldecubitus. Due to the suspicion of intracranial neoplasia and worsening of its clinical condition, the animal was euthanized. Necropsy of its body revealed a mass of approximately 3 cm in diameter in the third ventricle (in the left lateralregion). A histological examination revealed random clusters of ependymal cells with a few rosettes and pseudorosettes.The cells were cuboid to cylindrical in shape, with moderate eosinophilic cytoplasm with indistinct borders, and round tooval moderately hyperchromatic nuclei with 1-2 visible nucleoli. Based on these findings, the tumor was characterized asanaplastic ependymoma.Discussion: Intracranial tumors occur more frequently in older animals, and usually neurological signs tend to evolve progressively. Most affected dogs are mongrels, like the dog described in this report, but Golden Retrievers, Boxers, LabradorRetrievers...(AU)
Assuntos
Animais , Cães , Ependimoma/veterinária , Neoplasias Encefálicas/veterinária , Comportamento Compulsivo/diagnóstico , Ventrículos Cerebrais/patologiaRESUMO
Background: Anaplastic ependymoma is a rare primary intracranial neoplasm in dogs and cats, which originates fromependymal cells that line the ventricular system of the brain and spinal cord. Normally, this neoplasm occurs as a single,expansive mass that develops mainly in the lateral ventricles, and neurological changes are due to local tissue impairmentand peritumoral tissue compression. This article reports a case of anaplastic ependymoma in a dog treated at the VeterinaryHospital of the Federal University of Mato Grosso do Sul (UFMS), emphasizing and describing the neurological signsand histopathology of this tumor.Case: This article reports the case of a 11-year-old mongrel dog with a history of butting its head against obstacles, ofcompulsive walking, and altered proprioception of the right side limbs. The condition evolved to positional strabismus ofthe left eye, left lateral deviation of the head, vertical nystagmus, decreased level of consciousness, and constant lateraldecubitus. Due to the suspicion of intracranial neoplasia and worsening of its clinical condition, the animal was euthanized. Necropsy of its body revealed a mass of approximately 3 cm in diameter in the third ventricle (in the left lateralregion). A histological examination revealed random clusters of ependymal cells with a few rosettes and pseudorosettes.The cells were cuboid to cylindrical in shape, with moderate eosinophilic cytoplasm with indistinct borders, and round tooval moderately hyperchromatic nuclei with 1-2 visible nucleoli. Based on these findings, the tumor was characterized asanaplastic ependymoma.Discussion: Intracranial tumors occur more frequently in older animals, and usually neurological signs tend to evolve progressively. Most affected dogs are mongrels, like the dog described in this report, but Golden Retrievers, Boxers, LabradorRetrievers...
Assuntos
Animais , Cães , Comportamento Compulsivo/diagnóstico , Ependimoma/veterinária , Neoplasias Encefálicas/veterinária , Ventrículos Cerebrais/patologiaRESUMO
Trilateral retinoblastoma (TRb) presents a management challenge, since intracranial tumours are seldom times resectable and quickly disseminate. However, there are no risk factors to predict the final outcome in each patient. OBJECTIVE: To evaluate minimal disseminated disease (MDD) in the bone marrow (BM) and the cerebrospinal fluid (CSF) at diagnosis and during follow-up and reviewing its potential impact in the outcome of patients with TRb. METHODS AND ANALYSIS: We evaluated MDD in five patients with TRb, detecting the mRNA of CRX and/or GD2, in samples from BM and CSF, obtained at diagnosis, follow-up and relapse. RESULTS: Treatment involved intensive systemic chemotherapy in four patients, one did not receive this treatment and died of progression of the disease. Two patients underwent stem cell rescue. Three patients had leptomeningeal relapse and died. One patient remains disease-free for 84 months. RB1 mutations were identified in the five patients, all of them were null mutations. At diagnosis, one patient had tumour cells in the CSF, and none had the BM involved. Only one case of four presented MDD during follow-up in the CSF, without concomitant detection in the BM. On leptomeningeal relapse, no case had MDD in the BM. In all these cases, cells in the CSF were positive for GD2 and/or CRX. CONCLUSION: CSF dissemination always concluded in the death of the patient, without concomitant systemic dissemination denoting the importance of increasing treatment directed to the CSF compartment. The MDD presence could indicate a forthcoming relapse.
Assuntos
Neoplasias Encefálicas/diagnóstico , Glândula Pineal/patologia , Pinealoma/diagnóstico , Neoplasias da Retina/diagnóstico , Retinoblastoma/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Células da Medula Óssea/patologia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/genética , Proteínas do Líquido Cefalorraquidiano/genética , Pré-Escolar , Feminino , Transplante de Células-Tronco Hematopoéticas , Proteínas de Homeodomínio/genética , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , N-Acetilgalactosaminiltransferases/genética , Recidiva Local de Neoplasia , Glândula Pineal/efeitos dos fármacos , Pinealoma/tratamento farmacológico , Pinealoma/genética , RNA Mensageiro/genética , Neoplasias da Retina/tratamento farmacológico , Neoplasias da Retina/genética , Retinoblastoma/tratamento farmacológico , Retinoblastoma/genética , Proteínas de Ligação a Retinoblastoma/genética , Estudos Retrospectivos , Fatores de Risco , Transativadores/genética , Transplante Autólogo , Ubiquitina-Proteína Ligases/genéticaRESUMO
PURPOSE: To present the clinical characteristics of a group of patients with the diagnosis of chiasmal syndrome who attended a large ophthalmological institute. METHODS: Retrospective, observational clinical study with the review of medical records of patients with a diagnosis of chiasmal syndrome. The following variables were assessed: demographic characteristics, chief complaint upon presentation, best-corrected visual acuity (BCVA), presence or absence of diplopia, pupillary responses, optic nerve head morphology, etiology, and results from the ancillary tests including Ishihara test, Goldmann visual field (GVF) perimetry and neuroimaging. RESULTS: A total of 104 met the inclusion criteria, with a median age of 52 years (range 4-86 years). Fifty-four patients (51.9%) were referred to our institution with a diagnosis of a causative etiology for chiasmal syndrome, while in 50 (48.1%) the diagnosis was performed at our center. The most common presenting symptom was low visual acuity in 57 patients (54.8%), and the most common GVF defect was bitemporal hemianopsia in 39 patients (78 eyes, 39.8%). Pupillary abnormalities were present in 58 patients (55.7%), the optic nerve revealed pallor at any degree in 67 patients (64.4%) and the Ishihara test was affected in 65 patients (62.5%). The most common diagnosis was pituitary macroadenoma. CONCLUSION: The ophthalmologist participates in the diagnosis and rehabilitation of patients with chiasmal syndrome. Low visual acuity is the most common symptom at presentation, and bitemporal hemianopia the most frequent GVF defect. Examination of the optic nerve head and pupillary responses, and ancillary tests including Ishihara test and neuroimaging are relevant for diagnosis.
RESUMO
Background: Meningioma is a tumor that is usually attached to the dura mater. It typically arises from the meningothelial cell of the arachnoid or pia mater. Considered an extra-axial tumor of the central nervous system which can occur on any region of the meninges. The biological behavior tends to be benign and usually is not infiltrative allowing surgical indication, conferring to the patient a better prognosis. Geriatric patients are the most affected and there is no breed predisposition. This paper describes the clinical signs, pathological findings, and immunohistochemical features of a case of transitional meningioma in a cat. Case: A 14-year-old, neutered male mongrel cat was referred to the Veterinary Clinic Hospital. The history was that the cat had anorexia and disorientation. On the day of admission, lethargy and blindness were observed. Full complete blood counts showed leukopenia and lymphopenia. The serum biochemistry tests were unspecific. Thoracic and skull radiographs and ultrasound examination revealed no abnormalities. The cat was hospitalized and the main treatment was based on antibiotics and corticosteroids. The cat tested negative for FIV and FeLV. Toxoplasma gondii serum antibodies were not detected using indirect fluorescent antibody test performed with a commercial kit. The clinical signs progressed to walking in circles, stumbling, wandering [...]
Assuntos
Animais , Gatos , Carcinoma de Células de Transição/veterinária , Meningioma/veterinária , Neoplasias Encefálicas/veterinária , Imuno-Histoquímica/veterináriaRESUMO
Background: Meningioma is a tumor that is usually attached to the dura mater. It typically arises from the meningothelial cell of the arachnoid or pia mater. Considered an extra-axial tumor of the central nervous system which can occur on any region of the meninges. The biological behavior tends to be benign and usually is not infiltrative allowing surgical indication, conferring to the patient a better prognosis. Geriatric patients are the most affected and there is no breed predisposition. This paper describes the clinical signs, pathological findings, and immunohistochemical features of a case of transitional meningioma in a cat. Case: A 14-year-old, neutered male mongrel cat was referred to the Veterinary Clinic Hospital. The history was that the cat had anorexia and disorientation. On the day of admission, lethargy and blindness were observed. Full complete blood counts showed leukopenia and lymphopenia. The serum biochemistry tests were unspecific. Thoracic and skull radiographs and ultrasound examination revealed no abnormalities. The cat was hospitalized and the main treatment was based on antibiotics and corticosteroids. The cat tested negative for FIV and FeLV. Toxoplasma gondii serum antibodies were not detected using indirect fluorescent antibody test performed with a commercial kit. The clinical signs progressed to walking in circles, stumbling, wandering [...](AU)
Assuntos
Animais , Gatos , Meningioma/veterinária , Carcinoma de Células de Transição/veterinária , Neoplasias Encefálicas/veterinária , Imuno-Histoquímica/veterináriaRESUMO
OBJETIVO: determinar la coincidencia de los resultados de la tomografía computadorizada monocorte en el diagnóstico anatomopatológico posquirúrigico de los tumores intracraneales primarios. MÉTODOS: se realizó un estudio descriptivo en 85 pacientes a quienes se les realizó diagnóstico tomográfico de tumor intracraneal primario y anatomopatológico posquirúrgico. RESULTADOS: el diagnóstico tomográfico coincidió con el anatomopatológico en un 87 por ciento de los casos. La tomografía computadorizada monocorte permitió en un elevado porcentaje el diagnóstico de los tumores intracraneales primarios. CONCLUSIONES: existe una elevada coincidencia en los resultados de la tomografía computadorizada monocorte con el examen anatomopatológico posquirúrgico en el diagnóstico de los tumores intracraneales primarios.
OBJECTIVE: to determine the coincidence of the monoscan computed tomography with the postsurgical anatomopathological examination in the diagnosis of primary intracranial tumors. METHODS: a descriptive study was conducted in 85 patients underwent tomography diagnosis of a primary intracranial tumor and also a postsurgical anatomopathological diagnosis. RESULTS: the tomography diagnosis coincided with the anatomopathological one in a 87 percent of cases. The monoscan computed tomography allowed in a high percentage to diagnose the primary intracranial tumors. CONCLUSIONS: there is a high coincidence of the results of monoscan computed tomography with the postsurgical anatomopathological examination as regards the diagnosis of primary intracranial tumors.