Cystic prolactinoma: a variant of "transitional cell tumor" of the pituitary.

Pituitary tumors with features of both Rathke's cleft cysts and adenohypophysial adenomas are extremely rare and have been termed "transitional cel tumors." The ultrastructural features of one of these tumors has been reported, demonstrating cells with features transitional between those of adenohypophysial cells and Rathke's cleft cells, along with other cells with the distinctive features of either cell type. We report a case of a prolactin-secreting "transitional cell tumor" with similar light-microscopic and ultrastructural features. Additionally, the transitional cells in our case exhibited abundant intracellular mucin production. This represents a variant of "transitional cell tumor" of the pituitary gland.

Large intramedullary lipoma of the cervical cord and posterior fossa. Case report.

A large intramedullary lipoma of the cervical cord extending into the posterior fossa is reported in a 7-year-old boy. Magnetic resonance imaging was very useful for delineation of the anatomy of the lipoma as an aid in planning the operation.

Classification of hydrocephalus and outcome of treatment.

PURPOSE: Retrospective analysis in cooperative study of hydrocephalus at institutions of members of the Research Committee on Intractable Hydrocephalus sponsored by the Ministry of Health and Welfare of Japan was performed to determine the functional prognosis for all types of hydrocephalus and thus to clarify the outcome. METHODS: In preparation of this study, we have proposed the definition, clinical classification and diagnostic criteria of hydrocephalus. We have classified non-tumoral hydrocephalus into eight types based on its etiology and the time of onset. To establish the diagnosis in each type of hydrocephalus, we have set up inclusion and exclusion criteria, as well as supplementary criteria which are useful for its diagnosis. RESULTS: Analysis of the 1450 cases of hydrocephalus of various etiologies stored in the data base obtained from the study for each type of hydrocephalus revealed that following types and conditions were associated with a neurologic deficit: (1) early fetal hydrocephalus, (2) overt neonatal hydrocephalus, (3) hydrocephalus associated with such severe brain malformations as hydranencephaly, holoprosencephaly and lissencephaly, (4) hydrocephalus associated with severe brain damage, (5) hydrocephalus associated with epilepsy, (6) hydrocephalus shunted late after detection, and (7) hydrocephalus complicated by a shunting operation. CONCLUSION: The postnatal functional outcome was significantly poor in fetal hydrocephalus diagnosed in the early gestation. Childhood onset hydrocephalus showed a poorer outcome than adult hydrocephalus.

Successful combination chemotherapy (cisplatin, vinblastine, and bleomycin) with small-dose irradiation in the treatment of pineoblastoma metastasized into spinal cord: case report.

A case of successful combination chemotherapy using cisplatin, vinblastine, and bleomycin (PVB) therapy with small-dose irradiation (25 Gy) to treat a pineoblastoma that metastasized into the lumbar region through the cerebrospinal fluid is presented. Pain in the lower extremities and urinary incontinence with paraplegia improved during irradiation of the spinal cord after two courses of PVB therapy administered during a period of 6 weeks. The patient is presently attending school normally and has a score of 100% on the Karnofsky performance scale 4 years after therapy. These results suggest that combination chemotherapy with small-dose back-up radiotherapy may be one of the treatments of choice for recurrent or disseminated pineoblastoma.

Central nervous system bioaminergic responses to mechanical trauma. An experimental study.

Changes in biogenic amines in the brain and spinal cord following penetrating injury were studied in male Wistar rats using high-performance liquid chromatography with electrochemical detection. Rapid increase in hemispheric concentration of these substances was noted beginning shortly after trauma. This trend continued until they were about three to four times control levels by about 24 to 48 hours postinjury. In the spinal cord, however, there was an initial sharp reduction in regional concentrations 2 hours postinjury followed by a slow rise thereafter. By 48 hours postinjury, levels of norepinephrine, dopamine, and serotonin of the cords of injured animals were still less than those of nontraumatized controls. This variation in the central nervous system bioaminergic response with the level of injury raises questions as to its precise role in neurological damage following mechanical insult.

Cerebellopontine angle lymphoma: a case report and review of the literature.

BACKGROUND: Although malignant lymphomas of the central nervous system have been reported to be increasing in frequency, cerebellopontine (CP) angle lymphoma is rare and only 13 cases have been reported previously in the literature. CASE PRESENTATION: A 63-year-old woman had progressive dizziness and nausea for 2 months. Computed tomography scanning and magnetic resonance imaging (MRI) revealed a mass lesion in the left CP angle, that was compressing the lateral-dorsal aspect of the pons and the fourth ventricle. This tumor was avascular on angiography. The tumor was surgically removed through a left lateral suboccipital approach. It was considered to arise from the subarachnoid space of the CP angle cistern. For some reason, the histologic diagnosis was not definitively made, and therefore radiation therapy was not planned. The tumor recurred within 50 days after the tumor excision. Surgical excision of the recurrent tumor was performed again. The histologic diagnosis was B-cell type malignant lymphoma. Radiation therapy was performed. In the 27 months since irradiation, a recurrent tumor has not been detected on MRI. CONCLUSIONS: Although erosion and expansion of the internal auditory canal suggest an acoustic neurinoma, CP angle lymphoma can, in rare circumstances, erode the internal auditory canal. There are three distinct patterns in which malignant lymphomas occupy the CP angle: (1) an extra-axial CP angle lymphoma, (2) an intra-axial lymphoma extending to the CP angle, and (3) a leptomeningeal lymphoma presenting as a CP angle lesion. Although malignant lymphomas rarely occupy the CP angle, it should be considered in the differential diagnosis of CP angle tumors. It is desirable to obtain a frozen section in all CP angle tumors during surgery to identify the tumor, because aggressive removal is not necessary, but radiation therapy should additionally be performed for malignant lymphomas.

Immunohistochemical study of medulloblastoma with a monoclonal antibody against human copper and zinc-superoxide dismutase.

Superoxide dismutase (SOD) expression in tumor tissues was investigated in 10 cases of medulloblastoma by immunohistochemistry, using a monoclonal antibody against human copper and zinc-superoxide dismutase. Abundant SOD was expressed in tumors from patients with poor outcomes and little SOD in patients with good outcomes. These results suggest that resistance to adjuvant therapy depends on the amount of SOD in tumor tissues. The effects of adjuvant therapies for medulloblastomas depend on the production of free oxygen radicals, so if tumor cells contain a free radical scavenger such as SOD, the effects of adjuvant therapy may be reduced. Measurement of SOD in tumor tissues may be useful as a prognostic indicator for medulloblastoma.

Survival probability, delayed mortality, and relationship between short-term outcome and long-term survival after aneurysmal subarachnoid hemorrhage.

The long-term survival probability, causes of delayed mortality, and relationship between short-term outcome and long-term survival after aneurysmal subarachnoid hemorrhage were retrospectively studied in 106 patients followed up for longer than 5 years. The Kaplan-Meier cumulative survival probabilities at 1 month, 6 months, and 5 years were 85.9%, 79.2%, and 66.8%, respectively. Six months after the onset, 41 patients made a good recovery (GR) and 34 were moderately disabled (MD). On the last follow-up day, 64 had good outcome (GR or MD) and eight had died. In contrast, there were nine patients with poor 6-month outcome (severe disability or vegetative state), seven of whom died within 5 years. Five of these seven patients had experienced intraventricular hemorrhage (IVH) on admission. A total of 15 patients died beyond 6 months, five died of complications related to shunts. Six-month outcome is a predictor of long-term survival and delayed mortality. Improved long-term survival requires the development of better management for IVH, improved 6-month outcome, and careful follow-up of patients who undergo shunting.

Cerebral paragonimiasis--report of five cases.

Five cases of cerebral paragonimiasis presenting with hemianopsia, convulsion, and gait disturbance are discussed. The cases were all in the chronic stage. The intradermal paragonimiasis reaction, complement fixation, and Ouchterlony tests were not useful for diagnosis. Computed tomography demonstrated calcifications in all cases in sites consistent with the foci of symptoms. Surgical treatment in two cases failed to improve symptoms.

Bilateral aseptic femoral head necrosis associated with steroid therapy for prolactinoma--case report.

The authors report a recent case of prolactin-secreting pituitary adenoma in a young male who had earlier received treatment for infertility. Following partial adenomectomy, he was placed on postoperative steroid substitution among other treatments, but developed femoral head necrosis several months later. Hormone studies at the time showed significant findings, including an elevated serum cortisol level. The authors conclude that this complication resulted from prolonged steroid therapy and offer suggestions as to how a similar situation may be avoided.

Management of a broken atrial catheter migrated into the heart: a rare complication of ventriculoatrial shunt--case report.

A 21-year-old male, who had undergone a ventriculoatrial shunt for hydrocephalus 5 years previously, became stuporous. A roentgenogram revealed that the distal segment of the broken atrial catheter had migrated and become lodged in the heart. Because the fragment had not adhered to the myocardium, it was easily retrieved by the transvenous approach with a retriever catheter. If the migrated catheter does not adhere to the myocardium, transvenous catheter retrieval is absolutely necessary. If, however, the migrated catheter adheres to the myocardium, an open thoracotomy would be required for retrieval, or the alternative of warfarin administration without retrieval may be the treatment of choice, as long as other problems do not occur.

[Ossifying fibroma in the cranial vault. Case report].

Ossifying fibroma is relatively common in the maxilla, but rare in the cranial vault. A 10-year-old girl was referred for painful swelling of the left temporal region. On admission, she presented no abnormal physical and neurological findings except for the painful swelling. Plain skull X-ray films showed a radiolucent lesion of the left temporal bone about 4 cm in diameter, with a hyperostotic area of the parietal side. Computed tomography scan using bone window level also showed an abnormal density lesion in the same site. Curettage of this tumor was performed from a cosmetic point of view and at the family's petition. Histological examination showed vascular fibrous tissue in which lamellar bone was surrounded by osteoblasts.

[A case of eclampsia with intraventricular hemorrhage].

Our case is a 31-year-old primipara who had undergone a cesarean section for multiple pregnancy and was referred to our clinic because of attack of eclampsia. On admission, her consciousness level was lethargic. Computed tomography on admission showed high density area indicating right paraventricular hemorrhage with ventricular perforation, and low density areas in bilateral basal ganglia. Examination of the cerebral angiogram done six days after onset of symptoms revealed multisegmental vasospasm in Willis' circle mainly. An emergent ventricular drainage was performed. Two weeks later, repeat angiogram revealed that spasm had almost disappeared. Repeat CT scan three months after the onset showed small low density area in the right caudate nucleus and disappearance of the low density areas in bilateral basal ganglia. Her clinical course was uneventful and she was discharged without neurological deficit at about three weeks after the onset. In spite of absence of subarachnoid clot on CT scan, remarkable multisegmental spasm was found on cerebral angiogram. We suspected that eclampsia may have been responsible for the spasm in this case. Bleeding was believed to have originated in the superolateral angle of the lateral ventricle. It was supposed that infarcted hemorrhage or bleeding from small artery due to changes in arterial or venous pressure might have occurred and penetrated into the lateral ventricle.

[A recurrent case of TSH-PRL secreting microadenoma following hypothyroidism].

A thirty-seven-year-old housewife whose chief complaints were recurrence of galactorrhea and amenorrhea three years after having a selective adenomectomy. Hormonal examination done as a result of the continuation of the endocrinism revealed a hyperprolactinemia and high level of TRH due to hypothyroidism. Serum prolactin responded to neither TSH stimulation nor L-Dopa suppression tests. In addition, serum TSH did not react to TRH test. Contrast enhancement CT showed an intrasellar enhancing mass the size of which was less than 1 cm in diameter. A unilateral septal transsphenoidal operation was performed; and a soft white-yellowish mass 7 X 5 X 5 mm in size was found in the left inferolateral aspect of the pituitary gland. Histological studies of frozen sections of this revealed it to be a pituitary adenoma, with the border between tumor and normal tissue being quite distinct. Immunocytochemical diagnosis further confirmed it to be both PRL and TSH producing adenoma. Electron microscopy showed more than three different hormone-producing cells. The PRL cells contained large, and the TSH cells had small hormone granules; but some tumor cells contained secretory granules of both sizes suggesting production of both PRL and TSH in the cytoplasm. It is necessary in the management of patients like this, during the post-operative period, to adequately institute a thyroid hormone replacement therapy so as to prevent recurrence.

[Application of intravascular ultrasound imaging to carotid artery].

Although conventional angiography is utilized to assess the extent and severity of carotid artery disease, it yields only a silhouette of the vessel lumen. Intravascular ultrasound imaging (IUI), which has been developed for imaging the coronary artery, can supplement angiography by providing a tomographic perspective of the vessel wall structure. Therefore, we applied IUI (4.3F, 30MHz) to the carotid artery to evaluate the extent of arteriosclerosis, and we were successful in imaging the perspective of the carotid artery. Our results suggest that IUI is a useful device to evaluate the extent of atherosclerosis of the carotid artery.

[Three months angiographic follow-up after successful percutaneous transluminal angioplasty].

Percutaneous Transluminal Angioplasty (PTA) is applied to supra-aortic arteries. Although first follow-up angiography after coronary angioplasty is usually undergone three or four months later, there are few reports of follow-up angiography after PTA of supraaortic arteries. Because of this, we performed follow-up angiography three months after successful PTA on eight cases of stenosis in seven patients. Although no symptom due to restenosis occurred, it was shown to have occurred in one of four cases of internal carotid arterial stenosis. It was a case of ostial stenosis of a left common carotid artery. Restenosis occurred in neither two cases of subclavian arterial stenosis, nor in a case of left middle cerebral arterial stenosis. The overall restenosis rate was 25%. We suspect that it is important to perform a follow-up angiography after angioplasty of supra-aortic arteries, and our result suggests that the restenosis might occur before three months after PTA as well as after coronary angioplasty.

[Predictive factors for in-hospital mortality and delayed mortality following aneurysmal subarachnoid hemorrhage].

It is important to detect predictive factors for in-hospital and delayed mortality of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm. Forty-eight patients with initial bleeding of aneurysmal SAH were referred to our hospital from January 1982 to December 1985. In-hospital mortality was 16.7% (8 to 48), and 15% (6) of forty patients died later during the follow-up period. Using the Kaplan-Meier method we were able to conclude that, cumulatively, there was 70.8% probability that much patients would survive for 10 years. We analysed predictive factors of in-hospital and delayed mortality retrospectively. The most significant predictive factor for in-hospital mortality was SAH grading on admission, and for delayed mortality (29.2%) age on admission was the best predictive factor. In fact, two patients died with cardiac event during the follow-up period. This result suggests that, although the SAH grading on admission was the second most significant factor for delayed mortality, patients who survived in the acute phase had a survival probability similar to those in a normal control group.

[Immunohistochemical study on the expression of copper and zinc-superoxide dismutase (Cu, Zn-SOD) in human adenohypophysis and pituitary adenomas].

A location of copper and zinc- superoxide dismutase (Cu, Zn-SOD) in adenohypophysis and pituitary adenomas was examined with immunohistochemical technique. Pituitary adenomas include thirteen functioning, five nonfunctioning; functioning adenomas consist seven prolactinomas, four growth hormone (GH) secreting, two adrenocorticotropic hormone (ACTH) secreting adenomas. Three specimens of normal adenohypophysis were used for control study. The Cu, Zn-SOD was localized diffusely in the cytoplasm of normal adenohypophyseal cells and the tumor cells. Sometimes immunoreactive products of Cu, Zn-SOD revealed in the cytoplasm of endothelial cell, neutrophil, macrophage and the cell membrane of erythrocyte in the vessels. The content of Cu, Zn-SOD in normal adenohypophyseal cells and pituitary adenomas was markedly higher in normal cells than adenoma cells. No significant difference of the SOD content was observed not only in non-functioning adenoma but also in functioning adenoma cells including PRL, GH and ACTH cells.

[The correlation of immunohistochemical expression of human manganase-superoxide dismutase and outcome of the patients with medulloblastomas].

There in no clear indicator for making a prognosis in patients with medulloblastoma. The effects of adjuvant therapy on the tumor are exerted through free radicals that emerge in the cytoplasm of tumor cells following chemotherapy and/or radiotherapy. Thus, free radical scavengers, such as superoxide dismutase (SOD), in tumor cells may antagonize the effects of adjuvant therapy. In order to determine whether there is a correlation between SOD levels and the prognosis of medulloblastoma patients, SOD expression in tumor tissue was investigated immunohistochemically in eleven cases of medulloblastoma by using a polyclonal antibody against human manganase SOD. Abundant SOD was expressed in the tumors of patients with poor outcomes whereas there was little SOD expression in patients with good outcomes. This suggests that resistance to adjuvant therapy depends on the level of SOD in tumor tissue. The effect of adjuvant therapy on medulloblastoma depends on the production of oxygen free radicals. Thus, if the tumor cells contain free radical scavengers, such a SOD, the effects of adjuvant therapy may be reduced. Measurement of SOD in tumor tissue is useful as a prognostic indicator in medulloblastoma.

[Gonadotropin, as a tumor marker, in body fluid and tumor tissues of germ cell tumors].

The value of gonadotropin in the body fluids of germ cell tumor patients is its usefulness as a tumor marker. It is also used for differential diagnosis and/or judgement of therapeutic effects. In order to clarify the most effective value of gonadotropin as a tumor marker in the body fluids, we compared the value in serum, liquor and urine with one another. The liquor contained highest (1650 IU/l) value of gonadotropin in the primary intracranial germ cell tumors, mostly in choriocarcinoma. But the gonadotropin value was highest (3050 IU/l) in the serum of secondary intracranial choriocarcinoma. Chiasmal germ cell tumor, except choriocarcinoma, which does frequently secrete gonadotropin (alpha, beta) showed moderate or very high values in the liquor. However, pineal germ cell tumors rarely secrete gonadotropin and sometimes mild high value are obtained in the serum without gonadotropin secretion immunohistochemically. In such cases, the gonadotropin may be increased by indirect mechanism of gonadotropin-secretion following pineal disorder. In most of such cases, the gonadotropin was not human chorionic gonadotropin (HCG) but lutein hormone (LH). Because alpha-subunit of such gonadotropin has the same structure, their antibodies show immunologic cross reaction. So, a count of beta-subunit gonadotropin in the serum or liquor is the best way for differential diagnosis or judgement of therapeutic effects. From our results, it is considered that the tumor secretes HCG if the serum beta-HCG value was higher than 30 IU/l, and that it doesn't secrete HCG if beta-HCG value was lower than 10 IU/l or non calculable. The mild increased HCG may be caused by hypothalamo-diencephalic disorder such as pineal tumor.(ABSTRACT TRUNCATED AT 250 WORDS)