Cerebral phaeohyphomycosis.

The authors describe a case of cerebral phaeohyphomycosis with lethal outcome within five weeks from surgical resection. The lesion consisted of a multilocular abscess in the left parietal lobe. The histopathologic findings showed a granulomatous reaction surrounding the abscess cavities. The causative fungus was clearly visible because of its brown-pigmented, septate, branched hyphae and spherical thick-walled cells, sometimes inside the multinucleated giant cells. Although no cultures were obtained from the exsudate, the possible diagnosis of cerebral cladosporiosis is discussed.

Morphologic and pathogenetic considerations of supratentorial gliomas in children.

The results of a histological investigation carried out on 758 children's brain tumours are presented. Attention is drawn to supratentorial tumours, particularly gliomas of cerebral hemispheres (neoencephalic structures). Mono- or bicellular gliomas corresponding to tumours of adult age (astrocytoma, oligodendroglioma) as well as typical glioblastomas are seldom encountered in children. Supratentorial hemispheric tumours are mostly composed of more than two cell populations ("mixed heterogenous tumours"); this is commonly the case in infants. The importance of an extensive histological examination of many different tumour parts is stressed. Otherwise, the regional differences of neoplastic cells populations can give rise to wrong diagnoses as well as speculative hypotheses concerning "cell differentiation" or maturation" in recurrences.

Non tumoral aqueduct stenosis. Multiple microscopic subependymal glial protuberances demonstrated at hystological examination.

A case of hydrocephalus associated to aqueduct stenosis is described. The microscopic examination showed aqueduct gliosis which was not possible to distinguish congenital or acquired.

Early post traumatic seizures in adults. Study of 84 cases.

In a series of 2.980 brain-injured patients, 84 (2.8%) showed epileptic seizures. Epilepsy occurred with a higher incidence rate in operated patients (11.6%) than in non operated ones (1.2%). Seizures appeared within the first week since trauma in 91% of the cases. They have been single in 48%, recurring in 34%, with figures of status epilepticus in 16% partial in 61%, and GM in 33%. Prognosis quoad vitam of early epilepsy seems to be favourable, however, in severely brain-injured patients, seizures occur more frequently and may determine a worsening of the clinical picture even if they are not responsible for the death.

Enterogenous cyst of the cervical canal: report of a case in a 68-year-old woman and review of the literature.

A case of a cervical enterogenous cyst in a 68-year-old woman with associated vertebral malformation is presented. The diagnostic value of Magnetic Resonance Imaging, positive reaction to Periodic-Acid-Schiff and immunohistochemical staining for carcinoembryonic antigen are emphasized. The literature is reviewed: controversies about embryogenic theories and classification of these lesions are discussed.

Metastatic oligodendroglioma. Case report.

We report a case of remote metastasis of oligodendroglioma. Similar cases are reported in the literature for malignant cerebral tumors. Our case seems rather different because of low grade histology. Potential malignancy was evidenced only by further investigations with labeling indexes.

[Primary teratocarcinoma of the pineal region]. / Teratocarcinoma primitivo della regione pineale.

Primary Teratocarcinoma of Pineal Region. A case of a 12 year old boy admitted for intracranial hypertension of sudden onset has been reported. CT scanning and MR showed a triventricular hydrocephalus due to a space-occupying lesion of the pineal region. Tonic-clonic fits of the upper limbs and Parinaud syndrome were followed by loss of consciousness. Intervention I: ventriculo-peritoneal shunt with sampling of CSF and assay for beta-HCG, alpha FP and CEA, which proved negative. Cytology for neoplastic cells in cerebrospinal fluid was negative. Intervention II: grossly total removal of the tumor. This was followed by partial remission of Parinaud syndrome, total remission of the hypertensive symptoms and discharge on day 12. The 3 cm. whitish-pink tumor of rubbery consistency proved on histological examination to be a teratocarcinoma. The patient was further submitted to chemioterapy and irradiation but died 7 months after the second intervention. This is a rare tumor, much more than teratoma of the pineal gland, which is relatively frequent. It is interesting histologically because of the presence not only of chondroid and mesenchymal portions but also of adamantinomatous rudiments and of epithelial zones resembling embryonal carcinoma of the testis.

Cerebral listeriosis in adults. Three cases report.

The Authors describe three autoptic cases of meningoencephalitis in adults due to an emerging pathogen, the Gram-positive bacillus Listeria monocytogenes. Only one of these was an immunosuppressed patient (recurrent carcinoma of the larynx and bladder papillomas), while no severe cause of debilitation was detected in the other two cases, excluding colonic diverticulosis in both. The post-mortem examination revealed leptomeningitis and encephalitis. Lympho-monocytic tissue reaction with perivascular cuffing was present in all the cases. The etiologic agent, L. monocytogenes, was identified by cultures from clinical or autoptic specimens.

[The morphology of HIV encephalopathy]. / Zur Morphologie der HIV-Enzephalopathie.

Reported in this paper are postmortem findings recorded from the central nervous system of 51 HIV carriers, among them 43 with clinically manifest AIDS. Opportunistic infections and tumours were established in 24 cases, including toxoplasmosis, cytomegaly, progressive multifocal leucoencephalopathy, and lymphomas. Findings obtained from 5 patients were restricted to unspecific alterations. No pathological findings at all were recordable from 8 HIV carriers without AIDS. So-called subacute microglial encephalitis (SME) was detected in 26 cases. SME was found to provide for the morphological substrate of genuine HIV encephalopathy. It was characterised by occurrence of mononuclear and even multinucleated cells which were macrophages and obviously served as virus carriers. Multinucleated cells are pathognomonic of HIV encephalopathy. No unambiguous evidence has so far been produced to primary invasion of neurons or glial cells by HI viruses.

Long-term results in 62 cases of post-traumatic complete apallic syndrome.

After the transition state of decerebrate coma, at least four different kinds of the so-called apallic status can be identified: 1. Complete apallic syndrome: coma vigil, alertness without any awareness, mass movements only, impairment of sleep rhythm, absence of any emotional responses, postural abnormalities, some primitive motor responses, tetraplegia, and alteration of muscle tone. 2. Incomplete apallic syndrome: some of the features of the complete apallic syndrome are lacking, and the patient shows emotional reactions with appropriate grimacing and some appropriate motor responses. 3. False apallic syndrome: most signs of complete apallic syndrome are present, but the patient is in touch with the environment. This condition is somewhat similar to the so-called locked-in syndrome. 4. Functional apallic syndrome: full clinical picture of the complete apallic syndrome but full recovery within a few days. Long-term results in 62 patients, aged between 4 and 62, affected by a post-traumatic complete apallic syndrome are reported. Thirty two patients were operated upon and 30 were not operated upon. Out of these cases, 38 died after weeks or months; 3 patients entered a chronic apallic status; 2 patients are improving; 10 recovered with severe neurological or psychic sequels or both; 4 recovered with minimal sequels, and 5 without sequels; no patients in these two last groups were aged more than 20.

[The CNS in AIDS and in asymptomatic HIV positive patients]. / Das ZNS bei AIDS und bei asymptomatischen HIV-Trägern.

Neuropathological investigations were carried out on 166 autopsies of HIV-seropositive patients, with and without AIDS. Opportunistic infections and lymphomas were present in about 50% of cases; 65 patients were bearers of HIV-encephalopathy. HIV core protein p24 was detected in few mono- and multinucleated macrophages (HIV-cells), only in cases with HIV-encephalopathy. In the CNS of HIV-positive, asymptomatic patients no histological or immunohistochemical abnormalities were seen. These findings let suppose that AIDS-Dementia is a result of a late infiltration of HIV-infected macrophages from the bloodstream into the brain and not due to an impairment of neuronal or glial cells infected by HIV in the early stages of the disease.

Primary intracranial rhabdomyosarcoma: report of two cases.

Primary intracranial rhabdomyosarcoma (RMS) is a rare tumor in infancy and childhood that is found in various locations in the central nervous system. The clinical course worsens rapidly, and the final outcome is poor, with a median survival time of 8-10 months. Invasion of the meninges, spontaneous intratumoral bleeding, spinal leptomeningeal CSF spreading of tumor cells, and early recurrence of the mass are the distinctive features of RMS. Diagnosis of RMS may be missed: immunohistochemical staining using specific markers (myoglobin, myosin, desmin, vimentin, enolase), along with ultrastructural studies, provide the basis for making the final diagnosis. Treatment of RMS includes surgical excision, craniospinal radiation therapy, and chemotherapy. We report two cases of primary RMS in the CNS located in the posterior fossa and frontotemporal area. Both children underwent total surgical removal of the mass. Early recurrence of the tumor mass was noticed in both patients 2 months after surgery. Both children died shortly thereafter.