Cytology of desmoplastic medulloblastoma in imprint
smears: a report of 2 cases.
Riazmontazer
N, Daneshbod
Y.
Depament of Pathology, Shiraz Medical School, Shiraz University of Medical
Sciences, Shiraz, Iran.
BACKGROUND: Desmoplastic medulloblastoma is a rare subtype of
medulloblastoma with astroglial differentiation. The cytomorphologic
features in intraoperative imprint smears from 2 cases of desmoplastic
medulloblastoma are described. CASE REPORTS: A 22-year-old man and
27-year-old woman with a cerebellar tumor underwent craniotomy and tumor
resection. The imprint cytologic smears contained cellular zones and nodular
hypocellular areas containing astroglial and oligodendrogliallike elements.
The cytology was misinterpreted as glial tumors, while the final histologic
diagnosis in both cases were desmoplastic medulloblastoma. CONCLUSION:
Desmoplastic medulloblastoma shows distinctive cytology in intraoperative
smears. However, the occurrence of this rare type in adults and the presence
of astroglial elements in imprint smears may cause a cytologic
misinterpretation as gliomas.
PMID: 16514849 [PubMed - in process]
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Gliosarcoma with liposarcomatous differentiation: the new
member of the lipid-containing brain tumors family.
Vlodavsky
E, Konstantinesku
M, Soustiel
JF.
Department of Pathology, Rambam Medical Center, Faculty of Medicine,
Technion-Israel Institute of Technology, Haifa, Israel. e_vlodavsky@rambam.health.gov.il
Gliosarcoma is a rare malignant, biphasic brain tumor composed of
glioblastoma multiforme and sarcomatous components. Various types of
sarcomatous differentiation are described in this tumor: fibrosarcomatous,
malignant fibrous histiocytoma-like, chondrosarcomatous and osteosarcomatous
types. We report an extremely unusual variant of liposarcomatous
differentiation in gliosarcoma in 72-year-old woman. Fat cells were
presented by atypical multivacuolar and monovacuolar lipoblasts, stained
positive for S100. p53 that was positive in both glial and mesenchymal cells
of the tumor were negative in the lipoblasts. To the best of our knowledge,
this is the first report in the literature of liposarcomatous
differentiation in gliosarcoma.
PMID: 16519569 [PubMed - in process]>>>
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| 3: Cancer.
2006 Jan 1;106(1):172-9. |
|
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Salvage chemotherapy with cyclophosphamide for recurrent
temozolomide-refractory anaplastic astrocytoma.
Chamberlain
MC, Tsao-Wei
DD, Groshen
S.
Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center and
Research Center, Tampa, Florida 33612, USA. chamberl@moffitt.usf.edu
BACKGROUND: A prospective Phase II study of cyclophosphamide (CYC) was
conducted in adult patients with recurrent temozolomide-refractory
anaplastic astrocytoma (AA) with a primary objective of evaluating 6-month
progression-free survival (PFS). METHODS: Forty patients (28 men, 12 women)
ages 26-57 years (median, 43 yrs) with neuroradiographically recurrent AA
were treated. All patients had previously been treated with surgery and
involved-field radiotherapy. Additionally, all patients were treated with
temozolomide (TMZ) chemotherapy after radiotherapy. All patients were
treated at recurrence with CYC administered intravenously on 2 consecutive
days (750 mg/m2/day) every 4 weeks (operationally defined as a single
cycle). Neurologic and neuroradiographic evaluation were performed every 8
weeks. RESULTS: All patients were evaluable. A total of 215 cycles of CYC
(median, 4 cycles; range 2-12 cycles) was administered. CYC-related toxicity
included alopecia (all patients, 100%), anemia (5, 12.5%), thrombocytopenia
(6, 15%), and neutropenia (8, 20%). Four (10%) patients required
transfusion. Nine patients (22.5%) (95% confidence interval [95% CI],
11%-39%) demonstrated a neuroradiographic partial response, 16 patients
(40.0%) (95% CI, 25%-57%) demonstrated stable disease, and 15 patients
(37.5%) (95% CI, 23%-54%) had progressive disease after 2 cycles of CYC.
Time to tumor progression ranged from 2-19 months (median, 4 mos; 95% CI,
2-6 mos). Survival ranged from 2-26 months (median, 8 mos; 95% CI, 6-10 mos).
The 6-month and 12-month PFS was 30% and 8%, respectively. CONCLUSIONS: CYC
demonstrated modest efficacy with acceptable toxicity in this cohort of
adult patients with recurrent anaplastic astrocytoma, all of whom had failed
prior TMZ chemotherapy. Copyright 2005 American Cancer Society.
Publication Types:
PMID: 16323194 [PubMed - indexed for MEDLINE]>>>
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Isolation of immunoresistant human glioma cell clones
after selection with alloreactive cytotoxic T lymphocytes: cytogenetic and
molecular cytogenetic characterization.
Gomez
GG, Varella-Garcia
M, Kruse
CA.
Department of Pathology, University of Colorado Health Sciences Center,
Denver, CO 80262.
Intratumoral heterogeneity and genetic instability within gliomas may allow
intrinsically immunoresistant (IR) cells to escape alloreactive cytotoxic T
lymphocyte (aCTL) cellular immunotherapy. The potential existence of aCTL-resistant
variants prompted us to investigate whether cellular immunotherapy resistant
glioma models could be isolated. To generate the models, repeated
intermittent or continuous selective pressure (ISP or CSP) with multiple
aCTL populations was applied to a low-passage glioblastoma cell explant,
13-06-MG, obtained from a patient at initial diagnosis. IL-6 and IL-8
secretion was greater in coincubates of aCTL cells with 13-06-ISP and
13-06-CSP immunoselected cells than those with 13-06-MG parental cells.
Initially, the immunoselected cells were less sensitive to aCTL lysis;
however, the reduced aCTL-sensitivity was not maintained upon further
selection. We therefore isolated IR clones from continuously immunoselected
cells (13-06-CSP). The frequency of IR clones was 1-6 cells per 10,000
immunoselected cells. Two clones selected for further study, 13-06-IR29 and
13-06-IR30, resisted aCTL lysis in the absence of immunoselective pressure.
Cytogenetic analyses revealed structural anomalies and genomic imbalances
unique to the IR clones. Based on these findings, a hypothetical model is
proposed that traces the origin of the IR clones to a clonal variant within
the 13-06-CSP and 13-06-MG populations.
PMID: 16527606 [PubMed - in process]
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Head injury and brain tumours in adults: A case-control
study in Rio de Janeiro, Brazil.
Monteiro
GT, Pereira
RA, Koifman
RJ, Koifman
S.
Department of Epidemiology, National School of Public Health, FIOCRUZ,
Oswaldo Cruz Foundation, Rua Leopoldo Bulhoes, 1480 sala 812, Manguinhos,
CEP: 21.041-210, Rio de Janeiro, Brazil.
A hospital-based case-control study exploring the association between
selected risk factors and head injury in adults, brain trauma included, was
carried out in Greater Metropolitan Rio de Janeiro, Brazil. Cases included
adults diagnosed with primary brain tumours (n=231). Controls were matched
for gender and age among in-patients hospitalized for various conditions
unrelated to brain cancer (n=261) identified in the same hospitals where
cases were enrolled. Risk of having experienced head injury was more
frequent among cases (46%) than controls (36%) (OR(adj)=1.49; 95%
CI=1.03-2.15). A dose-response effect was observed according to the number
of head injuries, and a statistically borderline association was observed
for meningioma (OR(adj)=1.63; 95% CI=0.96-2.75). Although recall bias cannot
be ruled out, our results suggest an association between prior head injury
and the development of brain tumours in adults.
PMID: 16517153 [PubMed - as supplied by publisher]
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Management of venous thromboembolism in patients with
primary and metastatic brain tumors.
Gerber
DE, Grossman
SA, Streiff
MB.
Departments of Oncology, Medicine, and Neurosurgery, The Johns Hopkins
University School of Medicine, Baltimore, MD 21205, USA.
Venous thromboembolism occurs commonly throughout the clinical course of
patients with brain tumors. A number of hemostatic and clinical factors
contribute to this hypercoagulable state. Concern over the possibility of
intracranial bleeding has limited the use of anticoagulation in this
population. However, mechanical approaches such as vena cava filters have
high complication and treatment failure rates in patients with intracranial
malignancies. In addition, the available data suggest that anticoagulation
can be used safely and effectively in most of these patients. Patients with
thrombocytopenia, recent neurosurgery, and tumor types prone to bleeding
require special consideration. When intracranial hemorrhage does occur, it
is often due to overanticoagulation, requiring prompt anticoagulation
reversal and neurosurgical consultation.
PMID: 16525187 [PubMed - in process]
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Whole-brain radiotherapy in the management of brain
metastasis.
Khuntia
D, Brown
P, Li
J, Mehta
MP.
University of Wisconsin, Madison, WI 53792, USA.
Brain metastases are an important cause of morbidity and mortality,
afflicting nearly 170,000 Americans annually. The prognosis for these
patients is poor, with median survival times measured in months. In this
review article, we present the standard treatment approach of whole-brain
radiotherapy and discuss new directions, including the role of chemical
modifiers and the management and prevention of neurocognitive deficits.
PMID: 16525185 [PubMed - in process]
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Resectable brain metastases.
Vogelbaum
MA, Suh
JH.
Brain Tumor Institute/ND40, Cleveland Clinic Foundation, Cleveland, OH, USA.
vogelbm@neus.ccf.org
Brain metastases are the most common brain tumors seen in clinical practice,
comprising well over half of all brain tumors. For many years, surgical
resection of brain metastases was considered a form of palliative therapy
only, but more recently it has been shown to have a more important role in
extending survival in appropriately selected patients. Newer surgical
techniques have helped to reduce the morbidity associated with tumor
resection. Although randomized studies have demonstrated the need for
postoperative whole-brain radiotherapy, there remains interest in the use of
other surgical adjuncts to delay or eliminate the need for fractionated
radiotherapy. The use of various treatment modalities, particularly
image-guided surgery and stereotactic radiosurgery, allows clinicians who
are focused on the treatment of brain metastases to achieve superior levels
of tumor control within the brain. As a result, overall survival is much
more dependent on the status of the patient's systemic disease.
PMID: 16525184 [PubMed - in process]
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Advances toward an understanding of brainstem gliomas.
Donaldson
SS, Laningham
F, Fisher
PG.
Department of Radiation Oncology, Stanford University School of Medicine,
Stanford, CA 94305, USA. sarah@reyes.stanford.edu
The diagnosis of brainstem glioma was long considered a single entity.
However, since the advent of magnetic resonance imaging in the late 1980s,
neoplasms within this anatomic region are now recognized to include several
tumors of varying behavior and natural history. More recent reports of
brainstem tumors include diverse sites such as the cervicomedullary
junction, pons, midbrain, or the tectum. Today, these tumors are broadly
categorized as either diffuse intrinsic gliomas, most often in the pons, or
the nondiffuse brainstem tumors originating at the tectum, focally in the
midbrain, dorsal and exophytic to the brainstem, or within the
cervicomedullary junction. Although we briefly discuss the nondiffuse
tumors, we focus specifically on those diffuse brainstem tumors that
regrettably still carry a bleak prognosis.
PMID: 16525181 [PubMed - in process]
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Diffusely infiltrative low-grade gliomas in adults.
Lang
FF, Gilbert
MR.
Department of Neurosurgery, The University of Texas M.D. Anderson Cancer
Center, Houston, TX 77030, USA. flang@mdanderson.org
Diffusely infiltrating low-grade gliomas (LGGs) include astrocytomas,
oligodendrogliomas, and mixed oligoastrocytomas (WHO grade 2). Due to the
routine use of magnetic resonance imaging, there is an increasing need to
formulate treatment guidelines for patients with LGGs. However, there is
little consensus about the optimal treatment strategy for diffusely
infiltrative LGGs, and the clinical management of LGGs is one of the most
controversial areas in neurooncology. Although the standard of care has not
been established, several randomized trials are beginning to provide some
answers. Furthermore, laboratory correlative studies are defining subsets of
LGG that may identify patients with better prognoses and increased chance of
responding to therapy. This article reviews the most recent data regarding
the treatment of LGG, emphasizing evidenced based approaches from current
clinical trials.
PMID: 16525178 [PubMed - in process]
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Physiologic and metabolic magnetic resonance imaging in
gliomas.
Cao
Y, Sundgren
PC, Tsien
CI, Chenevert
TT, Junck
L.
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
48109-0010, USA. yuecao@umich.edu
Magnetic resonance (MR) imaging provides excellent soft tissue
differentiation and in vivo assessment of physiologic and metabolic
properties of tissue. As new and more aggressive treatment modalities and
combined modalities are being investigated for brain tumor treatment, it is
becoming more important to accurately define tumor volumes for treatment
planning, to determine the most aggressive tumor regions for intensified
radiation treatment, to identify early regional response to therapy for
reoptimization of treatment, and to detect early indicators of developing
normal tissue toxicity. Readily available MR techniques of physiologic and
metabolic imaging can currently provide useful information regarding tumor
tissue properties including chemical composition, cerebral blood volume,
perfusion, vascular permeability, and water mobility. This article will
focus on the potential value of MR physiologic and metabolic imaging in the
clinical management of malignant gliomas.
PMID: 16525177 [PubMed - in process]
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Specific regulation of rat glial cell line-derived
neurotrophic factor gene expression by riluzole in C6 glioma cells.
Caumont
AS, Octave
JN, Hermans
E.
Laboratoire de Pharmacologie Experimentale, Universite catholique de Louvain,
54.10, Avenue Hippocrate 54, 1200 Bruxelles, Belgium.
Contrasting with its robust expression during embryogenesis, the glial cell
line-derived neurotrophic factor (GDNF) is repressed in the adult organism.
However, rapid induction of this neuronal growth factor is observed
following diverse neuronal insults and it is now widely accepted that the
control of its expression could constitute a powerful target in
neuropharmacology. We investigated the effects of the neuroprotective drug,
riluzole, on the GDNF gene expression in glial cells. Exposure of C6 glioma
cells to riluzole (1 microm) significantly increased GDNF protein and mRNA
levels. Using luciferase reporter gene constructs encoding fragments of the
5' untranslated region of the rat GDNF gene, we demonstrated that riluzole
mediates its effect at the transcription level. Furthermore, luciferase
assays revealed the presence of a negative regulatory region within the
+343/+587 region of exon 1. This region was shown to contribute to the high
sensitivity and specificity of the induction mediated by riluzole in the C6
glioma cell line at pharmacologically relevant concentrations. The effects
of riluzole were inhibited by the mitogen-activated protein kinase
extracellular signal-related kinase (MEK) inhibitor PD 98059. Together,
these results indicated that the induction of GDNF release by riluzole in
the C6 glioma cells results from the activation of its corresponding gene
promoter through a signalling pathway involving MEK activity. This study
suggests that the regulation of GDNF gene transcription in glial cells could
contribute to the pharmacological properties of riluzole and possibly other
neuroprotective drugs.
PMID: 16524382 [PubMed - as supplied by publisher]
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Correlation of Hypoxic Cell Fraction and Angiogenesis
with Glucose Metabolic Rate in Gliomas Using 18F-Fluoromisonidazole, 18F-FDG
PET, and Immunohistochemical Studies.
Cher
LM, Murone
C, Lawrentschuk
N, Ramdave
S, Papenfuss
A, Hannah
A, O'keefe
GJ, Sachinidis
JI, Berlangieri
SU, Fabinyi
G, Scott
AM.
Centre for PET, Austin Hospital, Heidelberg, Victoria, Australia; 2Ludwig
Institute for Cancer Research, Austin Hospital, Heidelberg, Victoria,
Australia; 3Departments of Surgery, Urology, and Medicine, University of
Melbourne, Austin Hospital, Heidelberg, Victoria, Australia; and 4Division
of Genetics and Bioinformatics, Walter and Eliza Hall Institute of Medical
Research, Parkville, Victoria, Australia.
PET offers a noninvasive means to assess neoplasms, in view of its
sensitivity and accuracy in staging tumors and potentially in monitoring
treatment response. The aim of this study was to evaluate newly diagnosed
primary brain tumors for the presence of hypoxia, as indicated by the uptake
of (18)F-fluoromisonidazole ((18)F-FMISO) and to examine the relationship of
hypoxia to the uptake of (18)F-FDG and molecular markers of hypoxia.
METHODS: Seventeen patients with suspected primary glioma were enrolled
prospectively in this study. Sixteen patients had histology, with 2 having
metastatic disease. All patients had PET studies with (18)F-FMISO and
(18)F-FDG and MRI studies. Immunohistochemistry was undertaken with tumor
markers of angiogenesis and hypoxia. Patients were monitored for disease
progression and statistical analysis of data was performed. RESULTS: Of the
14 patients with histology, 8 died with a median time of 16 mo (range, 2-30
mo) until death. Of those who died, 7 had positive and 1 had negative
(18)F-FMISO uptake. (18)F-FMISO uptake was observed in all high-grade
gliomas but not in low-grade gliomas. A significant relationship was found
between (18)F-FDG or (18)F-FMISO uptake and expression of VEGF-R1 and Ki67
expression. Other immunohistochemical markers demonstrated a trend toward
increased uptake but none was significant. CONCLUSION: (18)F-FMISO PET
provides a noninvasive assessment of hypoxia in glioma and was prognostic
for treatment outcomes in the majority of patients.(18)F-FMISO PET may have
a role not only in directing patients toward targeted hypoxic therapies but
also in monitoring response to such therapies.
PMID: 16513609 [PubMed - as supplied by publisher]
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Analysis of 18F-FET PET for Grading of Recurrent Gliomas:
Is Evaluation of Uptake Kinetics Superior to Standard Methods?
Popperl
G, Kreth
FW, Herms
J, Koch
W, Mehrkens
JH, Gildehaus
FJ, Kretzschmar
HA, Tonn
JC, Tatsch
K.
Department of Nuclear Medicine, Klinikum Grosshadern, University of Munich,
Munich, Germany; 2Department of Neurosurgery, Klinikum Grosshadern,
University of Munich, Munich, Germany; and 3Institute for Neuropathology,
University of Munich, Munich, Germany.
The aim of the present study was to evaluate whether extended analyses of
O-(2-(18)F-fluoroethyl)-l-tyrosine (FET) uptake kinetics provide results
superior to those of standard tumor-to-background ratios in predicting tumor
grade in patients with pretreated gliomas. METHODS: Dynamic (18)F-FET PET
studies (0-40 min after injection of 180 MBq of (18)F-FET) were performed on
45 glioma patients with suspected tumor recurrence after multimodal
treatment. For the standard method, tumoral maximal standardized uptake
value (SUVmax) and the ratio to the background were derived from a summed
image 20-40 min after injection. Dynamic data evaluation comprised several
approaches: first, SUV within a 90% isocontour threshold (SUV90) and the
respective ratio to the background calculated for each time frame between 5
and 40 min after injection; second, the time to peak analysis; and third,
various parameters accounting for the individual time course of (18)F-FET
uptake. Results were correlated with the histopathologic findings of MRI/PET-guided
stereotactic biopsies and were evaluated with respect to their
discriminatory power to separate low- from high-grade tumors using
receiver-operating characteristic (ROC) analyses. RESULTS: The parameters
taking into account the individual time course of (18)F-FET uptake were able
to differentiate low-grade from high-grade recurrent astrocytomas with high
diagnostic accuracy, reaching the best differentiation with a sensitivity
and specificity of 92% and an area under the ROC curve (AUC) of 0.94. For
the other parameters, the respective values were considerably lower (time to
peak: 85% sensitivity and 88% specificity; SUV90-to-background ratio for
single-frame evaluation of the early-uptake phase: 100% sensitivity, 62%
specificity, and 0.81 AUC). The lowest performance was provided by the
standard method (SUVmax: 73% sensitivity, 54% specificity, and 0.60 AUC;
SUVmax-to-background ratio: 62% sensitivity, 62% specificity, and 0.59 AUC).
Time-activity curves (5-40 min after injection) slightly and steadily
increased in tumor-free patients and in low-grade tumors, whereas high-grade
tumors showed an early peak around 10-15 min after injection followed by a
decrease. CONCLUSION: This study has shown differences in the dynamics of
(18)F-FET uptake between recurrent low- and high-grade gliomas. Therefore,
parameters addressing the different kinetic behaviors allow discrimination
with high diagnostic power between these 2 prognostically different groups.
Thus, the techniques introduced here are clearly superior to the yet most
widely used standard method.
PMID: 16513607 [PubMed - in process]
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Adenoviral modification of mouse brain derived
endothelial cells, bEnd3, to induce apoptosis by vascular endothelial growth
factor.
Mitsuuchi
Y, Powell
DR, Gallo
JM.
Department of Pharmacology, Fox Chase Cancer Center, 333 Cottman Avenue,
Philadelphia, PA 19111, USA.
A second generation genetically-engineered cell-based drug delivery system,
referred to as apoptotic-induced drug delivery (AIDD), was developed using
endothelial cells (ECs) that undergo apoptosis upon binding of vascular
endothelial growth factor (VEGF) to a Flk-1:Fas fusion protein (FF). This
new AIDD was redesigned using mouse brain derived ECs, bEnd3 cells, and an
adenovirus vector in order to enhance and control the expression of FF. The
FF was tagged with a HA epitope (FFHA) and designed to be coexpressed with
green fluorescence protein (GFP) by the regulation of cytomegalovirus
promoters in the adenovirus vector. bEnd3 cells showed favorable
coexpression of FFHA and GFP consistent with the multiplicity of infection
of the adenovirus. Immunofluorescence analysis demonstrated that FFHA was
localized at the plasma membrane, whereas GFP was predominantly located in
the cytoplasm of ECs. Cell death was induced by VEGF, but not by platelet
derived growth factor or fibroblast growth factor in a dose-dependent manner
(range 2-20 ng/ml), and revealed caspase-dependent apoptotic profiles. The
FFHA expressing bEnd3 cells underwent apoptosis when cocultured with a
glioma cell (SF188V+) line able to overexpress VEGF. The combined data
indicated that the FFHA adenovirus system can induce apoptotic signaling in
ECs in response to VEGF, and thus, is an instrumental modification to the
development of AIDD.
PMID: 16247462 [PubMed - indexed for MEDLINE]
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| 16: Surg
Neurol. 2006;65 Suppl 1:S1:33-1:37; discussion 1:37-1:38. |
|
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Transbasal approach to skull base tumors: evaluation and
proposal of classification.
Raso
JL, Gusmao
S.
Servico de Neurocirurgia do Biocor Instituto, Belo Horizonte 30140 000,
Brazil. jraso@uol.com.br
A clinical study of the TBA was performed in 22 patients harboring tumors of
the skull base. The follow-up ranged from 3 to 89 months (average, 30.5
months). The main complications were intracerebral hematoma, ptosis, and
infection. One patient died (4.5%) because of an extradural hematoma. Eight
patients died during the follow-up because of tumor complications. Among the
survivals, the median of the Karnofsky index was 96.4. Based on this study,
we propose a classification for the TBA, according to its extension.
PMID: 16427445 [PubMed - indexed for MEDLINE]
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Stereotactic computed tomography-guided brain biopsy:
diagnostic yield based on a series of 170 patients.
Ferreira
MP, Ferreira
NP, Pereira
Filho Ade A, Pereira
Filho Gde A, Franciscatto
AC.
Neurosurgery Department, Hospital Sao Jose/Complexo Hospitalar Santa Casa de
Porto Alegre, Porto Alegre 90020-060, Brazil.
BACKGROUND: Stereotactic CT-guided biopsy is a valuable and safe procedure
for diagnosing intracranial lesions. The objectives of this article are to
analyze the diagnostic yield in a series of stereotactic CT-guided brain
biopsies and to evaluate whether predictive factors may influence diagnostic
yield. METHODS: The medical records of a series of patients who underwent
stereotactic CT-guided brain biopsy from 1993 to 2005 in a neurosurgical
center were reviewed. Clinical data were stored and analyzed with Microsoft
Access (Microsoft Corp, Seattle, WA) and SPSS V11.0 software (SPSS, Inc,
Chicago, IL). The following variables were analyzed: age, sex,
anatomopathologic diagnosis, lesion topography and volume, postsurgical
complications, and predictive factors that may affect diagnostic yield.
RESULTS: One hundred seventy patients (102 males, 68 females; average age,
48.5 years) were analyzed. Stereotactic CT-guided biopsies allowed diagnosis
in 157 cases (92%). The most frequent anatomopathologic diagnoses were
high-grade glioma (n = 45), low-grade glioma (n = 31), nonspecific
inflammatory lesions (n = 19), metastasis (n = 10), and lymphoma (n = 10).
The most frequent topographies were frontal (n = 42), basal ganglia (n =
40), and parietal (n = 27) and front-parietal lobes (n = 9). Complications
occurred in 5 patients (2.9%). Mortality rate was 1.2% (2 patients). Age had
a positive impact, whereas female sex negatively affected diagnostic yield.
All other predictive factors analyzed were not significant. CONCLUSION:
Stereotactic CT-guided brain biopsies performed presented acceptable
anatomopathologic diagnostic rate. Age had a positive impact, whereas female
sex negatively affected diagnostic yield in this series.
PMID: 16427444 [PubMed - indexed for MEDLINE]
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Evaluation of magnetic resonance imaging criteria for
cavernous sinus invasion in patients with pituitary adenomas: logistic
regression analysis and correlation with surgical findings.
Vieira
JO Jr, Cukiert
A, Liberman
B.
Department of Neurosurgery, Hospital Brigadeiro, Sao Paulo, Brazil
04544-000.
BACKGROUND: This study used high-resolution magnetic resonance (MR) imaging
(1.5 T) to define and evaluate preoperative imaging criteria for cavernous
sinus invasion (CSI) by pituitary adenoma (PA). METHODS: Magnetic resonance
images obtained from 103 patients with PA submitted to surgery (48 with CSI)
were retrospectively reviewed. The following MR signs were studied and
compared with intraoperative findings: (1) presence of normal pituitary
gland between the adenoma and cavernous sinus (CS), (2) status of the CS
venous compartments, (3) CS size, (4) CS lateral wall bulging, (5)
displacement of the intracavernous internal carotid artery (ICA) by adenoma,
(6) grade of parasellar extension (Knosp-Steiner classification), and (7)
percentage of intracavernous ICA encased by the tumor. Statistical analysis
was performed using chi2 testing, and sensitivity, specificity, positive
predictive value (PPV), and negative predictive value (NPV) were obtained
for each MR finding. The odds ratio of the most significant criteria was
also obtained, and the multiple logistic regression test was used to compare
the criteria altogether. RESULTS: The following signs have been found to
represent accurate criteria for noninvasion of the CS: (1) normal pituitary
gland interposed between the adenoma and the CS (PPV, 100.0%), (2) intact
medial venous compartment (PPV, 100.0%), and (3) percentage of encasement of
the intracavernous ICA lower than 25% (NPV, 100.0%). Cavernous sinus
invasion was certain if the percentage of encasement of the intracavernous
ICA was higher than 45% and 3 or more CS venous compartments were not
depicted. The most valuable criterion of CSI by logistic regression analysis
was the percentage of encasement of intracavernous ICA of 30% or more, with
an odds ratio of 49.25. CONCLUSION: The preoperative diagnosis of CSI by PA
is extremely important because endocrinologic remission is rarely obtained
after microsurgery alone in patients with invasive tumors. The
aforementioned MR imaging criteria may be useful in patient's management and
in advising most of the patients preoperatively on the potential need for
complimentary therapy after surgery.
PMID: 16427401 [PubMed - indexed for MEDLINE]
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Chemotherapy for glioblastoma multiforme (GBM).
Roitberg
B.
Publication Types:
PMID: 16427394 [PubMed - indexed for MEDLINE]
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| 20: BMC
Cancer. 2006 Mar 9;6(1):56 [Epub ahead of print] |
|
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The fibrinolytic system facilitates tumor cell migration
across the blood-brain barrier in experimental melanoma brain metastasis.
Perides
G, Zhuge
Y, Lin
T, Stins
MF, Bronson
RT, Wu
JK.
ABSTRACT: BACKGROUND: Patients with metastatic tumors to the brain have a
very poor prognosis. Increased metastatic potential has been associated with
the fibrinolytic system. We investigated the role of the fibrinolytic enzyme
plasmin in tumor cell migration across brain endothelial cells and growth of
brain metastases in an experimental metastatic melanoma model. METHODS:
Metastatic tumors to the brain were established by direct injection into the
striatum or by intracarotid injection of B16F10 mouse melanoma cells in
C57Bl mice. The role of plasminogen in the ability of human melanoma cells
to cross a human blood-brain barrier model was studied on a transwell
system. RESULTS: Wild type mice treated with the plasmin inhibitor epsilon-aminocaproic
acid (EACA) and plg-/- mice developed smaller tumors and survived longer
than untreated wild type mice. Tumors metastasized to the brain of wild type
mice treated with EACA and plg-/- less efficiently than in untreated wild
type mice. No difference was observed in the tumor growth in any of the
three groups of mice. Human melanoma cells were able to cross the human
blood-brain barrier model in a plasmin dependent manner. CONCLUSIONS:
Plasmin facilitates the development of tumor metastasis to the brain.
Inhibition of the fibrinolytic system could be considered as means to
prevent tumor metastasis to the brain.
PMID: 16524486 [PubMed - as supplied by publisher]>>>
http://www.biomedcentral.com/1471-2407/6/56
http://www.biomedcentral.com/content/pdf/1471-2407-6-56.pdf
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