Multiple recurrences of unknown primary tumor in a meningioma: A case report.

Metastasis of a systemic tumor into a primary brain tumor has been rarely reported in the literature. These metastases could be seen mostly in meningiomas and in less frequently in the other intracranial tumors. Carcinoma of an unknown primary site (CUP) metastasizing into an intracranial meningioma is not a common occasion. According to the best of our knowledge, in this report, we present the first case with multiple recurrent CUP, which metastasized to intracranial meningioma, reported in the literature. The whole body was investigated with FDG PET/CT and biomarkers of the most common carcinomas for primary cancer. However, these tests showed no primary affected region. Despite all adjuvant therapies, the tumor had multiple recurrences. Such cases are still a challenge to offer optimal management.

AnvirzelTMregulates cell death through inhibiting GSK-3 activity in human U87 glioma cells.

Objectives: Cardiac glycosides are used as potential anti-cancer agents due to their effects on the inhibition of proliferation and induction of apoptosis and/or autophagy in cancer cells. Herein, we aimed to study the potential signaling pathways taken role in differential cell-death properties of AnvirzelTM which is consisted of two toxic cardiac glycosides (oleandrin and oleandrigenin), in U87 human glioblastoma cells.Methods: The anti-proliferative and anti-migratory effects of AnvirzelTM were assessed in U87 cells by WST-1 assay and wound healing assay, respectively. After treatment of AnvirzelTMwith doses of 10, 25, 50, 100 and 250 µg/ml, expression levels of proteins related to cell death were investigated by Western blot.Results: Anvirzel™ markedly inhibited the growth of U87 cells in a time- and dose-dependent manner following 24 h and 48 h treatments (p < 0.05). In addition, it was found that Anvirzel™ inhibited GSK-3, NOS and HIF1-α expressions whereas activated ERK in U87 cells compared to vehicle (p < 0.05).Discussion: The results suggested that AnvirzelTM regulated cell death distinctly from apoptosis in human glioblastoma cells. Further studies are required for validation of mechanistic insights about the potential signaling pathways taken role in differential cell death properties of AnvirzelTM.

Gamma knife radiosurgery compared to whole brain radiation therapy enhances immunity via immunoregulatory molecules in patients with metastatic brain tumours.

Background: There is lack of data on the effect of stereotactic radiosurgery in modulation of the immune system for cancer patients with metastatic brain tumours. Therefore, we investigated the change in levels of immunoregulatory molecules after Gamma Knife radiosurgery (GKR) and whole brain radiation therapy (WBRT) in patients with brain metastases.Methods: Peripheral blood samples were collected from 15 patients who received GKR, nine patients who received WBRT for brain metastases and 10 healthy controls. Samples were obtained at three time points such as before, 1h after and 1 week after the index procedure for patients treated with GKR or WBRT. All patients' demographic data and radiosurgical parameters were retrospectively reviewed. We analyzed the change in the levels of T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death ligand-1 (PD-L1), and cytokines such as IL-2, IL-10, IFN-γ, TNF-α after GKR and WBRT using Enzyme-linked immunosorbent assays (ELISA).Results: Baseline level of IFN-γ was found to be lower and that of PD-L1 was higher in the GKR group compared to WBRT group and healthy controls (p < 0.05 and p < 0.01, respectively). Levels of IFN-γ and IL-2 were increased (p < 0.01 and p < 0.01, respectively), while CTLA-4 and PD-L1 were decreased (p = 0.05 and p = 0.01, respectively) after GKR compared to pre-GKR levels, while there was no change after WBRT.Conclusion: GKR regulates immunoregulatory molecules towards enhancing the immune system, while WBRT did not exert any effect. These findings suggested that treatment of metastatic brain lesion with GKR might stimulate a systemic immune response against the tumour.

The correlation between phosphorylated Histone H3 (PHH3) and p-STAT3 in Meningiomas.

OBJECTIVE: To assess the correlation between PHH-3 and STAT-3 in grade I and grade II meningiomas. PATIENTS AND METHODS: Medical records were retrospectively reviewed for all cranial cases which diagnosed and underwent surgery at Bezmialem Vakif University Hospital between 2012 and 2017. All cranial grade I and grade II meningioma patients constituted the core sample for this study. RESULTS: This series included 104 (69 female, 35 male) patients, with a median age of 57.3 years. The mean preoperative course was 23.0 ± 40.5 months. The most common symptom was headache (76%) and followed by seizure (24%), weakness (18%) and visual disturbances (14%). Seventy one (68.2%) patients were diagnosed as WHO grade I meningioma and 33 (31.8%) were WHO grade II, grade III meningiomas were excluded from study due to small number of patients. Subtypes of meningioma includes 5 angiomatous (4,8%), 6 fibroblastic (5.7%), 1 meningothelial (0,9%), 11 psammomatous (10,5%), 3 secretory (2,8%), 43 transitional (41,3%) and 33 atypical (31,7%) meningiomas. There is a strong correlation with PHH-3 and Ki-67 (p:0,001>) and mitosis index (p:0,001 > ) although there is no correlation with STAT-3 (p:0,260). There is a strong correlation with STAT-3 and Ki-67 (p:0,013), although there is no correlation with mitosis index (p:0,085) and PHH-3 (p:0,260). CONCLUSIONS: In our study we also obtain same results with Ki-67 and mitotic index, although correlation with PHH-3 and STAT-3 is firstly determined and there was no statistically significant relation were observed. Depends on the STAT-3 cell proliferation feature, inactivation of these pathways may predict new chemotherapies for grade II meningiomas.

Matrix metalloprotease-9 expresssion in meningioma: Correlation with growth fraction and role of gender. A pilot immunohistochemical study.

OBJECTIVE: Matrix metalloproteases (MMPs), particularly MMP2 and MMP9 increase tumor invasion and edema in meningiomas. Although lesser recognized, MMPs may also enhance cell growth via liberating growth factors or via cleaving inactive growth factors into active isoforms. However, there exist very few studies, which investigated correlation of MMPs with growth fraction in meningiomas. Meningiomas are seen more frequently in women and their growth accelarate during pregnancy. However, no study examined whether MMP-expressions in meningioma differ with gender. PATIENTS AND METHODS: In a pilot immunohistochemical study, we analyzed the correlation of MMP9 expression with Ki67 index and whether gender influences MMP9 expression. We retrospectively selected 24 meningioma cases including 10 cases with WHO Grade-1 tumors and 7 cases each with WHO Grade-2 and 3 tumors, respectively. RESULTS: We separately determined the intensity and area of MMP9 staining and also calculated an expression index by multiplying these two parameters. Spearman correlation analyses revealed that MMP9 staining intensity, staining area and expression index significantly correlated with Ki67 proliferation index. MMP9 staining indices were significantly higher in women specimens. CONCLUSION: If these findings will be confirmed in larger series, MMP-inhibitors and female hormone receptor-antagonists may be combined to augment chemotherapy efficacy and to attenuate invasion in high-grade meningiomas.

En Plaque Pituitary Adenoma within a Rathke's Cleft Cyst: Report of Three Cases.

Concomitant pituitary adenomas and Rathke's cleft cysts (RCCs) are rare. These coexisting lesions are difficult to diagnose preoperatively due to their variable signal intensity on magnetic resonance imaging (MRI) and position of the RCC. We describe three cases of coexisting pituitary adenoma and RCC, and review the relevant literature. In our cases, the RCCs were relatively large and the en plaque adenomas appeared as enhanced cyst walls on MRI examination. We also report the clinical, radiologic, surgical, and histopathologic findings of each case.

Comparison of TOF MRA, Contrast-Enhanced MRA and Subtracted CTA from CTP in Residue Evaluation of Treated Intracranial Aneurysms.

AIM: To compare effectiveness of contrast-enhanced MRA (CE-MRA), 3D-Time-of-flight MRA (3D-TOF-MRA) and subtracted CTA from CTP (sub-CTA) in residue evaluation of intracranial aneurysms treated either with coiling or clipping. MATERIAL AND METHODS: Sixteen treated aneurysms, which were evaluated with three methods within two weeks after the operation, were enrolled. The success of each imaging techniques in demonstration of residue aneurysm and nearby vessels was compared by Fisher\'s Exact Test. The differences among three was evaluated by Cochran\'s Q test (p ≤ 0.05). RESULTS: Perfusion abnormality was noted in % 81 of clipped and none of coiled patients. Vessel visualization in the vicinity of aneurysm was better in sub-CTA, followed by CE-MRA. In clipped aneurysms, sub-CTA revealed residue aneurysms in % 16,7 of the patients while 3D-TOF-MRA and CE-MRA revealed none. In coiled aneurysms, CE-MRA revealed residue aneurysms in 100 %, and TOF-MRA in 33,3 % while sub-CTA revealed none. Although dramatic differences were noted in the evaluation of residue aneurysm as well as nearby vessel visualization, no statistical significance noted due to very few patients in subcategories Conclusion: This is first study comparing the effectiveness of CE-MRA, 3D-TOF MRA and sub-CTA in residue aneurysms evaluation. Vessel visualization in the vicinity of aneurysm was better in sub-CTA in all regardless of coiling or clipping. Residue aneurysms were more commonly revealed by CE-MRA in coiled patients and more commonly and better shown by sub-CTA in clipped patients in addition of showing perfusion abnormality that's is more common in clipped patients.

Multimodal Intraoperative Neurophysiological Monitoring in Spinal Cord Surgery.

AIM: Intraoperative neurophysiological monitoring (IONM) monitors the functional integrity of critical neural structures by electrophysiological methods during surgery. Multimodality combines different neurophysiological methods to maximize diagnostic efficacy and provide a safety margin to improve the outcomes of spinal surgery. Our aim was to share our intraoperative monitoring experiences with patients who underwent surgery because of spinal cord pathologies between September 2013 and January 2015. MATERIAL AND METHODS: We had twenty-six cases. Location of the lesions, surgery, neurological findings, and electrophysiological findings intraoperatively and postoperatively were documented. RESULTS: The combination of motor evoked potential (MEP), somatosensorial evoked potential (SSEP), free-run and trigger electromyography (EMG) were performed according to lesion localization. MEPs plus SSEPs were run in 23 patients and MEPs with triggered EMG were performed in 4 patients. In only one patient, optimal recording could not be elicited because of technical problems. MEP and SSEP changes were recorded in 12 and 3 patients respectively. Postoperative neurological deficits were observed in 2 patients. Deficits were transient in one case and permanent in the other. While baseline MEP responses were either absent or low amplitude ( < 50 microvolt) in 7 patients, following resection they were either visible or increased in amplitude. Surgery was ended in one patient with C7-T2 intramedullary tumour after the right distal MEP response disappeared. CONCLUSION: Multimodal IONM is an important method to monitor the neural structures under risk in spine surgery and to keep the surgery within safety limits, especially for intramedullary spinal cord lesion surgery.

Chronic intradiploic hematomas of the skull without coagulopathy: report of two cases / Hematoma crónico intradiploico sin coagulopatía: informe de 2 casos

Background: Chronic intradiploic hematoma was first described by Chorbski and Davis in 1934. To date, only twelve cases have been reported in the literature. Chronic intradiploic hematomas have also been described as non-neoplastic cysts of the diploe, traumatic cysts, and giant cell repetitive granulomas. The term chronic intradiploic hematoma was coined by Sato et al. in 1994. Case description: Case 1: a 16-year-old male presented with a non-tender scalp swelling on the right fronto-orbital region. Computed tomography (CT) scans showed an intraosseous isodense lesion with surrounding sclerosis. Magnetic resonance imaging (MRI) results revealed an intradiploic mass with homogeneous cystic and abnormal signal intensities. Case 2: a 64-year-old male presented with a 6-month history of headaches and visual disturbances. CT scans showed an isodense lesion with surrounding sclerosis in the posterolateral left orbit. MRI results revealed a hypointense lesion on both the T1weighted and T2-weighted images of the posterolateral left orbit. Conclusion: Although rarely seen, the presence of a benign chronic hematoma should be considered as part of the differential diagnosis for each intradiploic mass lesion. When taking the medical history, all patients with such mass lesions should be asked about previous minor or major head traumas. Due to the possibility of progressive growth, surgical excision of an intradiploic hematoma is recommended after radiological diagnosis of the condition

Antecedentes: El hematoma crónico intradiploico fue descrito por primera vez por Chorbski y Davis en 1934. Hasta la actualidad solo se han publicado 12 casos en la literatura. Los hematomas crónicos intradiploicos también se han descrito como quistes no neoplásicos del diploe, quistes traumáticos y granulomas repetitivos de células gigantes. El término hematoma crónico intradiploico fue acuñado por Sato et al. en 1994. Descripción de los casos: Caso 1: Varón de 16años que consultó por hinchazón no dolorosa en región frontoorbitaria derecha. La tomografía computarizada mostró una lesión intraósea isodensa con esclerosis circundante. La resonancia magnética (RM) reveló una masa intradiploica con quiste homogéneo de señal anormal. Caso 2: Varón de 64años que consultó por historia de 6meses de dolor de cabeza y alteraciones visuales. La tomografía computarizada craneal mostró una lesión isodensa con esclerosis circundante en la región posterolateral de la órbita izquierda. La RM mostró una lesión hipointensa tanto en las secuencias TI como T2 de la porción posterolateral de la órbita izquierda. Conclusión: A pesar de su rareza, la presencia de un hematoma crónico benigno debe considerarse en el diagnóstico diferencial de cada lesión masiva intradiploica. A los pacientes con este tipo de lesiones de masa se les debe interrogar sobre el antecedente de trauma craneal previo mayor o menor. Debido a la posibilidad de crecimiento progresivo, se recomienda la extirpación quirúrgica del hematoma intradiploico una vez realizado el diagnóstico radiológico de la enfermedad

Chronic intradiploic hematomas of the skull without coagulopathy: Report of two cases.

BACKGROUND: Chronic intradiploic hematoma was first described by Chorbski and Davis in 1934. To date, only twelve cases have been reported in the literature. Chronic intradiploic hematomas have also been described as non-neoplastic cysts of the diploe, traumatic cysts, and giant cell repetitive granulomas. The term chronic intradiploic hematoma was coined by Sato et al. in 1994. CASE DESCRIPTION: Case 1: a 16-year-old male presented with a non-tender scalp swelling on the right fronto-orbital region. Computed tomography (CT) scans showed an intraosseous isodense lesion with surrounding sclerosis. Magnetic resonance imaging (MRI) results revealed an intradiploic mass with homogeneous cystic and abnormal signal intensities. Case 2: a 64-year-old male presented with a 6-month history of headaches and visual disturbances. CT scans showed an isodense lesion with surrounding sclerosis in the posterolateral left orbit. MRI results revealed a hypointense lesion on both the T1weighted and T2-weighted images of the posterolateral left orbit. CONCLUSION: Although rarely seen, the presence of a benign chronic hematoma should be considered as part of the differential diagnosis for each intradiploic mass lesion. When taking the medical history, all patients with such mass lesions should be asked about previous minor or major head traumas. Due to the possibility of progressive growth, surgical excision of an intradiploic hematoma is recommended after radiological diagnosis of the condition.

Spinal Extradural Arachnoid Cysts: A Series of 10 Cases.

BACKGROUND AND OBJECTIVE: Spinal arachnoid cysts are rare lesions, accounting for only 1% of all primary spinal mass lesions. They can occur in extradural, intradural, or intramedullary locations. The extradural cysts are thought to arise from defects in the dura mater through which the arachnoid herniates. This report presents 10 cases of spinal extradural arachnoid cysts and discusses our diagnostic and therapeutic approach to this rare clinical entity. PATIENTS: The archive records of 10 patients with extradural arachnoid cysts who were treated between 2002 and 2009 were evaluated retrospectively. The study included four male and six female patients. In nine cases, the lesion was symptomatic; in only one case was the cyst diagnosed incidentally. Surgical treatment was performed in the nine symptomatic cases. RESULTS: In nine of these cases, the extradural cysts were solitary; in one case, multiple extradural cysts were observed. In most of the cases, the lesion was located in the thoracic region. Total excision of the cyst was achieved for all of the cases treated surgically except the case with multiple extradural arachnoid cysts. On follow-up examination, neurologic improvement was observed in all of the surgically treated patients. CONCLUSION: Spinal extradural arachnoid cysts are rare pathologies, and treatment options should be considered carefully. In symptomatic cases, total excision of the cyst should be considered the gold standard of treatment. We believe that the closure of the dural defect should be the main surgical goal to prevent recurrence. We propose laminoplasty for the treatment of extradural arachnoid cysts that involve multiple segments to prevent postoperative kyphosis.

A Simple Technique for Bone Storage after Decompressive Craniectomy in Children.

Cranial vault reconstruction in the pediatric population is a specialized procedure, which requires additional considerations. Generally, inherent difficulties of bone storage and cranioplasty are neglected in the literature. We present a simple method of bone storage and autologous cranioplasty in a small child with severe head injury. The child underwent surgical treatment with decompressive craniectomy. A bone flap was transversally divided into two pieces and stored under the galea. Bone storage and reconstruction of the cranial vault with our surgical technique is a safe, easy and cost-effective choice excluding the surgical trauma to obtain a new subcutanous pocket for bone storage in pediatric decompressive craniectomy patients.

Is progesteron receptor status really a prognostic factor for intracranial meningiomas?

OBJECTIVE: Presence of steroid hormone receptors in meningiomas is well-known, but their correlation with tumour behaviour is unclear. The purpose of this study was to assess the relation between steroid hormone receptor expression and tumour behaviour. METHODS: We retrospectively reviewed 48 patients undergoing surgery for intracranial meningioma between January 2002 and December 2004. We included World Health Organization (WHO) Grade I meningiomas in Group 1 and WHO Grades II and III in Group 2. Tumour grade, progesterone receptor (PR), oestrogen receptor (ER) expressions, MIB-1 Index and Mitotic Index were assessed. We sought the correlation between tumour grade and MIB-1, Mitotic Indices, and also PR expression. Furthermore, the correlation between PR expression and MIB-1 and Mitotic Indices was assessed in Group 1 and Group 2, separately. RESULTS: 26 patients were in Group 1 and 22 patients in Group 2. PR expression was determined in 56% of the tumours while there was no ER expression. PR expression was found to be higher in Group 1 compared to Group 2. The Mean MIB-1 Index and the Mean Mitotic Index were significantly higher in Group 2 compared to Group 1. However, when Groups 1 and 2 were assessed separately, PR expression does not appear to be correlated with MIB-1 and Mitotic Indices in benign and also in non-benign meningioma groups. CONCLUSION: Our findings suggest that tumour grade, but not PR expression, is correlated with meningioma behaviour.

Pineal epidermoid tumors: report of five cases.

AIM: The aim of this study was to retrospectively analyse the clinical, radiological features and surgical outcome of pineal epidermoid tumors treated at a single neurosurgical department. MATERIAL AND METHODS: We performed surgery on five patients with pineal region epidermoid tumors at a single neurosurgical department between the years 1998 and 2006. Headache, diplopia and ataxia were the most common presenting findings. Parinaud's syndrome was found in three patients. Hydrocephalus was demonstrated radiologically in two patients. RESULTS: Two patients were operated on with the occipital-transtentorial approach, two were operated on with the infratentorial-supracerebellar approach and one was operated on with van Wagenen's approach. Recurrence of tumor was observed in one patient. One patient died at the first postoperative month due to ventriculitis. CONCLUSION: Total removal of epidermoid tumors may provide good clinical recovery and may reduce the possibility of tumor recurrence and shunt placement.

Intradural extramedullary tuberculoma mimicking en plaque meningioma.

In this paper we report an 18 year old woman with an intradural extramedullary tuberculoma mimicking en plaque meningioma located in the thoracic region. The patient was operated via thoracic laminoplasty and tumor was totally resected. On the follow-up examination the magnetic resonance imaging demonstrated the total excision of the tumor. Here we describe a case of intradural extramedullary tuberculoma of the spinal cord as a complication of tuberculosis meningitis in a previously healthy young female.