RESUMO
BACKGROUND AND PURPOSE: Quantifying MVA rather than MVD provides better correlation with survival in HGG. This is attributed to a specific "glomeruloid" vascular pattern, which is better characterized by vessel area than number. Despite its prognostic value, MVA quantification is laborious and clinically impractical. The DSC-MR imaging measure of rCBV offers the advantages of speed and convenience to overcome these limitations; however, clinical use of this technique depends on establishing accurate correlations between rCBV, MVA, and MVD, particularly in the setting of heterogeneous vascular size inherent to human HGG. MATERIALS AND METHODS: We obtained preoperative 3T DSC-MR imaging in patients with HGG before stereotactic surgery. We histologically quantified MVA, MVD, and vascular size heterogeneity from CD34-stained 10-µm sections of stereotactic biopsies, and we coregistered biopsy locations with localized rCBV measurements. We statistically correlated rCBV, MVA, and MVD under conditions of high and low vascular-size heterogeneity and among tumor grades. We correlated all parameters with OS by using Cox regression. RESULTS: We analyzed 38 biopsies from 24 subjects. rCBV correlated strongly with MVA (r = 0.83, P < .0001) but weakly with MVD (r = 0.32, P = .05), due to microvessel size heterogeneity. Among samples with more homogeneous vessel size, rCBV correlation with MVD improved (r = 0.56, P = .01). OS correlated with both rCBV (P = .02) and MVA (P = .01) but not with MVD (P = .17). CONCLUSIONS: rCBV provides a reliable estimation of tumor MVA as a biomarker of glioma outcome. rCBV poorly estimates MVD in the presence of vessel size heterogeneity inherent to human HGG.
Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Glioma/patologia , Glioma/cirurgia , Angiografia por Ressonância Magnética/métodos , Microvasos/patologia , Recidiva Local de Neoplasia/patologia , Adulto , Determinação do Volume Sanguíneo , Neoplasias Encefálicas/irrigação sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/irrigação sanguínea , Recidiva Local de Neoplasia/prevenção & controle , Neovascularização Patológica/patologia , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatística como Assunto , Técnicas Estereotáxicas , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Relative cerebral blood volume (rCBV) accuracy can vary substantially depending on the dynamic susceptibility-weighted contrast-enhanced (DSC) acquisition and postprocessing methods, due to blood-brain barrier disruption and resulting T1-weighted leakage and T2- and/or T2*-weighted imaging (T2/T2*WI) residual effects. We set out to determine optimal DSC conditions that address these errors and maximize rCBV accuracy in differentiating posttreatment radiation effect (PTRE) and tumor. MATERIALS AND METHODS: We recruited patients with previously treated high-grade gliomas undergoing image-guided re-resection of recurrent contrast-enhancing MR imaging lesions. Thirty-six surgical tissue samples were collected from 11 subjects. Preoperative 3T DSC used 6 sequential evenly timed acquisitions, each by using a 0.05-mmol/kg gadodiamide bolus. Preload dosing (PLD) and baseline subtraction (BLS) techniques corrected T1-weighted leakage and T2/T2*WI residual effects, respectively. PLD amount and incubation time increased with each sequential acquisition. Corresponding tissue specimen stereotactic locations were coregistered to DSC to measure localized rCBV under varying PLD amounts, incubation times, and the presence of BLS. rCBV thresholds were determined to maximize test accuracy (average of sensitivity and specificity) in distinguishing tumor (n = 21) and PTRE (n = 15) samples under the varying conditions. Receiver operator characteristic (ROC) areas under the curve (AUCs) were statistically compared. RESULTS: The protocol that combined PLD (0.1-mmol/kg amount, 6-minute incubation time) and BLS correction methods maximized test AUC (0.99) and accuracy (95.2%) compared with uncorrected rCBV AUC (0.85) and accuracy (81.0%) measured without PLD and BLS (P = .01). CONCLUSIONS: Combining PLD and BLS correction methods for T1-weighted and T2/T2*WI errors, respectively, enables highly accurate differentiation of PTRE and tumor growth.
Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Glioma/diagnóstico , Glioma/cirurgia , Angiografia por Ressonância Magnética/métodos , Angiografia por Ressonância Magnética/normas , Adulto , Neoplasias Encefálicas/patologia , Feminino , Glioma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
BACKGROUND AND PURPOSE: Differentiating tumor growth from posttreatment radiation effect (PTRE) remains a common problem in neuro-oncology practice. To our knowledge, useful threshold relative cerebral blood volume (rCBV) values that accurately distinguish the 2 entities do not exist. Our prospective study uses image-guided neuronavigation during surgical resection of MR imaging lesions to correlate directly specimen histopathology with localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC) measurements and to establish accurate rCBV threshold values, which differentiate PTRE from tumor recurrence. MATERIALS AND METHODS: Preoperative 3T gradient-echo DSC and contrast-enhanced stereotactic T1-weighted images were obtained in patients with high-grade glioma (HGG) previously treated with multimodality therapy. Intraoperative neuronavigation documented the stereotactic location of multiple tissue specimens taken randomly from the periphery of enhancing MR imaging lesions. Coregistration of DSC and stereotactic images enabled calculation of localized rCBV within the previously recorded specimen locations. All tissue specimens were histopathologically categorized as tumor or PTRE and were correlated with corresponding rCBV values. All rCBV values were T1-weighted leakage-corrected with preload contrast-bolus administration and T2/T2*-weighted leakage-corrected with baseline subtraction integration. RESULTS: Forty tissue specimens were collected from 13 subjects. The PTRE group (n = 16) rCBV values ranged from 0.21 to 0.71, tumor (n = 24) values ranged from 0.55 to 4.64, and 8.3% of tumor rCBV values fell within the PTRE group range. A threshold value of 0.71 optimized differentiation of the histopathologic groups with a sensitivity of 91.7% and a specificity of 100%. CONCLUSIONS: rCBV measurements obtained by using DSC and the protocol we have described can differentiate HGG recurrence from PTRE with a high degree of accuracy.
Assuntos
Neoplasias Encefálicas/patologia , Circulação Cerebrovascular , Glioma/patologia , Imageamento por Ressonância Magnética/métodos , Recidiva Local de Neoplasia/patologia , Radioterapia/efeitos adversos , Biópsia , Volume Sanguíneo , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Terapia Combinada , Craniotomia , Diagnóstico Diferencial , Glioma/radioterapia , Glioma/cirurgia , Humanos , Imageamento por Ressonância Magnética/normas , Neuronavegação , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Experimental autoimmune encephalomyelitis (EAE) is a primary animal model of multiple sclerosis (MS). MS predominantly presents with evidence of lesions in the subcortical periventricular white matter regions of the brain. Research into the pathogenesis of the demyelinating lesions in the brain has been hampered by the fact that conventional models of EAE present with progressive ascending paralysis which recapitulates mainly the spinal cord lesions of multiple sclerosis. There is little evidence of brain involvement. Systemic administration of pertussis toxin (PTx) has been shown to induce the proinflammatory cascade of TGF-beta, IL-6, and Th17 in the central nervous system, which recently has been identified as essential in the development of EAE. To determine whether intracerebroventricular (icv) administration of PTx would result in subcortical periventricular demyelinating lesions in the brain, we examined the effect in a MOG induced EAE model. We found that icv PTx induced subcortical periventricular brain lesions that resemble the pathologic demyelinating lesions of MS. Moreover, icv PTx induced Th17 infiltration and increased expression of cytokines IL-6 and TGF-beta. We thus generated a highly reproducible model with remarkable histological similarities to the predominant demyelinating brain lesions seen in MS.
Assuntos
Ventrículos Cerebrais/efeitos dos fármacos , Encefalomielite Autoimune Experimental/induzido quimicamente , Camundongos , Esclerose Múltipla/induzido quimicamente , Toxina Pertussis/toxicidade , Animais , Ventrículos Cerebrais/imunologia , Ventrículos Cerebrais/patologia , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/patologia , Feminino , Interleucina-6/metabolismo , Leucócitos/imunologia , Meningite/imunologia , Meningite/patologia , Camundongos Endogâmicos C57BL , Esclerose Múltipla/imunologia , Esclerose Múltipla/patologia , Toxina Pertussis/administração & dosagem , Fator de Crescimento Transformador beta/metabolismoRESUMO
We report the imaging features of 4 cases of patients with papillary tumor of the pineal region, a tumor newly recognized in the 2007 World Health Organization "Classification of Tumors of the Nervous System." In each case, the tumor was intrinsically hyperintense on T1-weighted images with a characteristic location in the posterior commissure or pineal region. The pathologic hallmarks of the tumor are discussed, including a possible explanation for the MR imaging characteristics in our cases.
Assuntos
Neoplasias Encefálicas/patologia , Carcinoma Papilar/patologia , Imageamento por Ressonância Magnética/métodos , Glândula Pineal/patologia , Adulto , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The homeostasis of CD4+ CD25+ regulatory T cells (Tregs) depends on the cytokine interleukin (IL)-2. As IL-21 shares sequence homology with IL-2 and the IL-21 receptors contain a gamma-chain common to IL-2, we hypothesized that IL-21 could also affect the homeostasis of Tregs. We tested this hypothesis in experimental autoimmune encephalomyelitis (EAE), an animal model of relapsing-remitting human multiple sclerosis. We show that blockade of IL-21 in SJL/J mice before and after the induction of EAE enhances the influx of inflammatory cells into the central nervous system (CNS). The blockade of IL-21 leads to proliferation of proteolipid peptide (PLP(139-151))-autoreactive CD4+ T cells, which are capable to cause severe EAE in adoptively transferred recipient mice. Conversely, Tregs from mice where IL-21 was blocked, lose their capacity to prevent EAE induced PLP(139-151)-reactive T cells. Notably, direct effects of IL-21 on Tregs are confirmed by studies of blockade of IL-21 in mice expressing a green fluorescent protein 'knocked' into a Foxp3 allele, in which a reduction of the number of Tregs and a downregulation of their frequency and expression of Foxp3 are observed. These data suggest a role of the IL-21/IL-21R axis in the homeostasis of Tregs in CNS autoimmunity.
Assuntos
Encefalomielite Autoimune Experimental/imunologia , Homeostase/imunologia , Interleucinas/fisiologia , Linfócitos T Reguladores/imunologia , Sequência de Aminoácidos , Animais , Encefalomielite Autoimune Experimental/metabolismo , Feminino , Homeostase/genética , Humanos , Fragmentos Fc das Imunoglobulinas/fisiologia , Interleucinas/antagonistas & inibidores , Interleucinas/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Mutantes , Dados de Sequência Molecular , Receptores de Interleucina-21/biossíntese , Receptores de Interleucina-21/genética , Transdução de Sinais/genética , Transdução de Sinais/imunologia , Linfócitos T Reguladores/metabolismoRESUMO
BACKGROUND AND PURPOSE: There is variability in the literature concerning the appearance and histology of hypothalamic hamartomas. This study correlates the MR imaging and proton MR spectroscopic properties of hypothalamic hamartomas with histopathologic findings. METHODS: Studies were performed with 3T and 1.5T scanners. Single voxel hamartoma spectra were acquired by using short-echo-time point-resolved spectroscopy sequences (PRESS). 2D PRESS chemical shift imaging (CSI) spectroscopic sequences were also obtained for comparison of tumor-derived spectra with normal gray matter of the amygdala. Sequences were used to compare choline (Cho), N-acetylaspartate (NAA), and myoinositol (mI) resonances by using a creatine (Cr) reference. Spectral ratios and T2 signal intensity ratios of the hamartomas were then compared with histopathologic findings. RESULTS: Data from single voxel spectroscopic sequences demonstrated a statistically significant decrease in NAA/Cr and an increase in mI/Cr ratios in tumor tissue when compared with values in normal gray matter of the amygdala. In addition, Cho/Cr ratios were also increased when compared with those in normal gray matter controls. Among the 14 hamartomas sampled, a spectrum of increased mI/Cr ratios was seen. Those tumors with markedly elevated mI/Cr demonstrated an increased glial component when compared with the remaining tumors. Increased glial component was also found to have a positive correlation with hyperintensity of lesions on T2-weighted images. CONCLUSION: We have identified a correlation between the glial/neuronal fraction as determined by histopathology and MR spectral and T2 hyperintensity variations among hypothalamic hamartomas.
Assuntos
Hamartoma/diagnóstico , Doenças Hipotalâmicas/diagnóstico , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Adolescente , Criança , Pré-Escolar , Feminino , Glioma/diagnóstico , Humanos , MasculinoRESUMO
The finding of cavernous malformations within tumors of the central or peripheral nervous system is a rare occurrence. We report a case of a histologically proven cavernous malformation found within an eighth cranial nerve schwannoma in a 76-year-old man. The patient presented with progressive loss of hearing on the left, facial pain and dysesthesia. Symptoms improved significantly after the tumor was subtotally resected through a left retrosigmoid craniotomy. Including the present report, 34 cases of cavernous malformations associated with tumors of nervous system origin, 24 cases (71%) involving tumors of Schwann cell origin, and 9 cases (26%) involving gliomas have been published. The cases were classified into two forms based on the type of association. Conjoined association, in which the cavernous malformation is located within the tissue of the nervous system tumor, and discrete association, in which the cavernous malformation and nervous system tumor are in separate locations. We explore the etiology of this association and hypothesize that a common genetic pathway may be involved in a majority of these cases.
Assuntos
Vasos Sanguíneos/patologia , Predisposição Genética para Doença/genética , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico , Hemangioma Cavernoso do Sistema Nervoso Central/genética , Neuroma Acústico/diagnóstico , Neuroma Acústico/genética , Nervo Vestibulococlear/irrigação sanguínea , Nervo Vestibulococlear/patologia , Idoso , Vasos Sanguíneos/fisiopatologia , Transformação Celular Neoplásica/genética , Cromossomos Humanos Par 3/genética , Cromossomos Humanos Par 7/genética , Comorbidade , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/fisiopatologia , Hemangioma Cavernoso do Sistema Nervoso Central/fisiopatologia , Humanos , Proteína KRIT1 , Imageamento por Ressonância Magnética , Masculino , Proteínas Associadas aos Microtúbulos/genética , Mutação/genética , Neurofibromina 1/genética , Neuroma Acústico/fisiopatologia , Dor/etiologia , Dor/fisiopatologia , Proteínas Proto-Oncogênicas/genética , Células de Schwann/patologia , Transdução de Sinais/genética , Nervo Vestibulococlear/fisiopatologiaRESUMO
Endolymphatic sac tumors (EST) are rare intracranial tumors originating from the pars rugosa of the endolymphatic sac. Although typically described as histologically nonaggressive lesions, nevertheless they are termed adenocarcinomas and often become locally invasive. We report two patients with histologically proven EST with unique clinical features: the first pediatric case of an EST in an 11-year-old patient whose complaints started at the age of seven; and, a second patient, a 43-year-old man, the first report of metastatic EST which appeared in a remote location from the original site of surgery. Both patients underwent gamma-knife radiosurgery for recurrent tumor. This treatment has not been described previously for these tumors. Both patients have a follow-up of 7 years. Although not disease free they remain neurologically stable. We review the literature on EST.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias da Orelha/cirurgia , Saco Endolinfático/cirurgia , Doenças do Labirinto/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/cirurgia , Radiocirurgia , Neoplasias Cranianas/cirurgia , Osso Temporal/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/secundário , Adulto , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/secundário , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/cirurgia , Criança , Diagnóstico por Imagem , Neoplasias da Orelha/patologia , Embolização Terapêutica , Saco Endolinfático/patologia , Feminino , Seguimentos , Humanos , Doenças do Labirinto/patologia , Masculino , Microcirurgia , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/patologia , Reoperação , Neoplasias Cranianas/patologia , Osso Temporal/patologiaRESUMO
We report a rare case of intradural primary osteosarcoma (IPOS) in a 74-year-old man with aphasia and right-sided hemiparesis. Radiologic workup revealed a large, partially calcified, left-sided frontotemporal intracranial mass lesion. At surgery, the tumor was found to be entirely intradural; it involved the brain and subarachnoid space of the left sylvian fissure. The adjacent dura was uninvolved. Neuropathologic findings confirmed the diagnosis of chondroblastic osteosarcoma. To our knowledge, this is the sixth reported case of IPOS and the first reported case of the chondroblastic subtype.
Assuntos
Neoplasias Encefálicas/diagnóstico , Osteossarcoma/diagnóstico , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/patologia , Tomografia Computadorizada por Raios XRESUMO
Microarray analysis of complementary DNA (cDNA) allows large-scale, comparative, gene expression profiling of two different cell populations. This approach has the potential for elucidating the primary transcription events and genetic cascades responsible for increased glioma cell motility in vitro and invasion in vivo. These genetic determinants could become therapeutic targets. We compared cDNA populations of a glioma cell line (G112) exposed or not to a motility-inducing substrate of cell-derived extracellular matrix (ECM) proteins using two sets of cDNA microarrays of 5,700 and 7,000 gene sequences. The data were analyzed considering the level and consistency of differential expression (outliers) and whether genes involved in pathways of motility, apoptosis, and proliferation were differentially expressed when the motility behavior was engaged. Validation of differential expression of selected genes was performed on additional cell lines and human glioblastoma tissue using quantitative RT-PCR. Some genes involved in cell motility, like tenascin C, neuropilin 2, GAP43, PARG1 (an inhibitor of Rho), PLCy, and CD44, were over expressed; other genes, like adducin 3y and integrins, were down regulated in migrating cells. Many key cell cycle components, like cyclin A and B, and proliferation markers, like PCNA, were strongly down regulated on ECM. Interestingly, genes involved in apoptotic cascades, like Bcl-2 and effector caspases, were differentially expressed, suggesting the global down regulation of proapoptotic components in cells exposed to cell-derived ECM. Overall, our findings indicate a reduced proliferative and apoptotic activity of migrating cells. cDNA microarray analysis has the potential for uncovering genes linking the phenotypic aspects of motility, proliferation, and apoptosis.
Assuntos
Neoplasias Encefálicas/patologia , Regulação Neoplásica da Expressão Gênica , Glioma/patologia , Invasividade Neoplásica/genética , Proteínas de Neoplasias/biossíntese , Transcrição Gênica , Apoptose/genética , Neoplasias Encefálicas/química , Proteínas de Ciclo Celular/biossíntese , Proteínas de Ciclo Celular/genética , Movimento Celular/efeitos dos fármacos , Movimento Celular/genética , Sistemas Computacionais , Meios de Cultura/farmacologia , DNA Complementar/genética , Etiquetas de Sequências Expressas , Proteínas da Matriz Extracelular/farmacologia , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Glioblastoma/química , Glioblastoma/patologia , Substâncias de Crescimento/biossíntese , Substâncias de Crescimento/genética , Humanos , Lasers , Proteínas de Neoplasias/genética , Análise de Sequência com Séries de Oligonucleotídeos , Fenótipo , Reação em Cadeia da Polimerase , Tenascina/biossíntese , Tenascina/genética , Transcrição Gênica/efeitos dos fármacos , Células Tumorais Cultivadas/efeitos dos fármacos , Células Tumorais Cultivadas/metabolismo , Células Tumorais Cultivadas/patologiaRESUMO
PURPOSE: To discover the genetic determinants of glioma invasion in vivo, we compared the mRNA expression profiles of glioblastoma cells residing at the tumor core versus those at the invasive rim of a human tumor resection. EXPERIMENTAL DESIGN: From a single glioblastoma specimen, 20,000 individual cells from each region (core and invasive rim) were collected by laser capture microdissection and analyzed by mRNA differential display. Differential expression of gene candidates was confirmed by laser capture microdissection and quantitative reverse transcription-PCR in additional glioblastoma multiforme specimens, and the role in migration was further evaluated in glioma cell lines in vitro. RESULTS: Reproducible overexpression the death-associated Protein 3 (Dap-3) mRNA (NM 004632, GenBank; also reported as human ionizing resistance conferring protein mRNA, HSU18321, GenBank) by invasive cells was identified. Although the full-length Dap-3 protein has been described as proapoptotic, the NH(2)-terminal fragment can act in a dominant negative way resulting in protection from programmed cell death. In glioma cell lines T98G and G112 with an induced motility phenotype, Dap-3 was up-regulated at the mRNA and protein level as assessed by quantitative reverse transcription-PCR, cDNA microarray, and Western blot analysis. These cells showed an increased resistance to undergo camptothecin-induced apoptosis, which was overcome by effective Dap-3-antisense treatment. Antisense treatment also decreased the migration ability of T98G cells. CONCLUSIONS: Dap-3 is up-regulated in invasive glioblastoma multiforme cells in vivo and in glioma cells with an induced motility phenotype in vitro. When migration is activated, Dap-3 is up-regulated and cells become resistant to apoptosis. These findings suggest that Dap-3 confers apoptosis-resistance when migration behavior is engaged.
Assuntos
Movimento Celular , Glioblastoma/patologia , Proteínas/genética , Apoptose/efeitos dos fármacos , Proteínas Reguladoras de Apoptose , Movimento Celular/efeitos dos fármacos , Movimento Celular/genética , DNA Antissenso/farmacologia , Relação Dose-Resposta a Droga , Matriz Extracelular/fisiologia , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Glioblastoma/genética , Humanos , Imuno-Histoquímica , Laminina/farmacologia , Invasividade Neoplásica , Fenótipo , Proteínas/análise , RNA Mensageiro/efeitos dos fármacos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Proteínas de Ligação a RNA , Proteínas Ribossômicas , Células Tumorais CultivadasRESUMO
The mRNA expression profiles from glioblastoma cells residing at the tumor core and invasive rim of a human tumor resection were compared. From a single tumor specimen, 20,000 single cells from each region were collected by laser capture microdissection. Differential expression of 50-60 cDNA bands was detected. One of the sequences overexpressed by the invasive cells showed 99% homology to the P311 gene, the protein product of which is reported to localize at focal adhesions. Relative overexpression of P311 by invading glioblastoma cells compared with tumor core was confirmed by quantitative reverse transcription-PCR of six glioblastoma specimens after laser capture microdissection collection of rim and core cells. In vitro studies using antisense oligodeoxynucleotides and integrin activation confirmed the role of P311 in supporting migration of malignant glioma cells. Immunochemistry studies confirmed the presence of the P311 protein in tumor cells, particularly at the invasive edge of human glioblastoma specimens.
Assuntos
Glioblastoma/genética , Proteínas do Tecido Nervoso , Proteínas Oncogênicas/genética , Sequência de Aminoácidos , Movimento Celular/fisiologia , Dissecação , Perfilação da Expressão Gênica , Glioblastoma/patologia , Humanos , Lasers , Dados de Sequência Molecular , Invasividade Neoplásica , Oligonucleotídeos Antissenso/genética , Oligonucleotídeos Antissenso/farmacologia , Proteínas Oncogênicas/fisiologia , Oncogenes , Reprodutibilidade dos Testes , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Células Tumorais CultivadasRESUMO
OBJECTIVE AND IMPORTANCE: Excluding tumors of hematopoietic origin, osteosarcomas are the most common bone tumor, although involvement of the brain or cranial base is rare. CLINICAL PRESENTATION: A 16-year-old girl with an osteosarcoma of the temporal fossa presented with an intracerebral hemorrhage. The management strategy of this lesion, including the operative interventions, is described. INTERVENTION: Several modes of treatment were undertaken, including radical resection of the cranial base lesion and excision of the cavernous sinus after a cervical internal carotid artery-to-middle cerebral artery vein bypass graft. CONCLUSION: The patient was alive and without evidence of disease 11 months after presentation but died shortly thereafter of complications related to adjuvant therapies.
Assuntos
Neoplasias Ósseas/complicações , Neoplasias Ósseas/cirurgia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Osteossarcoma/complicações , Osteossarcoma/cirurgia , Osso Temporal , Adolescente , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/patologia , Hemorragia Cerebral/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Osteossarcoma/diagnóstico , Osteossarcoma/patologia , ReoperaçãoRESUMO
BACKGROUND AND PURPOSE: Single-voxel MR spectroscopy is a widely used tool for evaluating brain tumors. Although extensive data are available on the MR spectral appearance of tumors, less is known about the effect of voxel position on the accuracy of single-voxel MR spectroscopy findings. The purpose of this study was to test the hypothesis that the accuracy of single-voxel MR spectroscopy in the categorization of lesions as either tumor or not tumor is dependent on voxel position. METHODS: Fifty single-voxel MR spectra acquired with a fully automated stimulated-echo spectroscopy sequence were reviewed retrospectively in 43 patients with new or previously treated intra-axial brain tumors. Spectra were analyzed for the presence of choline, creatine, N-acetylaspartate (NAA), and lipid/lactate. Choline/creatine and NAA/creatine peak area ratios were assessed qualitatively. Lesions were grouped into one of three categories on the basis of spectral pattern: tumor, not tumor, or indeterminate. Results of MR spectroscopy were compared with the final histopathologic diagnosis. RESULTS: Histologic confirmation was obtained in 19 patients; MR spectra were interpretable in 17 of those. MR spectra correctly categorized nine of 17 lesions (six tumor, three nontumor). All eight misdiagnosed lesions were tumors. When the MR spectroscopy voxel included the enhancing edge of the lesion, the spectra correctly categorized seven of eight lesions (four of five tumors and all three cases of radiation necrosis). When the MR spectroscopy voxel was positioned centrally within the lesion, the spectra correctly reflected histologic outcome in two of nine lesions (all tumors). CONCLUSION: The reliability of single-voxel MR spectroscopy findings is dependent on voxel position. Spectra obtained from voxels at the enhancing edge of a tumor more accurately reflect lesion histopathology than do spectra obtained from the lesion center, even if the centrally placed voxels contain solidly enhancing tissue.
Assuntos
Astrocitoma/diagnóstico , Neoplasias Encefálicas/diagnóstico , Glioblastoma/diagnóstico , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Ácido Aspártico/análogos & derivados , Ácido Aspártico/metabolismo , Astrocitoma/patologia , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Colina/metabolismo , Creatina/metabolismo , Diagnóstico Diferencial , Glioblastoma/patologia , Humanos , Ácido Láctico/metabolismo , Metabolismo dos Lipídeos , Recidiva Local de Neoplasia/diagnóstico , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
This article discusses the gross and microscopic pathology of intracranial neoplasms. Primary intracranial neoplasms include tumors of the brain parenchyma; meninges; and rest of mesenchymal, epithelial, and germ cell derivation. The concept of tumor malignancy for primary central nervous system (CNS) neoplasms is somewhat different from that for systemic tumors. Although the capacity to metastasize is a defining feature of systemic malignancies and metastasis to the brain is a relatively common occurrence, primary CNS neoplasms rarely metastasize outside the CNS.
Assuntos
Neoplasias Encefálicas/patologia , Humanos , Invasividade Neoplásica , Estadiamento de NeoplasiasRESUMO
Plexiform neurofibroma of the cauda equina has been reported only twice previously. The authors report the first pediatric patient in whom such a tumor has been found. A 4-year-old boy presented with low-back pain that radiated bilaterally into the L-4 and L-5 dermatomes. A dermal sinus noted at the midthoracic level was surrounded by a hemangiomatous lesion. Magnetic resonance imaging confirmed the presence of the dermal sinus and revealed a well-defined lumbosacral mass that showed heterogeneous intensity with irregular enhancement. Intraoperatively, a solid mass, which engulfed the entire cauda equina, could not be dissected from the roots. The dermal sinus tract, however, was excised from the thoracic spine. The patient underwent radiotherapy to control the tumor and relieve his pain. Plexiform neurofibromas of the cauda equina are characterized by an insidious and progressive clinical course. The tumor mass may engulf all the roots of the cauda equina. No plexiform neurofibroma of the cauda equina has been reported to be associated with neurofibromatosis Type 1. The authors assume that the thoracic-level dermal sinus observed in this child was an incidental finding.
Assuntos
Cauda Equina/patologia , Neurofibroma Plexiforme/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Cauda Equina/efeitos da radiação , Cauda Equina/cirurgia , Pré-Escolar , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Neurofibroma Plexiforme/patologia , Neurofibroma Plexiforme/radioterapia , Neurofibroma Plexiforme/cirurgia , Neoplasias do Sistema Nervoso Periférico/patologia , Neoplasias do Sistema Nervoso Periférico/radioterapia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Espinha Bífida Oculta/diagnóstico , Espinha Bífida Oculta/cirurgiaRESUMO
Infantile myofibromatosis involving the skull is a benign disease if there is a solitary lesion. However, the multifocal form with skull involvement may portend a lethal course in the 1st year of life if there is involvement of the heart, lungs, or gastrointestinal tract. The authors report the case of a 3-year-old boy with an enlarging left parietal skull lesion that had been present since infancy. Increasing pain and the need to obtain tissue for diagnosis led to resection of the lesion by means of a small craniectomy. Further evaluation revealed no other lesions. A distinctly rare disease is presented, and the need for staging in children younger than 2 years of age is suggested to rule out cardiac, pulmonary, or gastrointestinal involvement.
Assuntos
Miofibromatose/cirurgia , Neoplasias Cranianas/cirurgia , Pré-Escolar , Craniotomia , Humanos , Masculino , Miofibromatose/diagnóstico por imagem , Miofibromatose/patologia , Osso Parietal/diagnóstico por imagem , Osso Parietal/patologia , Osso Parietal/cirurgia , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias Cranianas/patologia , Tomografia Computadorizada por Raios XRESUMO
We have induced in canines long-term immune tolerance to an allogeneic cell line derived from a spontaneous canine astrocytoma. Allogeneic astrocytoma cells were implanted endoscopically into the subcutaneous space of fetal dogs before the onset of immune competency (< 40th gestational day). At adulthood, dogs rendered tolerant successfully serve as recipients of intracranial transplants of their growing allogeneic, subcutaneous tumor. Transplanted dogs subsequently develop a solid brain tumor with histological features similar to the original astrocytoma. This model may allow rapid development and evaluation of new therapies for brain tumors, as well as afford tumor biology studies that are untenable in smaller, immune incompetent, or inbred animals harboring less representative tumors.
Assuntos
Astrocitoma/imunologia , Astrocitoma/patologia , Neoplasias Encefálicas/imunologia , Neoplasias Encefálicas/patologia , Animais , Cães , Imageamento por Ressonância Magnética , Transplante de Neoplasias , Neuroglia/patologia , Células Tumorais CultivadasRESUMO
BACKGROUND: The histologic differentiation of mitotic figures is a cornerstone of several highly predictive grading systems for gliomas. In some systems, the presence of even a single mitotic figure is sufficient to classify an astrocytoma as high grade. However, the extent of microscopic examination necessary to exclude the presence of significant mitotic activity has not been determined. METHODS: Hematoxylin and eosin-stained slides from 410 astrocytomas and 107 oligodendrogliomas/oligoastrocytomas were reviewed until the first mitosis was identified or 100 400x fields had been reviewed without identification of a mitosis. The number of the field in which the first mitosis was found was correlated with diagnosis, grade, and survival. RESULTS: A review of 50 400x fields was necessary to achieve a >90% sensitivity in identifying a mitosis in a Grade 3 astrocytoma specimen, compared with 20 400x fields in anaplastic (Grade 3 and 4) oligodendroglioma specimens. For Grade 3 astrocytomas, there was a significant independent correlation between survival and the field in which the first mitosis was found (P = 0.02). For the oligodendroglial tumors, there was a strong correlation between the number of fields counted until the first mitosis was found and grade (P < 0.0001). CONCLUSIONS: The evaluation of mitotic activity offers more prognostic information than can be obtained by the simple approach of noting only their presence or absence. Data were acquired regarding the diligence of the microscopic examination necessary to evaluate the presence or absence of mitotic activity. A 1 cm x 0.1 cm needle biopsy contains adequate tissue to evaluate mitotic activity for the purpose of histologic grading; however, this adequacy is dependent on the sample's being representative and composed entirely of cellular tumor.