Prognostic value of novel biomarkers in astrocytic brain tumors: nuclear receptor co-regulators AIB1, TIF2, and PELP1 are associated with high tumor grade and worse patient prognosis.

Estrogen receptors alpha (ERα) and beta (ERß) and their co-regulatory proteins are key components of complex signaling networks that specifically regulate the growth and development of various tissues and tumors. Still, their protein expression profiles and possible role in the pathogenesis of astrocytic tumors remain largely unknown. The purpose of the present study is to evaluate the differential protein expression of ΕRα, ERß, and their co-activators, AIB1, TIF2, and PELP1 in astrocytic tumors of World Health Organization (WHO) grade II-IV, using immunohistochemistry. Potential correlations with clinicopathological parameters and patient prognosis were also explored. ERα protein expression was undetectable while ERß levels were significantly decreased with progression of tumor grade (P < 0.001). High expression of ERß was an independent favorable prognostic factor on multivariate analysis (P = 0.003). Expression of AIB1, TIF2, and PELP1 was not correlated with ERß expression and followed an opposite trend, with increasing levels in high-grade relative to low-grade tumors (P < 0.001). Univariate survival analysis revealed that high AIB1, TIF2, and PELP1 expression was associated with worse prognosis (P = 0.049, P = 0.033, and P = 0.020, respectively). ERß and ER co-activators AIB1, TIF2, and PELP1 appear to play an important role in the pathogenesis and progression of astrocytic tumors and might have prognostic significance. The mechanisms underlying their involvement in astrocytic tumorigenesis, as well as their utility for prognostic and therapeutic purposes merit further investigation.

Altered cellular distribution and subcellular sorting of gamma-tubulin in diffuse astrocytic gliomas and human glioblastoma cell lines.

Centrosome amplification is a pivotal mechanism underlying tumorigenesis but its role in gliomas is underinvestigated. The present study specifically examines the expression and distribution of the centrosome-associated cytoskeletal protein gamma-tubulin in 56 primary diffuse astrocytic gliomas (grades II-IV) and in 4 human glioblastoma cell lines (U87MG, U118MG, U138MG, and T98G). Monoclonal anti-peptide antibodies recognizing epitopes in C-terminal or N-terminal domains of the gamma-tubulin molecule were used in immunohistochemical, immunofluorescence, and immunoblotting studies. In tumors in adults (n = 46), varying degrees of localization were detected in all tumor grades, but immunoreactivity was significantly increased in high-grade anaplastic astrocytomas and glioblastomas multiforme as compared to low-grade diffuse astrocytomas (p = 0.0001). A similar trend was noted in diffuse gliomas in children but the sample of cases was too small as to be statistically meaningful. Two overlapping patterns of ectopic cellular localization were identified in both primary tumors and glioblastoma cell lines: A punctate pattern, in which gamma-tubulin was partially co-distributed with pericentrin in the pericentriolar region, and a diffuse pattern, independent of pericentrin staining, denoting a soluble pool of gamma-tubulin. Cellular gamma-tubulin was detected in both soluble and insoluble (nocodazole-resistant) fractions of glioblastoma cells. Divergent localizations of gamma-tubulin and pericentrin suggest a differential distribution of these 2 centrosome-associated proteins in glioblastoma cell lines. Our results indicate that overexpression and ectopic cellular distribution of gamma-tubulin in astrocytic gliomas may be significant in the context of centrosome protein amplification and may be linked to tumor progression and anaplastic potential.

Neurilemoma of the popliteal fossa: report of two cases with long subclinical course and misleading presentation.

The authors report two cases of neurilemoma localised in the popliteal fossa. Both patients experienced non-specific symptoms, such as painful numbness and burning dysaesthesia, involving the lower extremity. Tinel's sign was positive over the popliteal fossa. The patients sought medical advice and underwent conservative treatment without any relief, for a long time before the right diagnosis was made. Magnetic resonance imaging revealed in both patients a well- circumscribed mass posterior to the sciatic nerve, occupying the popliteal fossa. Following surgical excision of the neurilemoma, the patients experienced immediate relief of their chronic symptoms. In similar situations, ultrasound or magnetic resonance imaging of the whole sciatic nerve should be performed if this is indicated by detailed physical examination. Once the diagnosis is made, neurilemomas should be surgically removed, in order to exclude malignancy, prevent neurologic deficits and provide relief of symptoms.

Atlantoaxial instability and myelopathy due to an ossiculum terminale persistens.

BACKGROUND: Many cases of ossiculum terminale in Down's syndrome have been reported. We describe an unusual case of sudden atlantoaxial instability in a previously healthy woman without a history of trauma due to a dystopic ossiculum of the dens that could be classified as an ossiculum terminale persistens or as os odontoideum according to different classification proposals. CASE REPORT: A 36-year-old woman was admitted with neck pain and Lhermitte's sign. Neurological examination revealed spasticity of both upper and lower limbs. Radiological evaluation of the cervical spine showed an ossiculum close to the anterior arch of the atlas. Flexion and extension films revealed an atlantoaxial instability. Additional findings using computerized tomography and magnetic resonance Imaging provided significant information about the soft tissue structures. The patient underwent a C1-C2 posterior cervical wiring and interspinous fusion with the Sonntag technique. Postoperatively, the patient was neurologically intact and without any symptoms. CONCLUSIONS: In the present report we address the notion that, in cases of atlantoaxial instability and myelopathy due to a dens anomaly, surgical intervention is required and that there is no need to distinguish which type of anomaly really exists according to different classification schemes.

Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique.

STUDY DESIGN: A case of a multisegmental, cervicothoracolumbar epidural abscess, in an 80-year-old man, successfully decompressed by using a minimally invasive technique, is presented. OBJECTIVE: To review risk factors, diagnosis, treatment, decompression techniques, and morbidity and mortality regarding spinal epidural abscess. SUMMARY OF BACKGROUND DATA: Extended spinal epidural abscess is a rate entity. To our knowledge, this is the first report of a multilevel spinal epidural abscess, completely decompressed by limited laminectomies in combination with the use of a silicon catheter, epidurally. METHODS: The clinical and radiographic features associated with spinal epidural abscess, as well as decompression technique, are presented. The 80-year-old man, with a one week history of urinary tract infection, presented with fever and low back pain, mild weakness in his legs and jaundice. He underwent bilateral limited laminectomies at T2-T3 and a right hemilaminectomy at L1-L2 and the pus was drained, under mild continuous suction, using a 2.7 mm outer and 1.3 mm inner diameter silicon catheter, inserted caudally and cranially into the epidural space, at both the laminectomy sites. RESULTS: The patient experienced immediate relief of the low back pain, gradual fever subsidence and full neurological recovery during the next 3 weeks. CONCLUSION: In cases of suspected acute epidural abscess, especially in elderly debilitating patients: the whole spine should be scanned by MRI to exclude the possibility of multilevel involvement and adequate pus drainage, when indicated, could be performed with the above described minimally invasive technique.