Imaging Findings of an Epidermoid Cyst Undergoing Malignant Transformation.

Malignant transformation of epidermoid cyst into squamous cell carcinoma (SCC) is rare. We report the case of a 39-year-old woman presenting with dizziness and cerebellar ataxia. MR scan revealed a mass in the left cerebropontine angle compressing the brainstem and the cerebellum, with two main components, a cystic and a solid one. The cystic component displayed imaging findings consistent with an epidermoid cyst. The solid component showed dense calcifications, low signal intensity on T1W, T2W and DW images and peripheral nodular enhancement. MR spectroscopy detected high lipid/lactate peaks and choline/creatine ratio. Imaging findings raised suspicion for malignant transformation, which was confirmed by histopathologic examination revealing an SCC. MR imaging with intravenous administration of gadolinium, DW images and MR spectroscopy can play a critical role in the diagnosis of malignant transformation of an epidermoid cyst.

Topical use of Rectogesic® and Emla® to improve cutaneous blood perfusion following thermal injury. A comparative experimental study.

Early post-burn ischemic necrosis of the skin is of particular interest in modern burn research. The purpose of this study was to test the hypothesis that blood perfusion could be improved by the topical application of vasoactive substances. A sample of 55 wistar rats was used to investigate the effect of 0,4% nitroglycerin ointment (Rectogesic(®)) comparatively to no application and placebo. The beneficiary action of 5% prilocaine/lidocaine cream (EMLA(®)) in burn blood perfusion was also tested comparatively to Rectogesic(®). Both preparations were tested respectively to non burned controls. Laser Doppler assessment of blood flow at 15, 30, 45, 60, 120 and 180 minutes after preparation application, demonstrated that the use of Rectogesic(®) improved perfusion at all measurements compared to placebo and to no preparation application (p&0,05). There was no statistical significant difference in the effect of the two preparations.

La nécrose ischémique précoce de la peau brûlée est d'un grand intérêt dans la recherche actuelle en brûlologie. Le but de cette étude était de vérifier l'hypothèse que la vascularisation peut être améliorée par l'application topique de substances vaso-actives. Un échantillon de 55 rats Wistar a été utilisé pour étudier l'effet de 0,4% onguent à la nitroglycérine (Rectogesic®) comparativement à aucune application d'onguent et un placebo. L'action bénéfique de la crème lidocaïne (EMLA®)( 5% prilocaïne) sur la vascularisation cutanée a également été testé comparativement àvec le Rectogesic®. Les deux préparations ont été testées respectivement sur des témoins non brûlés. Une évaluation Laser Doppler du flux sanguin à 15, 30, 45, 60, 120 et 180 minutes après l'application de la préparation, a démontré que l'utilisation de Rectogesic® améliore la circulation à chaque mesure par rapport au placebo et par rapport à la non application d'onguent (p&0,05). Il n'y avait aucune différence statistiquement significative dans l'incidence des deux préparations.

Primary prostatic lymphoma with components of both diffuse large B-cell lymphoma (DLBCL) and MALT lymphoma.

Although lymphomas involving the prostate gland are rare, they should always be considered in the differential diagnosis. We report a case of primary prostatic NHL in a 70-year-old man presented with hematuria and urinary obstructive symptoms. Routine laboratory tests were within normal limits and prostate-specific antigen (PSA) was 0,01 ng/ml. The patient underwent radical prostatectomy. Histologically, two different coexisting patterns of non-Hodgkin lymphoma, infiltrating the prostatic tissue, were identified. The diagnosis of diffuse large B-cell lymphoma (DLBCL) presenting with an associated low-grade lymphoma of MALT-type was confirmed by immunohistochemistry. The patient received chemotherapy without any complication and has been followed-up for 2 years since surgical resection with no recurrence. The clinicopathologic characteristics of prostatic lymphomas are discussed, while reviewing the current English-language literature.

EGFR expression and activation are common in HER2 positive and triple-negative breast tumours.

EGFR has been associated with unfavourable prognosis in patients with triple-negative breast carcinomas, although little is known about EGFR activation in these tumours. In a series of breast carcinomas (archived formalin fixed tumours, n=100), we investigated EGFR phosphorylation status at Tyr992 (pEGFR-Y992) and Tyr1068 (pEGFR-Y1068) by immunohistochemistry, along with EGFR protein expression (extracellular domain), gene amplification status (fluorescent in situ hybridization) and conventional clinicopathologic parameters. EGFR protein was present in 21.9%, while phosphorylation at Y1068 and Y992 was observed in 27.8% and 50.5% of tumours, respectively. None of the tumours showed EGFR gene amplification, whereas 21.1% exhibited chromosome 7 polysomy. The above EGFR parameters were usually not simultaneously detected and were not associated with each other. High grade (p=0.003), lymph node positive (p=0.045), estrogen receptor (ER) negative (p<0.001) tumours often expressed EGFR protein. EGFR-Y992 and Y1068 phosphorylation was inversely associated with ER presence (p=0.023 and p=0.029, respectively) but positively with HER2 expression status (p<0.001 and p=0.002, respectively). The global positivity for any EGFR parameter did not significantly differ between triple-negative and HER2 positive tumours. In conclusion, EGFR phosphorylation is commonly encountered in breast carcinomas, although unrelated to EGFR protein presence and gene amplification. EGFR may appear activated even in cases where the extracellular domain of this protein is not observed with immunohistochemistry. These findings may be useful for further studies aiming at the assessment of EGFR parameters on this type of material.

Subependymal giant cell astrocytoma with intratumoral hemorrhage in the absence of tuberous sclerosis.

Subependymal giant cell astrocytoma (SEGA) is an uncommon tumor that usually occurs in the setting of tuberous sclerosis (TS) syndrome. We report a rare case of an intratumoral and a small intraventricular hemorrhage complicating a SEGA in an adult patient without any signs of TS. Although pre-operative CT and MRI findings for the tumor were typical of SEGA, SEGA was not considered in the differential diagnosis because the patient was lacking any symptoms of TS. This is the second report of intraventricular and intratumoral hemorrhage complicating a SEGA and the first case in which these complications occurred in an adult patient in whom there was no previous suspicion of systemic disease.

[Solitary fibrous tumor of the nose and paranasal sinuses]. / Solitärer fibröser Tumor der Nasenhaupt- und Nasennebenhöhlen.

OBJECTIVE: The solitary fibrous tumor is an uncommon, benign lesion with a mesenchymal origin which arises most commonly from the pleura and, in extremely rare cases, from the mucosa of the nose and paranasal sinuses. PATIENT AND METHODS: We describe a case of solitary fibrous tumor in the nasal cavity with an extension into both ethmoid sinuses and destruction of the nasal septum in a 64-year-old woman presenting with nasal obstruction and frontal headache. In the histopathologic examination and by immunohistochemistry, the tumor was composed of spindle cells and nodular collagen, and was confirmed as a solitary fibrous tumor. It was completely removed using an endonasal approach with the patient being free of any complaints and without evidence of disease 2 years after surgery. CONCLUSIONS: Solitary fibrous tumor should be included in diagnostic considerations in patients with sinonasal masses, especially in cases with the appearance of spindle cells. Diagnostic procedures, clinicopathological features, therapeutic options and prognosis of the such tumors are discussed.

Classic (Mediterranean) Kaposi's sarcoma of the true vocal cord: a case report and review of the literature.

Kaposi's sarcoma (KS) is a rare subcutaneous lesion linked mainly with patients suffering from acquired immunodeficiency syndrome. The aim of the present study is to present the first documented case of classic Kaposi's sarcoma (CKS) located in the right true vocal cord. A 62 year old male presented with cough and hoarseness for 2 months. Clinical examination revealed a nodule on the right vocal cord. The patient underwent surgery and the lesion was removed and biopsied. The histopathology report showed that the lesion was KS but with no complete removal of the lesion, since the surgical margins of the nodule were not healthy. The patient, although fully informed, refused any further treatment. Further laboratory tests were performed, revealing an HIV-negative immunodeficiency profile. Although (Mediterranean) CKS is not an aggressive malignancy, surgery with complete removal of the affected area is indicated when it is applicable. Moreover, conservative treatment and follow up of the patient is essential in order to prevent relapse or other primary lesions.

Meningioma growth and interferon beta-1b treated multiple sclerosis: coincidence or relationship?

Although the coincidence of multiple sclerosis (MS) and central nervous system (CNS) tumors has been reported in over 30 cases in English literature, meningioma growth was associated with interferon-beta (INF-b) treated MS only in two of them. We report the case of a 19-year-old woman with clinically possible, laboratory supported MS, and a concomitant right intraventricular tumor with magnetic resonance imaging (MRI) characteristics consistent with meningioma (similar signal with grey matter on T1 and T2-weighted images and homogenous, intense enhancement). Two years after initiation of INF-b treatment, follow-up brain MRI revealed enlargement of the intraventricular mass and relative increase in the number of white matter lesions without significant clinical deterioration. She underwent almost total resection of the mass and histology confirmed the diagnosis of papillary meningioma. Based on the immunohistochemistry results, we speculate that INF-b resulted in meningioma growth by enhancing platelet derived growth factor (PDGF) receptors or/and down-regulating transforming growth factor receptors on the tumor itself.

Thrombotic thrombocytopenic purpura associated with rapidly progressive lupus nephritis: report of two cases.

There are a few reported cases in the literature of thrombotic thrombocytopenic purpura (TTP), associated with systemic lupus erythematosus (SLE). We describe two cases of TTP which have been presented during rapidly progressive lupus nephritis, with grand-mal seizures, thrombocytopenia and microangiopathic hemolytic anemia. Both cases were treated with hemodialysis, plasma exchange, corticosteroids, cyclophosphamide and intravenous gamma-globulin. In both cases the TTP was improved but not the renal function. Further experience is needed to determine whether intensive and prompt treatment with plasma exchange, corticosteroids and chemotherapy leads to a favorable outcome, in cases of TTP associated with SLE.

Fracture callus engulfing a peripheral nerve does not affect its function: an experimental study in rabbits.

The fate of a peripheral nerve engulfed in fracture callus is not known. We investigated the impact of envelopment of the sciatic nerve by fracture callus using a New Zealand rabbit femoral fracture model. The sciatic nerve was mobilized and coiled around the ipsilateral femur, which was surgically fractured, shortened, and osteosynthesized. Bony union was achieved, and callus engulfed the sciatic nerve in all animals. Nerve function was evaluated clinically and by conduction studies preoperatively and postoperatively. Although the nerve function in terms of clinical evaluation, amplitude, motor latency, and spontaneous activity deteriorated immediately postoperatively, recovery was evident in the following weeks indicating that the detected nerve dysfunction was attributable to the surgical mobilization. In addition, histologic and quantitative histomorphometric analyses proved that in none of the animals did the callus compress the sciatic nerve whereas an impressive process of axonal regeneration took place despite callus maturation. Results of our study suggest that callus, engulfing a peripheral nerve, does not compress it and the nerve appears to be intact in an osseous canal. This results in preservation of the integrity and function of the nerve, which may have significant clinical applications.

Relative expression of human telomerase catalytic subunit (hTERT) transcripts in astrocytic gliomas.

Human telomerase catalytic subunit (hTERT) expression has been reported as a marker for malignancy in various tumor systems. The aim of the present study was to investigate the relative expression of hTERT (relhTERT) and its transcripts A+B+ (contained in the full-length product), Adel and Bdel in astrocytic gliomas (grades I-IV, n=38). relhTERT was assessed by duplex reverse transcription-PCR and the expression profile of Adel, Bdel and A+B+ transcripts by nested real time-PCR. relhTERT and A+B+ presence correlated well with each other ( P<0.001) and with histological grading [grades I-II (low) vs III-IV (high), P(relhTERT)=0.002 and P(A+B+)<0.001]. A+B+ was detected in one out of seven hTERT-positive low-grade tumors, while it was present in 96.3%, and predominantly expressed in 59.3% of high-grade tumors. Bdel predominance was observed only in three cases, irrespective of grading, while Bdel levels equal or close to those of A+B+ were found in 30.4% of grade IV tumors. In situ hybridization with specific Bplus and Bdel probes revealed positive signals for both mRNAs in association with relhTERT and respective variant profiles. In addition, this method was useful in assessing hTERT expression in cases where sampling errors for RT-PCR were unavoidable. Our findings show that except for differences in relhTERT, low- and high-grade astrocytic gliomas exhibit distinct hTERT variant profiles, most of which seem to be in line with the role attributed to hTERT regarding its contribution to the acquisition of malignant potential during astrocyte carcinogenesis. Low-grade tumors mainly express Adel and Bdel. High-grade tumors, especially grade IV, always express A+B+, mostly but not always in predominance over Adel and Bdel. In this same group, profiles with Bdel predominance or relatively equal A+B+/Bdel expression are also observed, and Adel is often missing. Whether these differences characterize tumors with different biological behavior remains to be elucidated.

Effect of ketamine on hypoxic-ischemic brain damage in newborn rats.

The present study tests the hypothesis that ketamine, a dissociative anesthetic known to be a non-competitive antagonist of the NMDA receptor, will attenuate hypoxic-ischemic damage in neonatal rat brain. Studies were performed in 7-day-old rat pups which were divided into four groups. Animals of the first group, neither ligated nor exposed to hypoxia, served as controls. The second group was exposed to hypoxic-ischemic conditions and sacrificed immediately afterwards. Animals of the third and fourth groups were treated either with saline or ketamine (20 mg/kg, i.p.) in four doses following hypoxia. Hypoxic-ischemic injury to the left cerebral hemisphere was induced by ligation of the left common carotid artery followed by 1 h of hypoxia with 8% oxygen. Measurements of high energy phosphates (ATP and phosphocreatine) and amino acids (glutamate and glutamine) and neuropathological evaluation of the hippocampal formation were used to assess the effects of hypoxia-ischemia. The combination of common carotid artery ligation and exposure to an hypoxic environment caused major alterations in the ipsilateral hemisphere. In contrast, minor alterations in amino acid concentrations were observed after the end of hypoxia in the contralateral hemisphere. These alterations were restored during the early recovery period. Post-treatment with ketamine was associated with partial restoration of energy stores and amino acid content of the left cerebral hemisphere. Limited attenuation of the damage to the hippocampal formation as demonstrated by a reduction in the number of damaged neurons was also observed. These findings demonstrate that systemically administered ketamine after hypoxia offers partial protection to the newborn rat brain against hypoxic-ischemic injury.