RESUMO
Photodynamic therapy (PDT) induces selective cell death of neoplastic tissue and connecting vasculature by combining photosensitizers with light. Here we clarified the types of cell death induced by PDT in combination with the photosensitizer talaporfin sodium (mono-L-aspartyl chlorine e6, NPe6) in order to evaluate the potential of this therapy as a treatment for glioma. PDT with NPe6 (NPe6-PDT) induces dose-dependent cell death in human glioblastoma T98G cells. Specifically, cell death modalities were observed in NPe6-PDT treated T98G cells, including signs of apoptosis (activation of caspase-3, expression of phosphatidylserine, and DNA fragmentation) and necrosis (stainability of propidium iodide). In addition, high doses of NPe6-PDT decreased the proportion of apoptotic cell death, while increasing necrosis. Closer examination of apoptotic characteristics revealed release of cytochrome-c from mitochondria as well as activation of both caspse-9 and caspase-3 in cells treated with low doses of NPe6-PDT. Benziloxycarbonyl-Leu-Gln(OMe)-His-Asp(OMe)-fluoromethyl-ketone (Z-LEHD-fmk), a caspase-9 specific inhibitor, and benziloxycarbonyl-Asp(OMe)-Gln-Met-Asp(OMe)-fluoromethyl-ketone (Z-DQMD-fmk), a caspase-3 specific inhibitor, showed dose-dependent prevention of cell death in NPe6-PDT treated cells, indicating that mitochondrial apoptotic pathway was a factor in the observed cell death. Further, the cell morphology was observed after PDT. Time- and NPe6-dose dependent necrotic features were increased in NPe6-PDT treated cells. These results suggest that NPe6-PDT could be an effective treatment for glioma if used in mild doses to avoid the increased necrosis that may induce undesirable obstacles.
Assuntos
Antineoplásicos/administração & dosagem , Neoplasias Encefálicas/tratamento farmacológico , Glioma/tratamento farmacológico , Fotoquimioterapia , Fármacos Fotossensibilizantes/administração & dosagem , Porfirinas/administração & dosagem , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Caspase 3/metabolismo , Morte Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Citocromos c/metabolismo , Fragmentação do DNA , Glioma/metabolismo , Glioma/patologia , Humanos , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Necrose/induzido quimicamente , Necrose/metabolismo , Necrose/patologiaRESUMO
BACKGROUND: Oculomotor ophthalmoplegic migraine (O-OPM) occurs in many children, and in some cases MRI shows a small mass in the root exit zone (REZ) of the oculomotor nerve. This mass is considered to result from nerve hypertrophy caused by repeated demyelination. CASE RESULTS: A 51-year-old man has been on oral medication for O-OPM, which he had from 6 years of age. However, the frequency and intensity of his migraine attacks have gradually increased. Brain magnetic resonance imaging (MRI) revealed a small nodular mass in the REZ of the oculomotor nerve. The mass was initially diagnosed as oculomotor schwannoma and tumor resection was attempted. However, as the mass was tightly adhered to the oculomotor nerve and hemorrhagic, biopsy was performed. The pathological diagnosis was neuromuscular hamartoma. CONCLUSION: The small nodular mass in the REZ of the oculomotor nerve may be a hamartoma associated with congenital factors and may possibly be the primary pathology of O-OPM in this case.
Assuntos
Hamartoma/complicações , Neurilemoma/complicações , Doenças do Nervo Oculomotor/complicações , Nervo Oculomotor/patologia , Enxaqueca Oftalmoplégica/etiologia , Hamartoma/patologia , Hamartoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/patologia , Neurilemoma/cirurgia , Nervo Oculomotor/cirurgia , Doenças do Nervo Oculomotor/patologia , Doenças do Nervo Oculomotor/cirurgiaRESUMO
INTRODUCTION: The study aims to describe the endocrinological and magnetic resonance imaging (MRI) features of the rarely reported xanthogranulomas associated with pituitary adenoma. METHODS: Of 231 consecutive pituitary adenomas treated surgically, those with xanthogranulomatous reaction on histology were reviewed. RESULTS: Five patients (2.2%) had an adenoma with marked xanthogranulomatous reaction. They were all nonfunctioning macroadenomas and presented with anterior pituitary insufficiencies. On MRI, all adenomas showed mixed signal intensities on T1- and T2-weighted images with heterogeneous gadolinium enhancement, reflecting their complex histological features: Cholesterol clefts typically showed T1 high- and T2 low-signal intensities. Preoperative diagnosis was difficult in a case predominantly featuring xanthogranuloma. Although none of them had episodes of pituitary apoplexy, hemosiderin deposits and cysts with xanthochromic-like fluid were observed in five and four cases, respectively. CONCLUSIONS: Xanthogranulomatous reaction may develop in macroadenomas, probably triggered by hemorrhagic processes despite no apoplectic episodes. They typically exhibit complex mixed signal intensity on MRI, particularly T1 high- and T2 low-signal intensities, and patients present with pituitary dysfunction.
Assuntos
Adenoma/complicações , Adenoma/diagnóstico , Granuloma/complicações , Granuloma/diagnóstico , Imageamento por Ressonância Magnética/métodos , Hormônios Hipofisários/sangue , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Adenoma/sangue , Adulto , Idoso , Feminino , Granuloma/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangueRESUMO
BACKGROUND: Cerebellar infarction of childhood is rare, and is difficult in pathological diagnosis. We describe a case of radiographically diagnosed primary central nervous system angiitis of childhood. SUMMARY: A 7-year-old boy experienced dizziness and headache persisting for 7 days. Diffusion-weighted images of magnetic resonance (MR) showed high signals in the left cerebellar hemisphere and vermis. The MR angiogram (MRA) findings were normal. A conventional angiogram demonstrated severe stenoses and occlusions at distal portion of left posterior inferior cerebellar artery, and irregularity in the wall of the cervical portion of the left vertebral artery (VA). Although he recovered without any neurologic deficits, an angiogram 3 months after admission showed occlusion at the cervical portion of left VA and filling of the distal VA with collateral arteries from the deep cervical artery. He was doing well, with no additional changes demonstrated on MRA, 12 months after the onset. CONCLUSION: Although MRA can detect abnormality within the proximal intracranial vessels, angiography is essential, especially in cases with distal stenoses. Repeated angiography in primary central nervous system angiitis of childhood is necessary at least 3 months after the onset, even if the patient has no symptom.
Assuntos
Infarto Encefálico/etiologia , Doenças Cerebelares/etiologia , Cerebelo/irrigação sanguínea , Circulação Cerebrovascular , Vasculite do Sistema Nervoso Central/diagnóstico , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/fisiopatologia , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/fisiopatologia , Angiografia Cerebral/métodos , Criança , Constrição Patológica , Imagem de Difusão por Ressonância Magnética , Tontura/etiologia , Cefaleia/etiologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Fatores de Tempo , Vasculite do Sistema Nervoso Central/complicações , Vasculite do Sistema Nervoso Central/diagnóstico por imagem , Vasculite do Sistema Nervoso Central/fisiopatologia , Artéria Vertebral/diagnóstico por imagemRESUMO
PURPOSE: Trigeminal schwannomas extending into the deep parapharyngeal space are relatively rare, and a surgical approach to such tumors has not been well established. We report four cases in which the tumors were completely removed by using a combination of three approaches. METHODS: Four patients with trigeminal schwannomas extending into the extracranial space were surgically treated using a combination of the transcervical approach, anterolateral retromaxillar pathway via gingivobuccal sulcus, and epi and interdural middle fossa approach. RESULTS: The maximum diameters of the tumors ranged from 4 to 7 cm. Three tumors extended beyond the lower end of the maxillary sinus. All tumors were completely excised. The Karnofsky performance scales after surgery were more than 90% in all patients. CONCLUSION: Although the tumors extending to the deep parapharyngeal space are difficult to completely remove via a single approach, a combined approach is useful in these huge extracranial extensions.
Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Faringe/cirurgia , Doenças do Nervo Trigêmeo/cirurgia , Nervo Trigêmeo/cirurgia , Adulto , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/cirurgia , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/fisiopatologia , Craniotomia/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Maxila/anatomia & histologia , Maxila/cirurgia , Seio Maxilar/anatomia & histologia , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Boca/anatomia & histologia , Boca/cirurgia , Pescoço/anatomia & histologia , Pescoço/cirurgia , Neurilemoma/patologia , Neurilemoma/fisiopatologia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Faringe/patologia , Complicações Pós-Operatórias/epidemiologia , Procedimentos de Cirurgia Plástica/métodos , Espaço Subdural/anatomia & histologia , Espaço Subdural/cirurgia , Resultado do Tratamento , Nervo Trigêmeo/patologia , Doenças do Nervo Trigêmeo/patologia , Doenças do Nervo Trigêmeo/fisiopatologiaRESUMO
OBJECTIVE: Repair of a cerebrospinal fluid (CSF) leak after transsphenoidal surgery (TSS) is usually accomplished using various graft materials. These methods are effective in most, but not all, cases. METHODS: Since 2006, we have been directly suturing the sellar floor dura in patients with an intraoperative CSF leak. Fat and/or fascial grafts were utilized only when a major CSF leak developed. The incidence of postoperative CSF rhinorrhea was compared before and after the suture. RESULTS: Postoperative CSF rhinorrhea developed in 3.7% (7 out of 188) of cases before 2005, but never since the dural suture was introduced (0 out of 136, 0%; P = 0.0229). Although watertight closure was not achieved in some cases, narrowing the dural defect and supporting the intrasellar graft was attained in every case. Surgical time was approximately 30 min longer in patients who underwent dural suture (148 +/- 42 min) than those who did not (119 +/- 37 min; P = 0.0001). CONCLUSION: Direct suturing of the sellar dura is a simple, safe, and reliable surgical technique for repairing CSF leaks after TSS. Using this procedure, more than 70% of patients with an intraoperative CSF leak can avoid autologous tissue grafts.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Dura-Máter/cirurgia , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Osso Esfenoide/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Criança , Dura-Máter/anatomia & histologia , Dura-Máter/lesões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/anatomia & histologia , Cavidade Nasal/lesões , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Sela Túrcica/anatomia & histologia , Sela Túrcica/lesões , Sela Túrcica/cirurgia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/lesões , Técnicas de Sutura , Transplante de Tecidos/métodos , Resultado do Tratamento , Adulto JovemRESUMO
We encountered 2 patients with germinoma arising from the medulla oblongata in whom preoperative radiological diagnosis was difficult. A 30-year-old woman presented due to aspiration pneumonia caused by bilateral lower cranial nerve palsies, and a 24-year-old man presented with headache caused by obstructive hydrocephalus. In both patients, there was a midline tumor that extended from the lower part of the fourth ventricle to the C1 lamina level. It was well-demarcated and homogeneously enhanced tumor with a slightly high density on plain CT scan. The preoperative diagnosis for both patients was ependymoma. The former patient had persistent lower cranial nerve palsies due to brain stem injury after tumor resection. Both patients achieved complete remission with adjuvant therapy. Fewer than 10 cases of germinoma affecting the medulla oblongata have been reported. Radiological findings resembling those of the pineal region germinoma were observed in the two patients reported here. We would like to stress the importance of remembering germinoma when making a preoperative differential diagnosis of fourth ventricular tumors in young adults.
Assuntos
Germinoma/diagnóstico , Neoplasias Infratentoriais/diagnóstico , Bulbo/patologia , Adulto , Feminino , Germinoma/diagnóstico por imagem , Humanos , Neoplasias Infratentoriais/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Masculino , Bulbo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Hyponatremia is common after aneurysmal subarachnoid hemorrhage (SAH). It is caused by natriuresis, which induces osmotic diuresis and decreases blood volume, contributing to symptomatic cerebral vasospasm (SCV). Hypervolemic therapy to prevent SCV will not be efficient under this condition. We conducted a randomized controlled trial to assess the efficacy of hydrocortisone, which promotes sodium retention in the kidneys. METHODS: Seventy-one SAH patients were randomly assigned after surgery to treatment with either a placebo (n=36) or 1200 mg/d of hydrocortisone (n=35) for 10 days and tapered thereafter. Both groups underwent hypervolemic therapy. The primary end point was the prevention of hyponatremia. RESULTS: Hydrocortisone prevented excess sodium excretion (P=0.04) and urine volume (P=0.04). Hydrocortisone maintained the targeted serum sodium level throughout the 14 days (P<0.001), and achieved the management protocol with lower sodium and fluid (P=0.007) supplementation. Hydrocortisone kept the normal plasma osmolarity (P<0.001). SCV occurred in 9 patients (25%) in the placebo group and in 5 (14%) in the hydrocortisone group. No significant difference in the overall outcome was observed between the 2 groups. CONCLUSIONS: Hydrocortisone overcame excess natriuresis and prevented hyponatremia. Although there was no difference in outcome, hydrocortisone supported efficient hypervolemic therapy.
Assuntos
Hidrocortisona/administração & dosagem , Hiponatremia/tratamento farmacológico , Hipovolemia/prevenção & controle , Natriurese/efeitos dos fármacos , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Feminino , Humanos , Hidrocortisona/efeitos adversos , Hiponatremia/metabolismo , Hiponatremia/fisiopatologia , Hipovolemia/etiologia , Hipovolemia/fisiopatologia , Rim/efeitos dos fármacos , Rim/metabolismo , Masculino , Pessoa de Meia-Idade , Natriurese/fisiologia , Sódio/sangue , Sódio/urina , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/fisiopatologia , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/fisiopatologiaRESUMO
A 27-year-old woman presented with ectopic recurrence manifesting as an asymptomatic mass in the left frontal convexity 5 years after subtotal removal of suprasellar craniopharyngioma through a right orbitozygomatic craniotomy. The mass had enlarged gradually over the next 5 years, so a second operation was performed for total removal. The histological diagnoses of both lesions were adamantinomatous type craniopharyngioma with MIB-1 indexes of 4.2% and 7.4%. The second lesion probably resulted from dissemination. Craniopharyngioma is a benign tumor, and ectopic recurrence is rare. Long-term clinical and neuroimaging follow up is recommended.
Assuntos
Craniofaringioma/patologia , Lobo Frontal/patologia , Neoplasias Hipofisárias/patologia , Adolescente , Feminino , Humanos , Invasividade Neoplásica , RecidivaRESUMO
A 48-year-old woman with a history of viral influenza infection was admitted with rapidly progressive numbness and weakness of the right extremities. On admission, general physical examination revealed no abnormality. Cerebrospinal fluid analysis showed no abnormal findings. Brain computed tomography and magnetic resonance imaging showed an open ring-like enhanced lesion in the white matter of the right parietal lobe with massive perifocal edema. Cerebral angiography showed no tumor staining and thallium-201 single photon emission computed tomography showed no abnormal uptake. The preoperative diagnosis was malignant glioma and partial resection was performed. Histological examination showed perivascular accumulation of small lymphocytes and a large number of macrophages with reactive astrocytes. Phagocytosis of myelin was observed in the macrophages and nuclear fragmentation in the reactive astrocytes. The histological diagnosis was acute inflammatory demyelinating disease. After therapy with methylprednisolone, her neurological symptoms improved gradually and no relapse occurred during 18 months of follow up. Tumor-like masses of demyelination may occupy an intermediate position between acute multiple sclerosis and postinfectious encephalitis. Open ring sign may be a pathognomonic feature of these lesions.
Assuntos
Encéfalo/patologia , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/patologia , Inflamação/complicações , Inflamação/patologia , Encéfalo/cirurgia , Doenças Desmielinizantes/cirurgia , Feminino , Humanos , Linfócitos/patologia , Macrófagos/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Cuidados Pré-OperatóriosRESUMO
Metabolism of amyloid-beta peptide (Abeta) is closely associated with the pathology and etiology of Alzheimer's disease (AD). Since neprilysin is the only rate-limiting catabolic peptidase proven by reverse genetics to participate in Abeta metabolism in vivo, we performed detailed immunohistochemical analysis of neprilysin in mouse brain using neprilysin-deficient mice as a negative control. The aim was to assess, at both the cellular and subcellular levels, where Abeta undergoes neprilysin-dependent degradation in the brain and how neprilysin localization relates to Abeta pathology in amyloid precursor protein (APP)-transgenic mice. In hippocampus, neprilysin was present in the stratum pyramidale and stratum lacunosum-moleculare of the CA1-3 fields and the molecular layer of the dentate gyrus. Confocal double immunofluorescence analyses revealed the subcellular localization of neprilysin along axons and at synapses. This observation suggests that after synthesis in the soma, neprilysin, a type II membrane-associated protein, is axonally transported to the terminals, where Abeta degradation is likely to take place. Among various cell types, GABAergic and metabotropic glutamate 2/3 receptor-positive neurons but not catecholaminergic or cholinergic neurons, expressed neprilysin in hippocampus and neocortex, implying the presence of a cell type-specific mechanism that regulates neprilysin gene expression. As expected, Abeta deposition correlated inversely with neprilysin expression in TgCRND8 APP-transgenic mice. These observations not only support the notion that neprilysin functions as a major Abeta-degrading enzyme in the brain but also suggest that down-regulation of neprilysin activity, which may be caused by aging, is likely to elevate local concentrations of Abeta at and around neuronal synapses.
Assuntos
Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Axônios/metabolismo , Encéfalo/metabolismo , Endopeptidases/metabolismo , Proteínas de Membrana Transportadoras , Neprilisina/metabolismo , Sinapses/metabolismo , Proteínas de Transporte Vesicular , Doença de Alzheimer/patologia , Doença de Alzheimer/fisiopatologia , Precursor de Proteína beta-Amiloide/genética , Precursor de Proteína beta-Amiloide/metabolismo , Animais , Axônios/patologia , Encéfalo/patologia , Encéfalo/fisiopatologia , Proteínas de Transporte/metabolismo , Glutamato Descarboxilase/metabolismo , Hipocampo/metabolismo , Hipocampo/patologia , Imuno-Histoquímica , Isoenzimas/metabolismo , Masculino , Glicoproteínas de Membrana/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteínas Associadas aos Microtúbulos/metabolismo , Neocórtex/metabolismo , Neocórtex/patologia , Proteínas do Tecido Nervoso/metabolismo , Placa Amiloide/metabolismo , Placa Amiloide/patologia , Receptores de Glutamato Metabotrópico/metabolismo , Sinapses/patologia , Sinaptofisina/metabolismo , Tirosina 3-Mono-Oxigenase/metabolismo , Proteínas Vesiculares de Transporte de AcetilcolinaRESUMO
Distinction of gliomatosis cerebri (GC), a rare entity characterized by a widespread infiltration of the brain by tumor, from diffuse glioma is a difficult clinical problem. Most previously reported cases of GC have been autopsy cases because of the lack of objective and quantitative clinical diagnostic criteria. In order to better define this entity, we report the neuroradiological and pathological findings of three cases of GC. Three patients (one man and two women, aged 46-71 years) presented with symptoms of mild increased intracranial pressure, cognitive impairment, or seizure. Magnetic resonance imaging (MRI) was done with T1-weighted images after gadolinium injection, and with T2-weighted images and fluid attenuated inversion recovery (FLAIR) in all cases. Histological confirmation of glial proliferation was obtained in all cases by craniotomy. The topography of the tumoral infiltration was characteristic, involving mainly the white matter, basal ganglia, thalamus, and commissural fibers. More than two cerebral lobes were affected. Contrast enhancement was absent, and mass effects were minimal compared with the extent of tumoral infiltration, but one patient presented with a small frontal enhanced mass during the clinical course. The pathological analyses demonstrated infiltration of the brains by variably differentiated neoplastic glial cells with destruction of the myelin sheath, but the involved axis cylinder and neuronal cells were preserved. Diagnosis of GC should be faithful to the pathological diagnosis criteria of Scheinker and Evans, and therefore the precise assessment of MRI findings according to these criteria is required for clinical, antemortem diagnosis of GC.
Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Neuroepiteliomatosas/patologia , Idoso , Neoplasias Encefálicas/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Neuroepiteliomatosas/diagnóstico por imagem , Neoplasias Neuroepiteliomatosas/fisiopatologia , RadiografiaRESUMO
Since malignant glioma displays moderate resistance to conventional therapy, a new treatment modality is needed to improve the outcome of patients with these tumors. In this study, we examined whether combination stimulation with interferon alpha (IFN-alpha) and retinoic acid (RA) affected proliferation of the glioblastoma cell line GB 12 in vitro. Stimulation with IFN-alpha alone inhibited the GB 12 cell proliferation in a dose/time-dependent fashion, as assessed by WST-1 assay and uptake of 3H-thymidine, while RA limited it only slightly. The anti-proliferative action of IFN-alpha against glioblastoma cells was enhanced by the addition of RA. The IFN-alpha/RA combination also induced apoptosis in a substantial portion of the cells, compared with either reagent alone. Bcl-2 family proteins, regulating apoptosis, were altered by these stimuli: Bcl-2 was down-regulated, while Bax-alpha was up-regulated, especially by the combination. These findings suggest that the IFN-alpha/RA combination would synergistically affect glioblastoma cell growth, probably through apoptosis induction as well as a decreased cellular DNA synthesis.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Neoplasias Encefálicas/tratamento farmacológico , Divisão Celular/efeitos dos fármacos , Glioblastoma/tratamento farmacológico , Interferon-alfa/administração & dosagem , Tretinoína/administração & dosagem , Apoptose/efeitos dos fármacos , Apoptose/fisiologia , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/fisiopatologia , Divisão Celular/fisiologia , Relação Dose-Resposta a Droga , Glioblastoma/metabolismo , Glioblastoma/fisiopatologia , Humanos , Proteínas Proto-Oncogênicas/efeitos dos fármacos , Proteínas Proto-Oncogênicas/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Tempo de Reação/efeitos dos fármacos , Tempo de Reação/fisiologia , Timidina/metabolismo , Trítio , Células Tumorais Cultivadas , Proteína X Associada a bcl-2RESUMO
BACKGROUND: In comparison to prolactinomas in women, those in men are usually large tumors and have been suggested to have a higher proliferation activity. To elucidate the reason for the predominance of large tumors in men, we investigated the gender-related difference of prolactinomas including growth potential. METHODS: We conducted a retrospective study comparing unselected 16 men and 27 women with prolactinoma concerning clinical and endocrine findings, tumor volume, and the mean Ki-67 (MIB-1) positive cell index (PCI). RESULTS: Prolactinomas in men were larger in size (p = 0.0090), higher in serum prolactin level (p = 0.0359), and exhibited higher PCI (p = 0.0138) than those in women. However, the three factors-tumor volume, prolactin level, and the PCI-showed positive correlations with each other. There was no gender-related difference in the PCI when small tumors (<1.0 cm3) were excluded. CONCLUSION: High PCI is associated with large tumors in both men and women. Because large tumors predominate in men, this is in fact consistent with the view that the biologic behavior of prolactinomas is different between the sexes.
Assuntos
Estadiamento de Neoplasias , Neoplasias Hipofisárias/patologia , Prolactina/sangue , Prolactinoma/patologia , Adolescente , Adulto , Progressão da Doença , Feminino , Humanos , Antígeno Ki-67/análise , Masculino , Pessoa de Meia-Idade , Prolactina/farmacologia , Estudos Retrospectivos , Fatores SexuaisRESUMO
The hypothesis that genetic factors play a role in the genesis of cerebral aneurysms may be supported by clinical analysis of cerebral aneurysms in identical twins. In addition to reporting the present case, we review the literature on clinical features and genetical considerations in this matter. A forty-two-year-old male presented with subarachnoid hemorrhage (SAH) due to a left MCA aneurysm. At the age of 39, his identical twin brother also had SAH due to a ruptured left MCA aneurysm. This identical twin brother and his father's sisters died of SAH. Venous blood of the patient and his parents was collected to determine apolipoprotein E, angiotensinogen, angiotensin-converting enzyme, and very low density lipoprotein receptor genes. This analysis suggested a strong genetic association of apolipoprotein E epsilon4 with the pathogenesis. Including our cases, 13 cases of cerebral aneurysms in identical twins have been reported. There was a total of 37 aneurysms. Six twins had the same sites of aneurysm. These aneurysms show a tendency to be small in size, and to cause a high frequency of SAH occurring at a similar age. In young adults, cerebral aneurysms in identical twins tend to rupture. A screening diagnosis should be carried out as early as possible on an asymptomatic twin when the other has been discovered to have a ruptured cerebral aneurysm. Preventive treatment and systemic genome-wide linkage study should be conducted.
Assuntos
Aneurisma Roto/genética , Doenças em Gêmeos , Aneurisma Intracraniano/genética , Gêmeos Monozigóticos , Adulto , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Apolipoproteínas E/genética , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Masculino , Polimorfismo Genético , Ruptura Espontânea , Hemorragia Subaracnóidea/etiologia , Resultado do TratamentoRESUMO
In contrast to aneurysms of the middle cerebral artery at the bifurcation, aneurysms at the origin of the lenticulostriate arteries (LSA) are uncommon. Six surgically treated patients (34 to 70 year-old; 3 men, 3 women) were reviewed. 5 patients presented with subarachnoid hemorrhage (H&H grade 2:3, 3:1, 4:1; Fisher type 2:1, 3:3, 4:1) and 2 patients had multiple aneurysms. All aneurysms arose from the postero-superior surface of the M1. Although neck clipping was achieved in every patient, re-application of the clip was necessary during surgery in 3 patients because the tip of the blade extended to the other perforators that ran parallel to the M1. Results were as follows: GR 3, MD1, SD 1, D1. Apart from a 70 year-old patient who died of vasospasm (H & H 4), fair results in two patients were accompanied by ischemic complications of the LSA. All 3 patients who required re-application of the clip during surgery showed a lacunar infarct of perforating arteries on post-operative CT. Special care of perforating arteries not only around the neck (the LSA) but also behind the aneurysm is essential for successful neck-clipping of aneurysms at this location.
Assuntos
Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Adulto , Idoso , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Radiografia , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
A 33-year-old man was admitted to our hospital with a sudden severe headache five days after the onset CT scan showed a slight high-density area in the basal cistern, mimicking subarachnoid hemorrhage (SAH), and diffuse brain swelling. However, conventional cerebral angiography and CT angiography failed to demonstrate aneurysms and vascular malformations. MRI showed bilateral subdural hematoma, but no SAH. Irrigation of liquefied subdural hematoma, causing high intracranial pressure, was carried out. Postoperative course was uneventful and his headache resolved within a day. The author presented a case of bilateral chronic subdural hematoma who presented with a sudden severe headache mimicking a SAH. Hyper attenuation in the basal cistern and subarachnoid space in CT, don't always indicate SAH. MRI, including fluid-attenuated inversion recovery (FLAIR) sequences, is useful in differentiating the "pseudo" SAH from "true" SAH, and lead to the right diagnosis.
Assuntos
Hematoma Subdural Crônico/diagnóstico , Hemorragia Subaracnóidea/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
The purpose of the study was to investigate the pathological and clinical significance of the expression of nestin, a type-VI intermediate filament transiently expressed during brain development, in glioma tissue. This study was conducted in 70 patients with newly diagnosed adult supratentorial gliomas who underwent multimodality treatment in our department, including surgery. The pathological diagnosis was grade II in 6 patients, grade III in 21 patients, and grade IV in 43 patients. Two specimen sections, one from the bulk of the removed tumor and one from the border between the tumor and normal brain tissue, were subjected to immunostaining with a mouse anti-human nestin monoclonal antibody. Analyses were performed to investigate possible correlation with pathological features, the relationship between nestin expression and the continuity of tumor with the subventricular zone (SVZ), correlation with the therapeutic prognosis, etc. Nestin was expressed specifically in astrocytoma lineage cells. In oligodendroglial tumors, nestin was expressed only in less-differentiated cells and cells suggestive of the presence of astrocytoma. In astrocytic tumors, the rate and level of nestin expression increased as the degree of malignancy increased. There was no significant correlation between the expression level of nestin and the continuity of tumor with the SVZ in the contrast-enhanced imaging before surgery. In addition, no correlation with the therapeutic prognosis was observed. Nestin, a neural stem cell marker, was specifically expressed in astrocytoma lineage cells in glioma tissue. A positive correlation was observed between the degree of malignancy and the level of nestin expression. However, the level of nestin expression was not related to the tumor localization in the SVZ and was not correlated with the therapeutic prognosis.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Glioma/diagnóstico , Glioma/patologia , Nestina/análise , Células-Tronco Neurais/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Astrocitoma/diagnóstico , Astrocitoma/patologia , Feminino , Humanos , Imuno-Histoquímica , Ventrículos Laterais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Adulto JovemRESUMO
A 32-year-old man presented with a rapidly progressive decrease in visual acuity and diplopia. Magnetic resonance imaging (MRI) revealed a suprasellar cystic mass extending to the upper part of the clivus. The content of this cyst showed a slightly higher signal intensity than that of his cerebrospinal fluid (CSF) on T1-weighted images. The cyst stretched the pituitary stalk, but a normal pituitary signal was observed. The cyst wall was maximally resected under neuroendoscopy, which yielded fluid contents that were white and mucous like, with a carcinoembryonic antigen (CEA) level 1,400 ng/ml or higher. On light microscopy, one to two layers of epithelial cells with cylindrical nuclei on loose connective tissue lined the cyst cavity. These cells were positive for periodic acid-Schiff, CEA, and cytokeratin 7 and negative for cytokeratin 20. On electron microscopy, epithelial cells showed many short microvilli with coating material. The cytoplasm was rich in electron-dense material, and dense intercellular adhesion was observed, but neither goblet cells nor cilia were present. On the basis of MRI features, cytokeratin expression patterns and electron microscopic findings, the patient was considered to have a suprasellar endodermal cyst derived from Seessel's pouch.
Assuntos
Biomarcadores Tumorais/análise , Antígeno Carcinoembrionário/análise , Cistos do Sistema Nervoso Central/patologia , Bolsas Cólicas , Adulto , Cistos do Sistema Nervoso Central/química , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/ultraestrutura , Progressão da Doença , Humanos , Queratinas/análise , Imageamento por Ressonância Magnética , MasculinoRESUMO
OBJECTIVE: To investigate the kinetics of cell death in human glioma cell lines induced by photodynamic therapy (PDT) with the second-generation photosensitizer talaporfin sodium (TS) and a 664-nm diode laser. MATERIALS AND METHODS: Three human glioma cell lines (T98G, A172, U251) were studied. After incubation of the cell lines with various concentrations of TS for 4 h, PDT using diode laser irradiation at 33 mW/cm² and 10 J/cm² was performed. Cell viability and changes in cell morphology were examined by the Cell Counting Kit-8 assay and phase-contrast microscopy, respectively. In addition, to evaluate the pathology of cell death, changes in cell viability after treatment with a caspase activation inhibitor and an autophagy inhibitor were also examined. RESULTS: In all 3 human glioma cell lines, TS induced dose-dependent cell death. However, the 50% lethal dose of TS varied among these cell lines. The main morphological feature of cell death was shrinkage of the cell body, and the number of cells with this morphological change increased in a time-dependent manner, resulting in cell death. In addition, a dose-dependent improvement in cell viability by the caspase inhibitor Z-VAD-fmk was observed. CONCLUSION: PDT with TS induces dose-dependent apoptosis in human glioma cell lines. However, the sensitivity to PDT varied among the cell lines, indicating a possible difference in the intracellular content of TS, or a difference in the susceptibility to the intracellular oxidative stress caused by PDT.