Atypical Presentation of Temporal Dermoid Cyst: Case Report / Apresentação atípica de cisto dermoide temporal: caso clínico

Dermoid account for 0.04­0.06% of intracranial tumors. The rupture of these slowgrowing lesions are a rare event, generally taking place spontaneously. Their presentation are clinically variable according to cyst topography and integrity. Surgery remains the first-line therapy and gross total resection should be attempted if feasible. We report on a case of a 22-year-old male with a 2-year history of seizures and cognitive impairment and a temporal mesial dermoid cyst successfully treated with gross total resection microsurgery.

Os Cistos dermoides compreendem 0,04­0,06% dos tumores intracranianos. É uma lesão de crescimento lento, e sua ruptura é um evento raro e espontâneo. A variabilidade clínica vai de acordo com a topografia do cisto e sua integridade. A cirurgia continua a ser a terapia de primeira linha, e a ressecção total é a opção sempre que for possível. Os autores relatam um caso de paciente com 22 anos de idade com histórico de 2 anos de convulsões e comprometimento cognitivo e diagnosticado com um cisto dermoide mesial temporal, tratado com sucesso com ressecção microcirúrgica.

High prevalence of HCMV and viral load in tumor tissues and peripheral blood of glioblastoma multiforme patients.

Glioblastoma multiforme is the most prevalent and malignant tumor of the central nervous system. In the last few years, accumulating evidence has suggested an association between human cytomegalovirus (HCMV) infection and glioblastoma multiforme. In this study, tumor tissues and peripheral blood of patients with glioblastoma multiforme were examined for the presence of HCMV DNA. Twenty-two fresh surgical brain specimens and 20 peripheral blood samples were analyzed by real-time PCR (qPCR) and hemi-nested PCR (nPCR) for the presence of pp65 and (glycoprotein B) gB viral genomic regions, respectively. HCMV DNA was detected in the majority of the tumor samples analyzed (95% by qPCR and 91% by nPCR). About half of the patients with tumors positive for HCMV also had detectable viral DNA in their peripheral blood (47% by qPCR and 61% by nPCR). Genome copy numbers were determined and in the majority of the tumor samples cellular DNA outnumbers viral DNA (average of 1 infected cell in 33 cells). The gB genotypes were determined in HCMV-positive samples and gB2 was the most prevalent genotype in the tumor and blood samples. The results show a high prevalence of HCMV in glioblastoma multiforme samples reinforcing a possible association between HCMV infection and tumor development.

Massive intra and extracranial benign meningioma metastasizing to the lung and spine: the problem of meningiomas classification and iatrogenic metastasizing / Meningioma benigno intra e extracraniano com metástase para pulmão e coluna: o problema da classificação e disseminação iatrogênica

Meningioma is a common CNS tumor and metastasis in these tumours is a rare occurrence. Malignant meningiomas are more prone to metastase. However, there are frequent case reports of metastases in atypical (grade II) and even benign (grade I), which demonstrates the somehow unsatisfying prognostic power of the current classification system. We describe an extraordinary case of a patient with a massive intra and extra-cranial, benign meningioma, metastasizing to both lung and spine. Following the report we discuss 1) some of the problems of classifying meningioma, 2) massive meningiomas and 3) the possibility of intra-operative iatrogenic metastasizing. This case is unique due to its combination of different sites of metastases, massiveness, invasive growth and benign histology. Thus it ranks among those rare but not uncommon complicated courses in meningioma which is otherwise a common benign tumor. Unfortunately the existing classification-criteria do not have sufficient power to predict such complicated courses.

Meningioma é um tumor comum que raramente metastatiza, principalmente em casos de meningiomas malignos. Contudo, há casos frequentes de metástases em casos de tumores benignos ou atípicos, o que denota evidente falha no sistema atual de classificação desses tumores. Os autores descrevem o caso de um paciente com extenso meningioma benigno intra e extracraniano que metastizou para pulmões e coluna e adicionalmente discutem questões relativas a classificação e mecanismos de disseminação hematogênica.

Gliomas: casuística cirúrgica em um hospital-escola quaternário / Gliomas: a quaternary medical school hospital surgical casuistic

Objetivo: É apresentada neste trabalho a casuística cirúrgica de ressecção de gliomas em um hospitalescola quaternário da cidade de São Paulo, no período de 19 meses. Método: Foram coletados dados, prospectivamente, de todos os pacientes adultos com diagnóstico de glioma, submetidos à ressecção cirúrgica no hospital referido, no período de novembro de 2007 a junho de 2009, por meio de preenchimento de um protocolo pelo médico-assistente de cada caso. Resultados: No período estudado, foram realizadas 288 cirurgias para ressecção de tumores encefálicos. Dessas, 88 cirurgias foram destinadas à ressecção de gliomas do sistema nervoso central. Corresponde a 30,56% das cirurgias para ressecção de tumores encefálicos, sendo esse o maior grupo, com média anual de 55,5 gliomas operados. Conclusão: O predomínio dos astrocitomas de alto grau nos casos operados é semelhante aos dados da literatura, demonstrando a importância dessa doença. A gravidade e a considerável incidência desses tumores em nossa população mostram a necessidade de constante investimento e aprimoramento tecnológico e humano para o adequado tratamento desses pacientes.

Objective: We present in this work the gliomas surgery casuistic of a quaternary medical school hospital of São Paulo city during a 19 months period. Method: Data were collected, prospectively, of all patients with glioma operated at Hospital das Clínicas of São Paulo Medical School, in the period between November 2007 to June 2009. Results: In the studied period 288 surgeries were held for encephalic tumors resection. Of these, 88 surgeries were aimed at resection of central nervous system gliomas. That represents 30.56% of encephalic tumors surgery, the largest group with an annual average of 55.5 gliomas operated. Conclusion: The prevalence of high grade astrocytomas operated is similar to literature data, demonstrating the importance of this disease on the health of a community. The seriousness and considerable incidence of these tumors in our population show the necessity of constant investment in technological and human enhancement for the proper treatment of these patients.

Papel do citamegalovirus humano (HCMV) / The role of the citomegalovirus in the oncomulation of brain tumors

O citomegalovírus Humano (HCMV) é um agente viral que acomete indivíduos imunocomprometidos e recém nascidos,causando uma variedade de doenças graves e podendo levar ao óbito. Recentes evidências indicam que o HCMV está envolvido no processo de progressão tumoral. Estudos demonstraram que o DNA viral e proteínas virais estão presentes em diferentes tipos de câncer; proteínas virais são capazes de interferir com a progressão do ciclo celular, apoptose e ativação do sistema imune e há indicações de que a infecção de células tumorais pelo HCMV aumenta a malignidade das mesmas.Estas descobertas levaram à criação do termo oncomodulação,definido como a habilidade do vírus em promover um processo tumoral. Os estudos do papel do HCMV no processo de malignidade de tumores estão avançando enormemente e um melhor entendimento do fenômeno de oncomodulação é essencial para elucidação da participação do HCMV na progressão de tumores e para determinação de proteínas virais que podem ser alvo terapêutico em certos tipos de cânceres.Esta revisão discute os mecanismos envolvidos na oncogênese e oncomodulação de gliomas malignos promovidas pelo HCMV.

Human cytomegalovirus (HCMV) is an important viral pathogen that causes a variety of diseases in imunocompromised individuals and newborns that can culminate in death. Recent evidences indicate that HCMV is involved in tumor progression.Studies demonstrated that the viral DNA and proteins are present in many types of cancer tissues; viral proteins are able to interfere with cell cycle, apoptosis and the immune system.In addition, there are indications that the infection of tumor cells by HCMV increases their malignity. These evidences led to the creation of the term oncomodulation, defined as the abilityof the virus to promote tumor progression. The studies ofthe HCMV role in the process of tumor malignity are rapidlyadvancing and a better understanding of the oncomodulation phenomenon is essential to clarify the participation of HCMV in malignancy and for the determination of specific viral proteins that can be therapeutic targets in certain tumor types. This review discusses the mechanisms of tumor progression and oncomodulation promoted by HCMV in malignant gliomas.