Simultaneous conus medullaris ependymoma and cerebellar astrocytoma in the same patient.

Multiple primary tumors in the central nervous system of different histological cell types are uncommon. We report a patient who had pilocytic astrocytoma in the cerebellum and ependymoma in the cauda equina region, occurring simultaneously. The suggested mechanism of this association is that primitive multipotent cells might have been displaced in the different CNS areas and developed in different tumor cells. Multiplicity of primary CNS tumors should be considered in certain occasions, when clinical symptoms and signs are pointing in that direction.

Secondary hyperparathyroidism and brown tumor in dialyzed patients.

Secondary hyperparathyroidism is one of the most common complications of chronic renal failure (CRF). Its pathogenesis is multifactorial and still not completely understood. Pathological mechanism of hypocalcemia, hyperphosphatemia and calcitriol deficiency are basic characteristics of CRF and main reason for morphological changes in parathyroid glands and hyperparathyroidism (HP). We present a case of a female patient born in 1975. At the age of 10, a urinary infection was diagnosed for the first time and treated. Six years later, as nausea and vomiting started, CRF based on bilateral reflux was diagnosed and the patient was included in the hemodialysis treatment. The patient was again examined in 1997, when biochemical parameters, including the level of parathyroid hormone, ultrasonography of the neck, scintigraphy of the skeleton and densitometry revealed secondary HP. Parathyreoidectomy was perfomed in 1998. During the follow up period, a tumefaction on a ramus mandibulae dex. was noticed, which was cytologically diagnosed as osteitis fibrosa, "brown tumor", a rare complication of the secondary HP. Surgery was performed and PHD was granuloma gigantocelulare. Prevention and therapy of secondary HP is a problem that demands early actions to avoid possible complications.

Cerebral venous angiomas: surgery as a mode of treatment for selected cases.

Eleven patients with venous angiomas, 6 males and 5 females ranging in age from 4 to 58, are presented. Four patients presented with intracerebral haematoma and 3 patients had associated cavernous angioma, respectively. Patients with intracerebral haematoma had signs and symptoms due to the localization of the haematoma. The other patients presented with headache, seizures, vertigo, ataxia and mental disturbances. Pre-operative diagnosis was based on computerized tomography, magnetic resonance imaging and cerebral angiography. In 9 surgical cases it was confirmed by histopathological examination of operative specimens. After establishing the type, size and location of the lesion decision for operative treatment was made in nine cases, in four of them because of the presence of an intracerebral haematoma and in 5 of them due to severe disability. Eight of these 9 patients recovered completely and one improved. No severe cerebral oedema was encountered after converging medullary veins were excised and main draining veins partially coagulated. In this small series we encountered an unexpectedly large percentage of venous angiomas causing intracerebral haemorrhage which are commonly considered more benign than other vascular malformations. After reviewing previously reported cases of venous angiomas causing intracerebral haemorrhage and severe neurological deficit we think that the term "benign" is worth reconsidering. We propose a thorough examination of each case of venous angioma and the operative treatment when appropriate taking into account patients state and location of angioma.

Anaplastic ependymoma in children--increasing incidence?

During 1988 and 1989, 16 cases of ependymomas were diagnosed at the Department of Pathology, University Hospital "Sestre milosrdnice", Zagreb. The specimens were obtained from the Department of Neurosurgery of the same hospital. Seven tumors out of these 16 were supratentorial, four of them being diagnosed as anaplastic ependymomas. At the time of the first operation, patients with anaplastic ependymoma were aged 2 to 18 years, and there were three man and one woman. The criteria for this diagnosis were cellular pleomorphism and anaplasia, vascular hyperplasia with marked endothelial proliferation, and the most important of all, the presence of numerous mitoses. Necroses, cystic degenerations and bleeding were found in all four tumors. The aim of this study is the survey of morphology, tumor localisation and patient's age at the moment of diagnosis as relevant factors for the prognosis of these tumors. It seems significant to indicate a relatively great number of these tumors in only a two-year period in one hospital, while statistical data reported in the literature have been taken from several institutions in various towns or states for much longer period of even several decades. Hence, this study could be in favour of the idea presented in the recent literature data, that this tumor type is increasing.