RESUMEN
A 54 year old man was referred to the department of neurosurgery for frontal headache and vomiting. The patient was known in the department because of previous multiple surgery for a locally invasive pituitary prolactinoma (eight years, three years, and one year previously). The neurological examination revealed a frontal mass, which adhered to the dura, suggesting a meningioma. One year later, a left temporal metastasis was removed. Three months later, the patient died, with spinal metastases, of massive lung embolism. Histology revealed a progression of adenohypophyseal prolactinoma on neuroendocrine carcinoma, with an increase in proliferating indexes and modification of hormone production. This study documents a 10 year history of a rare prolactin producing pituitary carcinoma, which metastasised via liquoral flow.
Asunto(s)
Carcinoma Neuroendocrino/secundario , Recurrencia Local de Neoplasia/patología , Neoplasias Hipofisarias/patología , Prolactinoma/patología , Carcinoma Neuroendocrino/patología , Progresión de la Enfermedad , Resultado Fatal , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Cytopathological findings on three pedriatic gonadic-extragonadic pure yolk sac tumor are reported: the highly variable histological patterns (reticular, solid, festooning or pseudopapillary, polyvesicular vitelline), reflecting differentiation towards extraembryonic yolk sac structures, are not appreciated in cytologic samples. Since the tumor's cytologic spectrum is very broad, the most diagnostic differential difficulty with yolk sac tumor is adenocarcinoma. The presence of intracellular and extracellular hyaline globules, that are periodic acid-Schiff stain (PAS) positive and diastase resistant and correspond to alpha-fetoprotein production, alpha-fetoprotein positivity of the neoplastic cells; showing nuclear pleomorphism and vacuolated "bubbly" cytoplasm are the most consistent cytologic hallmarks of this neoplasm, which diagnosis would be confirmed by histologic, immunocytochemical and clinical findings.
Asunto(s)
Tumor del Seno Endodérmico/patología , Neoplasias Ováricas/patología , Pinealoma/patología , Neoplasias Testiculares/patología , Adenocarcinoma/diagnóstico , Adolescente , Biopsia con Aguja , Diagnóstico Diferencial , Tumor del Seno Endodérmico/química , Resultado Fatal , Femenino , Humanos , Hidrocefalia/etiología , Hidrocefalia/patología , Lactante , Masculino , Neoplasias Ováricas/química , Pinealoma/química , Neoplasias Testiculares/química , Tomografía Computarizada por Rayos X , alfa-Fetoproteínas/análisisRESUMEN
AIM: We studied the immunophenotype of 9 cases of secretory meningioma (SM), a rarely reported meningioma variant, characterized by small gland-like lumina filled with a PAS-positive, diastase-resistant substance. METHODS: Three samples of arachnoid tissue and 9 SMs were studied with a panel of monoclonal antibodies (MoAbs) against cytokeratins (Ck) 7,8, 20, vimentin, EMA, CEA and the mucin epitopes sialyl-Tn, Tn, CA19.9, CA125, against the BerEP4 and CD15; 3 colonic adenocarcinomas metastatic to the brain and a case of meningioma with metastasis from a gastric signet-ring cell carcinoma were also studied with the same panel of MoAbs for comparison. RESULTS: The 3 samples of arachnoid cap cells were positive only for EMA and vimentin in the supportive stroma. All 9 SMs resulted Ck7+, Ck8+, Ck20-, EMA+, CEA and mucin epitopes+, confirming at an immunohistochemical level the glandular differentiation. Notable exceptions were the negativity for BerEP4 and CD15 antigens. Conversely, the 3 metastatic colonic adenocarcinomas to the brain were Ck7-, Ck8+, Ck20+, CEA and mucin epitopes+, BerEP4 and CD15+; the gastric signet-ring cell carcinoma metastatic to a meningioma showed the same immunophenotype as the other metastatic adenocarcinomas with the exception of BerEP4 negativity. CONCLUSION: The different pattern of cytokeratin expression (Ck7+/Ck20- for SMs, and Ck7-/ Ck20+ for adenocarcinomas) and the negativity for BerEP4 and CD15 epitopes of SMs, could be relevant for the distinction between SMs and metastatic adenocarcinomas.
Asunto(s)
Neoplasias Meníngeas/patología , Meningioma/patología , Adenocarcinoma/química , Adenocarcinoma/secundario , Anticuerpos Monoclonales , Antígenos de Neoplasias/análisis , Aracnoides/química , Aracnoides/patología , Neoplasias Encefálicas/química , Neoplasias Encefálicas/secundario , Neoplasias del Colon/química , Neoplasias del Colon/patología , Humanos , Técnicas para Inmunoenzimas , Inmunofenotipificación , Neoplasias Meníngeas/química , Neoplasias Meníngeas/clasificación , Meningioma/química , Meningioma/clasificaciónRESUMEN
We report the clinico-pathological and immunohistochemical findings of 12 cases of gangliogloma that were diagnosed at Legnano Civil Hospital over a period of 10 years. The patients' age at presentation ranged from 2-69 years with a mean duration of symptoms equal to 52 months. Seizures were the most common presenting symptoms. These tumors, mainly located in the temporal lobe (5/10), displayed in 10 cases a low density appearance at CT scan. Histologically the tumors were composed of neoplastic ganglion cells mixed together with a glial component. All but one of the tumors were surgically treated: complete removal was accomplished in 8 cases and incomplete in 3 cases; 1 case was an incidental autopsy finding. Radiotherapy was administered in the incompletely removed cases. The mean follow-up period was 40.8 months, with 3 patients deceased. Our findings support the notion that ganglioglioma is a slow-growing relatively benign tumor of young adults, ubiquitous in the central nervous system with a non-specific CT scan appearance and varied histological morphology, in which immunochemical stains will confirm the diagnosis and could provide a prognostic marker.
Asunto(s)
Ganglioglioma/patología , Adolescente , Adulto , Anciano , Diferenciación Celular/fisiología , Niño , Preescolar , Femenino , Ganglioglioma/metabolismo , Humanos , Inmunohistoquímica , Masculino , Fenotipo , Estudios RetrospectivosRESUMEN
The authors describe their experience in the treatment of dumbbell neurogenic tumours, intrathoracic and intraspinal, with particular reference to clinical presentation, diagnostic for imaging, anatomo-pathological classification and surgical treatment, comparing their clinical cases (9) with the international literature, accurately reviewed. The authors think that the best surgical treatment is the combined approach, in only one stage, of thoracic surgeon and neurosurgeon by hemilaminectomy and extended costotrasversectomy, reserving hemilaminectomy and thoracotomy only for the tumours with big dimension of intrathoracic portion.
Asunto(s)
Ganglioneuroma/cirugía , Neurilemoma/cirugía , Neurofibroma/cirugía , Neoplasias de la Columna Vertebral/cirugía , Neoplasias Torácicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Ganglioneuroma/diagnóstico , Ganglioneuroma/patología , Humanos , Laminectomía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neurilemoma/diagnóstico , Neurilemoma/patología , Neurofibroma/diagnóstico , Neurofibroma/patología , Radiografía Torácica , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/patología , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/patología , Toracotomía , Tomografía Computarizada por Rayos XRESUMEN
The effect of chronic administration of SMS 201-995, a long acting analogue of somatostatin, has been studied in 30 acromegalic patients (pts). CT-scan showed pituitary adenoma in 20/30 pts, empty sella in 9/30 pts and no sign of pituitary tumor in one case. SMS 201-995 was administered subcutaneously every 8 hours at the daily dose of 150-900 micrograms. Blood samples for GH, insulin and blood glucose were taken hourly from 04:00 to 20:00 h before treatment, after 15 days and then monthly or fortnightly. IGF-I plasma levels were assayed at 08:00 h in the same day as GH determinations. CT-scan controls were carried out after 12-24 months of treatment in 16/20 pts. GH plasma levels were normalized in 16/30 pts after 0.5-9 months of SMS treatment, whereas in 14/30 pts they were reduced by about 50%. In 10/16 pts the CT-scan examination showed a shrinkage of the tumor size of 20-55%, while no variation of the tumor mass was observed in the 2 pts. In conclusion our data show that SMS 201-995 is a very effective medical treatment in acromegalic patients.
Asunto(s)
Acromegalia/tratamiento farmacológico , Octreótido/uso terapéutico , Acromegalia/diagnóstico , Acromegalia/etiología , Adulto , Anciano , Anciano de 80 o más Años , Metabolismo de los Hidratos de Carbono , Femenino , Prueba de Tolerancia a la Glucosa , Hormona del Crecimiento/sangre , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Persona de Mediana Edad , Octreótido/efectos adversos , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/tratamiento farmacológico , Neoplasias Hipofisarias/patología , Tomografía Computarizada por Rayos XRESUMEN
Somatosensory evoked potentials have been serially recorded in 21 patients with cervical spinal cord injury. Each patient received the SEP test and a full neurological examination within 1 day after admission, after surgery, and 3-6 weeks following admission. Further SEP test and clinical evaluation were carried out 3-6 months after injury. Neurological status was graded according to the Sunnybrook Scale. In all patients we evaluated latency and amplitude of SEPs obtained from both median and tibial nerve stimulation. Immediately following injury SEPs were absent in 6 patients, abnormal in 10, and normal in 5 patients. No surgery was carried out in patients with normal SEPs where myelography and CT scan could not demonstrate surgical lesions. Four patients had some distal motor improvement but SEPs still absent, one had traceable SEPs following surgery but no motor improvement. Surgery was performed in all 10 patients with abnormal SEPs: 7 patients improved following surgery. In two patients SEPs showed an early postoperative recovery with subsequent late clinical improvement. The SEP technique is well suited to the non invasive study of spinal cord condition and serial recording in patients with spinal cord injury. Although SEPs are of limited clinical value when absent immediately following trauma, the presence of well preserved median and tibial SEP in the postinjury period indicates the best prognosis for motor and sensory functions.
Asunto(s)
Vértebras Cervicales/lesiones , Potenciales Evocados Somatosensoriales , Traumatismos de la Médula Espinal/fisiopatología , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A recently developed 99mTc radiocompound, hexamethyl-propyleneamine oxime (99mTc-HM-PAO) exhibits favorable properties for regional cerebral tomograms in man utilizing conventional instrumentation (SPECT). Planar and tomographic studies using a rotating gamma camera equipped with a high sensitivity, low energy, collimator were performed in 5 normal subjects and 20 patients suffering from different cerebral diseases. SPECT abnormalities observed in patients with CVD, brain tumors and hydrocephalus were compared with results from X-ray CT. Our preliminary study demonstrates the feasibility of assessing regional brain perfusion using SPECT and a 99mTc radiopharmaceutical which is lipid soluble and has a high extraction fraction in the brain.
Asunto(s)
Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Compuestos Organometálicos , Oximas , Tomografía Computarizada de Emisión , Encefalopatías/diagnóstico por imagen , Humanos , Exametazima de Tecnecio Tc 99m , Tomografía Computarizada por Rayos XRESUMEN
3 cases of acute subdural hematoma associated with bleeding from cortical arteries are described. There was no history of trauma. Referred cases in the literature and the possible mechanisms are discussed.
Asunto(s)
Hematoma Subdural/etiología , Adulto , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/cirugía , Femenino , Hematoma Subdural/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Btween 1971 and 1978 140 cases of spinal metastasis treated by decompression or possible removal of secondary neoplasm, were studied. Patients were divided according to their preoperative neurological conditions and then evaluated on the ground of regression of spinal cord and root symptom. The possibility of treating this type of compressive spinal pathology surgically is discussed.
Asunto(s)
Neoplasias de la Médula Espinal/secundario , Femenino , Humanos , Masculino , Persona de Mediana Edad , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/cirugíaRESUMEN
The Authors report on nine cases of thoracic disc hernia operated on through Carson's posterolateral approach. Several steps were taken to protect the spinal cord, and to remove completely disc fragments and any calcifications. The importance of the combined use of the operating microscope and the posterolateral approach are emphasized, and the longterm results are evaluated.