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1.
Zhonghua Bing Li Xue Za Zhi ; 50(2): 114-118, 2021 Feb 08.
Artigo em Chinês | MEDLINE | ID: mdl-33535305

RESUMO

Objective: To analyze the clinicopathological characteristics, diagnosis and prognosis of meningioangiomatosis (MA), and to investige the possible origion of spindle cells. Methods: Seventeen cases of MA were collected at Xuanwu Hospital of Capital Medical University and the First Affiliated Hospital of Fujian Medical University, from June 2012 to March 2020. The clinical manifestations, radiologic, histopathologic, immunohistochemical features and patients' outcome were analyzed. The presumed origin of spindle cells was evaluated by immunohistochemical staining. Results: Of the 17 patients, 9 were males and 8 were females. The age ranged from 3 to 56 years old. Thirteen patients presented with seizure as the initial symptom. The lesions were solitary and located in the cerebral cortex. Histopathologically, there were proliferation of small blood vessels and perivascular spindle cells in the cerebral cortex. The spindle cells had no obvious atypia, mitoses and necrosis. Four cases were combined with transitional meningioma. Immunohistochemically, the proliferative perivascular spindle cells were positive for vimentin in all cases, and focally positive for EMA and SSTR2. Ki-67 proliferation index was low. Neurofibrillary tangles were demonstrated by AT8. All 17 patients received surgical treatment and were followed up for one to 93 months. None had seizure attacks or tumor recurrence. Conclusions: MA is a rare slow-growing intracranial lesion, and the perivascular spindle cells could be derived from meningothelial cells, and MA is often associated with degeneration of the cerebral cortex and meningioma. The patients have good prognosis after surgical treatment.


Assuntos
Neoplasias Meníngeas , Meningioma , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Imuno-Histoquímica , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Prognóstico , Vimentina , Adulto Jovem
2.
Artigo em Russo | MEDLINE | ID: mdl-33560625

RESUMO

The combination of intracranial tumors and asymptomatic brain aneurysms is an urgent problem, since it can significantly affect surgical intervention. Aneurysms are common in patients with meningioma, glioma and pituitary adenoma. According to certain authors, combination of aneurysms with pituitary adenomas is 7 times more common than with other tumors. In these cases, a comprehensive examination of the patient and decision-making on surgical strategy are required. This review is devoted to epidemiology, diagnosis and treatment of patients with a combination of pituitary adenomas and intracranial aneurysms detected intraoperatively or at the preoperative stage. The manuscript is illustrated by cases observed at the Burdenko Neurosurgery Center.


Assuntos
Adenoma , Aneurisma Intracraniano , Neoplasias Meníngeas , Neoplasias Hipofisárias , Adenoma/epidemiologia , Adenoma/cirurgia , Humanos , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos , Neoplasias Hipofisárias/cirurgia
3.
BMJ ; 372: n37, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536184

RESUMO

OBJECTIVE: To assess the risk of meningioma associated with use of high dose cyproterone acetate, a progestogen indicated for clinical hyperandrogenism. DESIGN: Observational cohort study. SETTING: Data from SNDS, the French administrative healthcare database, between 2007 and 2015. PARTICIPANTS: 253 777 girls and women aged 7-70 years living in France who started cyproterone acetate between 2007 and 2014. Participants had at least one reimbursement for high dose cyproterone acetate and no history of meningioma or benign brain tumour, or long term disease status. Participants were considered to be exposed when they had received a cumulative dose of at least 3 g during the first six months (139 222 participants) and very slightly exposed (control group) when they had received a cumulative dose of less than 3 g (114 555 participants). 10 876 transgender participants (male to female) were included in an additional analysis. MAIN OUTCOME MEASURE: Surgery (resection or decompression) or radiotherapy for one or more intracranial meningiomas. RESULTS: Overall, 69 meningiomas in the exposed group (during 289 544 person years of follow-up) and 20 meningiomas in the control group (during 439 949 person years of follow-up) were treated by surgery or radiotherapy. The incidence of meningioma in the two groups was 23.8 and 4.5 per 100 000 person years, respectively (crude relative risk 5.2, 95% confidence interval 3.2 to 8.6; adjusted hazard ratio 6.6, 95% confidence interval 4.0 to 11.1). The adjusted hazard ratio for a cumulative dose of cyproterone acetate of more than 60 g was 21.7 (10.8 to 43.5). After discontinuation of cyproterone acetate for one year, the risk of meningioma in the exposed group was 1.8-fold higher (1.0 to 3.2) than in the control group. In a complementary analysis, 463 women with meningioma were observed among 123 997 already using cyproterone acetate in 2006 (risk of 383 per 100 000 person years in the group with the highest exposure in terms of cumulative dose). Meningiomas located in the anterior skull base and middle skull base, particularly the medial third of the middle skull base, involving the spheno-orbital region, appeared to be specific to cyproterone acetate. An additional analysis of transgender participants showed a high risk of meningioma (three per 14 460 person years; 20.7 per 100 000 person years). CONCLUSIONS: A strong dose-effect relation was observed between use of cyproterone acetate and risk of intracranial meningiomas. A noticeable reduction in risk was observed after discontinuation of treatment.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Acetato de Ciproterona/efeitos adversos , Neoplasias Meníngeas/induzido quimicamente , Meningioma/induzido quimicamente , Adolescente , Adulto , Idoso , Antagonistas de Androgênios/administração & dosagem , Estudos de Casos e Controles , Criança , Acetato de Ciproterona/administração & dosagem , Bases de Dados Factuais , Relação Dose-Resposta a Droga , Feminino , França/epidemiologia , Humanos , Incidência , Estudos Longitudinais , Neoplasias Meníngeas/epidemiologia , Meningioma/epidemiologia , Pessoa de Meia-Idade , Medição de Risco , Adulto Jovem
4.
Medicine (Baltimore) ; 100(6): e24704, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578608

RESUMO

RATIONALE: Foramen magnum meningiomas are very rare lesions. They frequently originate from the arachnoid cells at the dura matter of the craniocervical junction. Foramen magnum meningiomas are challenging for neurosurgeons because of the complex anatomy of foramen magnum. We present a rare case of FMM with excessive calcification and without the dura tail sign which made the lesion mimic a teratoma. PATIENTS CONCERNS: A 63 years old woman presented with progressive numbness and hyperesthesia of the shoulders and upper limbs for 2 and half years. She also experienced occasional headaches and dizziness with no nausea, vomiting or fever. DIAGNOSES: Computed tomography scan, and magnetic resonance imaging revealed a calcified mass at occipital cistern. The lesion did not show the usual "dura tail sign" which made it mimic a teratoma on magnetic resonance imaging. Histopathology established meningioma. INTERVENTION: The tumor was completely resected via suboccipital approach. OUTCOMES: Two years follow-up revealed no recurrence of the lesion and no neurological deficits. LESSONS: We advocate the use of electromyographic and auditory brainstem responses to monitor the inferior cranial nerves because the tumor often adheres to these nerves.


Assuntos
Forame Magno/patologia , Neoplasias Meníngeas/patologia , Meningioma/patologia , Calcinose/diagnóstico por imagem , Calcinose/patologia , Angiografia por Tomografia Computadorizada , Feminino , Forame Magno/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade
5.
Am J Phys Med Rehabil ; 100(1): 100-104, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534219

RESUMO

ABSTRACT: The incidence of leptomeningeal disease (LMD) is believed to be increasing in part because of more effective chemotherapy treatments allowing cancer progression behind the blood-brain barrier. However, little has been published about the rehabilitation of this growing patient population. In this study, impairments and rehabilitation utilization by cytology-proven LMD patients receiving intrathecal chemotherapy at a cancer center are described. A total of 109 consecutive patients with pathology-confirmed LMD who received an intrathecal chemotherapy infusion from January 1, 2017, through October 31, 2017, were retrospectively reviewed. Of the 109 patients, 103 (95%) had impairments described in their medical record that could impact physical function, including 74 of 109 (68%) who had deconditioning or fatigue. Kaplan-Meier median survival from initial LMD diagnosis was 13.1 mos. The median number of hospital admissions and intrathecal chemotherapy administrations was both 8. Of the 109 patients, 43 (39%) had magnetic resonance imaging radiology interpreted LMD. Most LMD patients used rehabilitation services (95/109, 87%) and most were able to forego post-acute inpatient rehabilitation facilities (96/109, 88%). Additional research and education for rehabilitation professionals about this increasingly common syndrome are needed.


Assuntos
Neoplasias Encefálicas/reabilitação , Fadiga/reabilitação , Neoplasias Meníngeas/reabilitação , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/tratamento farmacológico , Fadiga/etiologia , Feminino , Humanos , Injeções Espinhais , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/tratamento farmacológico , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
6.
Anticancer Res ; 41(2): 983-991, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517305

RESUMO

BACKGROUND/AIM: Tumorigenesis and cancer progression might be driven by abnormal activation of growth factor receptors. Importantly, molecular changes in EGFR-dependent signaling is one of the most common characteristics of brain tumors. PATIENTS AND METHODS: HER1 and EGFRvIII variants in meningiomas and glioblastomas were evaluated at the RNA level. RESULTS: EGFRvIII was found in 18.6% of glioblastomas (GBM), whereas 25% of EGFRvIII positive tumors express wild-type EGFR as well. HER1 was over-expressed in benign meningiomas compared to glioblastomas, whereas HER1 expression in meningiomas differed significantly between sub-types of meningiomas. EGFRvIII and HER1 where positively correlated in glioblastomas. Yet, the patient overall survival did not differ between high- and low-HER1 expressing glioblastomas or between EGFRvIII positive and negative GBMs. CONCLUSION: HER1 may be considered as an independent factor for classification of benign meningiomas. The mRNA levels of HER1 or EGFRvIII should not be used as independent prognostic factors for patients with gliomas.


Assuntos
Neoplasias Encefálicas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Mutação , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/genética , Receptores ErbB/genética , Feminino , Marcadores Genéticos , Humanos , Masculino , Neoplasias Meníngeas/genética , Meningioma/genética , Pessoa de Meia-Idade , Análise de Sobrevida , Resultado do Tratamento , Regulação para Cima
7.
Artigo em Chinês | MEDLINE | ID: mdl-33472300

RESUMO

Objective: To evaluate the application of combination use of endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically in skull base tumor with intra and extra-cranial involvement. Methods: A total of 7 patients (4 males and 3 females, aging from 27 to 65 years old, with a medium age of 48) undergone complicated skull base surgeries via endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically from May 2016 to January 2018 were reviewed respectively. The patients included 2 cases of recurrent invasive pituitary adenoma, 3 cases of basal skull meningiomas, 1 case of clivus chondrosarcoma, and 1 case of recurrent nasopharyngeal carcinoma. The lesion extensively infiltrated nasal cavity, extending to the paranasal sinus, bilateral cavernous sinus, sellar region, suprasellar, superior clivus, temporal lobe, pterygopalatine fossa, infratemporal fossa and important intracranial vessels. All the 7 patients were treated under general anesthesia by endoscopic endonasal approach combined with frontotemporal orbitozygomatic approach under the microscope. Total excision rate, intraoperative and postoperative complications and postoperative curative effect were observed. All of them were followed up for 6 to 12 months. The Glasgow Outcome Scale (GOS) was used to evaluate the prognosis. Result: Total tumor removal was performed in 5 cases, subtotal removel in 2 cases. There was no complication during the operation. Postoperative severe complications occurred in 2 cases, including 1 case of cerebrospinal fluid rhinorrhea and intracranial infection, which was cured by lumbar cistern drainage and intrathecal injection; 1 case occurred oculomotor nerve paralysis, which recovered during follow-up. Postoperative complications occurred in 1 case of trochlear nerve dysfunction, 2 cases of facial numbness, and 1 case of tinnitus. During follow-up, all patients recovered to varying degrees. There was no bleeding and death after the operation. No tumor recurred during the follow-up period. All patients were recovered well with GOS grade Ⅳ-Ⅴ. Conclusions: Endoscopic transnasal approach combined with microscopic frontotemporal orbitozygomatic approach can remove tumors in one stage, reduce surgical complications and improve surgical effect. It has good application prospects and is suitable for excising complex intracranial and extracranial communicating tumors of widely involving sellar, clivus and petrous apex area.


Assuntos
Neoplasias Meníngeas , Meningioma , Neoplasias da Base do Crânio , Adulto , Idoso , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fossa Pterigopalatina , Estudos Retrospectivos , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/cirurgia
8.
Clin Nucl Med ; 46(1): 58-59, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33234918

RESUMO

A 68-year-old man in whom a prostate cancer biochemical recurrence was being investigated was referred for a full-body Ga-prostate-specific membrane antigen PET/CT. Focal uptake in a lesion on the choroid plexus projection was detected. Patient had no neurological complaints. A previous MRI performed 4 years ago showed the same lesion. According to the location and radiological and clinical characteristics, the diagnosis of meningioma was defined. The interpretation of prostate-specific membrane antigen PET/CT must take into account the low frequency of metastases in sites such as the central nervous system, and the possibility of intense uptake in lesions unrelated to prostate cancer.


Assuntos
Neoplasias do Plexo Corióideo/diagnóstico por imagem , Glicoproteínas de Membrana/metabolismo , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Compostos Organometálicos/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Transporte Biológico , Neoplasias do Plexo Corióideo/metabolismo , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/metabolismo , Meningioma/metabolismo , Pessoa de Meia-Idade
9.
Medicine (Baltimore) ; 99(50): e23183, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327235

RESUMO

Most of the craniopharyngioma is considered to derive from residual epithelial cells during the craniopharyngeal canal degeneration. Meningioma accounting for the primary intracranial neoplasm is considered to be mainly derived from cells of arachnoid granulations. Nevertheless, rare cases show coexistence of craniopharyngioma and meningioma.Case 1: A 43-year-old male patient referred to the hospital due to paroxysmal headache combined with blurred vision for 1 month. On physical examination, the visual acuity of left eye was poorer than that of the right eye. The visual acuity of the right eye near the nasal part showed defect.MRI and pathological examination were performed. The patient received intracranial tumor resection. After surgery, the patient showed hormone disorder, followed by corresponding treatment. However, the patient was lost in the 6-month follow-up.Case 2: The 64-year-old male patient presented to our department due to decline of visual acuity within 1 year combined with polydipsia (5,000 ml per day), polyuria and fatigue for 6 months. On physical examination, the bilateral visual acuity showed decline, especially the temporal part which was nearly hemiscotosis. MRI was performed. The adamantinomatous craniopharyngioma was diagnosed with the HE staining findings. The patient received intracranial resection. After surgery, the patient was in a deep coma condition, and was lost in the follow-up.In this case study, we presented 2 patients with coexistence of craniopharyngioma and meningioma. In addition, a complete literature review was carried out to illustrate the studies on coexistence of craniopharyngioma and meningioma. Meanwhile, we tried to explain the possible mechanisms for such condition.


Assuntos
Craniofaringioma/complicações , Craniofaringioma/cirurgia , Meningioma/complicações , Meningioma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Craniofaringioma/diagnóstico por imagem , Fadiga/diagnóstico , Fadiga/etiologia , Feminino , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Perda de Seguimento , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Polidipsia/diagnóstico , Polidipsia/etiologia , Poliúria/diagnóstico , Poliúria/etiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Acuidade Visual
10.
Medicine (Baltimore) ; 99(50): e23504, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327290

RESUMO

RATIONALE: Solitary fibrous tumor is a rare mesenchymal tumor. This case report describes the diagnosis and treatment of this tumor. PATIENT CONCERNS: A 31-year-old patient presented with epileptic seizure and headache 1 day prior to the visit and showed transient right limb hemiplegia for 6 hours that was resolved after intravenous infusion of mannitol. DIAGNOSES: Based on imaging, the provisional diagnosis was meningioma. Postsurgical histopathological diagnosis confirmed solitary fibrous tumor. INTERVENTIONS: The lesion was totally excised. The patient improved remarkably after the operation, without any signs of associated limb movement disorder. No epileptic seizure was observed or reported after the operation. OUTCOMES: Postoperation computed tomography (CT) scans showed no obvious residual tumor. The patient was followed up every 3 months for a total of 1 year following the operation, during which time the patient did not complain of headache or seizure. LESSONS: The manifestation of solitary fibrous tumor (SFT) through imaging methods has certain specific findings,butimmunohistochemistry is still very important for confirming the diagnosis.


Assuntos
Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Adulto , Diagnóstico Diferencial , Cefaleia/etiologia , Hemiplegia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Lobo Parietal , Convulsões/etiologia , Tomografia Computadorizada por Raios X
11.
Medicine (Baltimore) ; 99(50): e22928, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327228

RESUMO

RATIONALE: Primary leptomeningeal melanoma is an extremely rare disease of the central nervous system. There are no standard treatment protocols with a poor prognosis in very few reported cases. Immunotherapy in primary brain melanoma has not been successfully applied so far. PATIENT CONCERNS: We describe a female patient 72-year-old diagnosed in the Neurosurgery Department which presented with generalized seizures. DIAGNOSES: Histological examination confirmed atypical melanocytes immunohistochemically positive for melan A, HMB45 and S-100 protein in the meninges, BRAF V600E negative. Dermatological, ophthalmological examinations, and 18-FDG PET/CT were negative. INTERVENTIONS: The patient was successfully treated with pembrolizumab 2 mg/kg every 3 weeks for 2 years. OUTCOMES: The disease was stable for 2 years and the patient had no significant toxicity. LESSONS: Our report describes durable intracranial tumor response suggesting the efficacy of PD-1 inhibitor pembrolizumab for central nervous system primary leptomeningeal melanoma.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Melanoma/tratamento farmacológico , Neoplasias Meníngeas/patologia , Idoso , Feminino , Humanos , Antígeno MART-1/metabolismo , Melanoma/diagnóstico , Antígenos Específicos de Melanoma/metabolismo , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Proteínas S100/metabolismo , Convulsões/etiologia , Resultado do Tratamento
12.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 299-305, nov.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-ET2-7550

RESUMO

INTRODUCCIÓN: El nevo de Ota y el nevo de Ito son melanocitosis dérmicas hiperpigmentarias que surgen como consecuencia de alteraciones o fallas en la migración de los melanocitos desde la cresta neural hacia la epidermis, tienen una etiopatogenia poco conocida y pueden ser congénitas o adquiridas. CASO CLÍNICO: Se trata de un paciente con diagnóstico simultáneo de nevo de Ota y nevo de Ito desde el nacimiento que acude al Servicio de Neurocirugía del hospital Carlos Andrade Marín de la ciudad de Quito y consulta por presentar cefalea súbita de gran intensidad asociada a hemiparesia braquiocrural izquierda. Evolución: Por medio de exámenes complementarios es diagnosticado de dos lesiones ocupantes intracraneales extraaxiales, una parasagital frontoparietal derecha y otra localizada en polo temporal derecho. Se planificó una resección quirúrgica de la lesión parasagital cuyo diagnóstico histopatológico fue melanocitosis meníngea. La lesión de polo temporal fue derivada para tratamiento con Gamma Knife(R). CONCLUSIÓN: Los tumores melanocíticos primarios son extremadamente raros, existe evidencia de su asociación con las melanocitosis dérmicas y en especial con el nevo de Ota. El caso presentado describe la coexistencia de dos melanocitosis dérmicas poco frecuentes (nevo de Ota - nevo de Ito) y un tumor melanocítico primario en el mismo paciente, un caso muy fuera de lo común


BACKGROUND: Nevus of Ota and nevus of Ito are hyperpigmentary dermal melanocytoses which develop as a consequence of disturbances or failures during migration of melanocytes from the neural crest towards the epidermis; they have a relatively unknown aetiopathogenesis and may be congenital or acquired. CASE REPORT: This case involves a male patient with a simultaneous diagnosis of nevus of Ota and nevus of Ito at birth. He attended the Neurosurgery department at Carlos Andrade Marín hospital (Quito) with sudden severe headache associated with left brachio-crural hemiparesis. PROGRESS: Investigations revealed two extra-axial space-occupying lesions, one parasagittal at the right frontal and parietal lobes and the other located at the right temporal lobe pole. A surgical resection was planned for the parasagittal lesion and the histopathological diagnosis was meningeal melanocytosis. The temporal pole lesion was referred for treatment with Gamma Knife(R). CONCLUSION: Primary melanocytic neoplasms are extremely rare. There is evidence of their association with dermal melanocytosis and, in particular, with nevus of Ota. This highly unusual case describes the coexistence of two very rare dermal melanocytoses (nevus of Ota and nevus of Ito) and a primary melanocytic neoplasms in the same patient


Assuntos
Humanos , Masculino , Adulto , Nevo de Ota/cirurgia , Neoplasias Cutâneas/cirurgia , Melanócitos/patologia , Nevo Pigmentado/cirurgia , Neoplasias Meníngeas/cirurgia , Nevo de Ota/patologia , Neoplasias Cutâneas/diagnóstico , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patologia , Cefaleia/etiologia , Paresia/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/cirurgia , Biópsia
13.
Brain Nerve ; 72(10): 1105-1111, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33051400

RESUMO

Meningioma and glioma represent two common primary intracranial tumors. However, the coexistence of these two lesions in the same patient at the same location is rare. Here, we present a case of a fibroblastic meningioma with a secondary glioblastoma occurring at the same location. A 67-year-old woman underwent surgery for a left frontal parasagittal meningioma, and the tumor was subtotally removed. Two years and 11 months after the surgery, the patient had a tumor at the same location with invasion into the adjacent brain, suggesting recurrent meningioma with malignant transformation. The resected tumor was confirmed histopathologically as a glioblastoma. Genetic analysis revealed that the isocitrate dehydrogenase 1 and 2 genes were wild type, and the TERT promoter mutation was detected. The gene analysis suggests that the tumor was a de novo glioblastoma, not a secondary glioblastoma from a lower-grade glioma. (Received April 9, 2020; Accepted May 27, 2020; Published October 1, 2020).


Assuntos
Neoplasias Encefálicas , Glioblastoma , Neoplasias Meníngeas , Meningioma , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/genética , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/cirurgia , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Recidiva Local de Neoplasia/cirurgia
14.
Eur J Endocrinol ; 183(6): K7-K12, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33105102

RESUMO

A monoallelic germline alteration of ARMC5 causes primary bilateral macronodular adrenal hyperplasia (PBMAH) with Cushing's syndrome via its subsequent somatic alteration on the other allele as the second hit. PBMAH is sometimes complicated with meningioma. Dependency of such a multi-organ disease on the second hit mechanism was reported before, but this finding has not been confirmed yet. We describe a case of a 65-year-old female with PBMAH, carrying a heterozygous germline alteration of ARMC5, p.R267*, complicated with meningioma associated with somatic loss of heterozygosity (LOH) of the unaffected allele. Pathogenic alterations of ARMC5 may also contribute to the development of meningioma by the two-hit mechanism.


Assuntos
Proteínas do Domínio Armadillo/genética , Síndrome de Cushing/genética , Neoplasias Meníngeas/genética , Meningioma/genética , Idoso , Alelos , Feminino , Mutação em Linhagem Germinativa/genética , Humanos , Perda de Heterozigosidade/genética
15.
Artigo em Russo | MEDLINE | ID: mdl-33095531

RESUMO

OBJECTIVE: To compare monopolar and bipolar mapping in point-by-point fashion by using of threshold amperage, frequency of positive motor responses and the number of muscles involved in response. MATERIAL AND METHODS: A prospective non-randomized study included 14 patients with supratentorial tumors who underwent surgery in 2018-2019. All neoplasms were localized within 2 cm from the motor cortex and pyramidal tract. Age of patients ranged from 25 to 74 years. There were 9 women and 5 men. Eight patients had malignant glioma (grade III - 4, grade IV - 4), 6 patients - meningioma. Motor functions were assessed in all patients before and after surgery (1, 7 days and 3 months later) by using of a 5-point scale. In addition to routine neurophysiological monitoring, comparative mono- and bipolar mapping of the pyramidal tract within the bed of excised tumor was carried out at the end of surgery. The points of motor responses were marked. Comparative analysis of mono- and bipolar stimulation at identical points included threshold amperage, frequency of positive motor responses and the number of muscles involved in response (leg, forearm, hand, facial muscles). Brain MRI was performed in early postoperative period for assessment of resection quality. RESULTS: There were 64 points of motor responses in 14 patients. The number of these points ranged from 2 to 8 per a patient (mean 5 points). Motor responses were recorded in 57 points during monopolar and bipolar stimulation, in other 7 points - only during monopolar stimulation. Amperage of monopolar stimulation was 3-15 mA, bipolar stimulation - 2.5-25 mA. Threshold amperage (7.37 mA for monopolar stimulation and 8.88 mA for bipolar stimulation; p=0.12), frequency of positive motor responses and the number of muscles involved in response (p=0.1 and p=0.73) were similar. Seven (50%) patients had neurological deterioration in early postoperative period (4 patients with glial tumors and 3 patients with meningiomas). At the same time, only 2 patients (14.3%) had persistent neurological deficit (both patients with infiltrative meningioma). According to postoperative MRI in T1+C mode, resection volume was 100% in 1 patient with contrast-enhanced glioma and 94% in another one. According to FLAIR MRI data, resection volume exceeded 70% in 2 patients with non-enhancing glioma and less than 70% in 2 patients. Meningioma resection volume was estimated according to postoperative T1+C MRI data and made up over 90% in 4 patients. CONCLUSION: Monopolar stimulation is a reliable method of pyramidal tract identification in supratentorial brain tumor surgery.


Assuntos
Transtorno Bipolar , Neoplasias Encefálicas , Neoplasias Meníngeas , Córtex Motor , Neoplasias Supratentoriais , Mapeamento Encefálico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Potencial Evocado Motor , Feminino , Humanos , Masculino , Monitorização Intraoperatória , Córtex Motor/diagnóstico por imagem , Estudos Prospectivos , Tratos Piramidais/diagnóstico por imagem , Neoplasias Supratentoriais/diagnóstico por imagem , Neoplasias Supratentoriais/cirurgia
17.
No Shinkei Geka ; 48(10): 903-907, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071225

RESUMO

DuraGen®, an absorbable, engineered collagen-based artificial graft was introduced in Japan in September 2019 for cranial, transsphenoidal, and spinal surgeries. In addition to its efficacy and safety profile, owing to sutureless dural repair, DuraGen® is widely accepted by neurosurgeons. Direct tenting with DuraGen® is occasionally required in patients with large dural defects, particularly in cases of tumors adherent to the dura. To overcome this limitation, we introduced a surgical technique for epidural tenting using DuraGen®. A 78-year-old man with a history of alexia underwent craniotomy for resection of a left temporal lobe metastatic tumor. We completely removed the recurrent tumor, which was strongly adherent to the dura in the middle cranial fossa. A layer of DuraGen® was used as a subdural underlay beneath the autologous dura to close the wide dural defect. To avoid postoperative epidural fluid collection, we retracted the DuraGen® from the epidural aspect and interposed several pieces of muscle, which were sutured on the subdural aspect to ensure that the muscle pieces securely plugged the dural defect. We placed an additional overlay of DuraGen® along the autologous dura. The patient's postoperative course was uneventful without cerebrospinal fluid leakage, tension pneumocephalus, or wound infection. Reoperations for tumor resection, particularly surgical procedures for refractory meningiomas and malignant tumors cause increasing fragility and wide defects of the dura. DuraGen® placement enables sutureless closure and is less time-consuming. Our technique of epidural direct tenting with DuraGen® using muscle pieces sutured on the subdural aspect could be useful in patients with significantly large dural defects and can prevent postoperative epidural fluid collection to ensure complete dural sealing.


Assuntos
Neoplasias Meníngeas , Recidiva Local de Neoplasia , Idoso , Dura-Máter/cirurgia , Humanos , Japão , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Crânio
18.
Medicine (Baltimore) ; 99(44): e22919, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126353

RESUMO

RATIONALE: Pain is the fifth vital sign of human beings. Morphine is the first choice for relieving moderate to severe cancer pain. Most of the previous studies merely focused on the analgesic effect of high-dose or ultra-high-dose morphine in patients with advanced cancers but did not report any cases related to successful morphine withdrawal. PATIENT CONCERNS: A 42-year-old woman was admitted to our hospital in March 2019. DIAGNOSIS: She was diagnosed with progressive aggravation of headache for 1 month, which was meningeal metastasis of lung cancer. INTERVENTIONS: Symptomatic treatments like dehydration, hormone, intrathecal injection chemotherapy and an increased dose of osimertinib to 160 mg/day were applied but showed poor curative effects. The patient refused whole-brain radiotherapy. Pain intensity level was re-evaluated and the patient scored 9 based on numerical rating scale, which suggested that the patient suffered from severer cancerous pain. Thus, the patient started to receive morphine for treating headache. OUTCOMES: The patient's headache was alleviated after receiving high-dose morphine treatment, and she continued to undergo anti-cancer treatment. After tumor remission, the patient's morphine dose gradually decreased and eventually stopped, without any withdrawal symptoms. In addition, the quality of life of the patient was greatly improved with performance status scored 2 and limb muscle strength increased from Grade 2 to Grade 5. LESSONS: For patients with advanced cancers, the application of ultra-high-dose morphine may significantly relieve cancerous pain, improve survival and quality of life, and overcome their fear for death and desperation, which contributes to the establishment of a basis for subsequent anticancer treatments. Thus, timely effective pain management and routine anticancer treatments are the key to addressing the cancer pain problem.


Assuntos
Adenocarcinoma de Pulmão , Dor do Câncer , Cefaleia , Neoplasias Pulmonares , Neoplasias Meníngeas , Manejo da Dor/métodos , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/terapia , Administração Intravenosa , Adulto , Analgésicos Opioides/administração & dosagem , Dor do Câncer/diagnóstico , Dor do Câncer/tratamento farmacológico , Relação Dose-Resposta a Droga , Feminino , Cefaleia/diagnóstico , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Neoplasias Meníngeas/fisiopatologia , Neoplasias Meníngeas/secundário , Neoplasias Meníngeas/terapia , Morfina/administração & dosagem , Medição da Dor , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(44): e23028, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126391

RESUMO

RATIONALE: Tumor-to-tumor metastasis is a rare clinical phenomenon. Although meningioma is the most common intracranial recipient of cancer metastasis, only a few cases have been reported. We present a case of metastasis of lung adenocarcinoma into intracranial meningioma and review the published literature. PATIENT CONCERNS: A 70-year-old woman was admitted to our hospital for a 1-month history of headache and pain in her lower extremities. DIAGNOSIS: Brain and lumbar vertebral magnetic resonance imaging showed an intracranial space-occupying lesion in the right occipital region and spinal canal stenosis. Pulmonary computed tomography showed an irregular mass in the right upper lobe of the lung. The postoperative histological examination demonstrated adenocarcinoma metastasis to meningioma. INTERVENTION: The patient underwent right occipital craniotomy for tumor removal and lumbar spinal canal decompression. OUTCOMES: There were no initial abnormal conditions after the operation. However, the patient died suddenly 7 days after surgery. LESSONS: Tumor-to-meningioma metastasis is a rare but important phenomenon. According to previous reports, it is associated with rapid onset of symptoms and a poor prognosis. Histological examination is of great importance in diagnosis. The history and process of malignant carcinoma should be closely monitored.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Idoso , Craniotomia , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/secundário , Meningioma/complicações , Meningioma/diagnóstico por imagem , Meningioma/secundário , Metástase Neoplásica , Lobo Occipital
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1758-1761, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018338

RESUMO

Using medical images recorded in clinical practice has the potential to be a game-changer in the application of machine learning for medical decision support. Thousands of medical images are produced in daily clinical activity. The diagnosis of medical doctors on these images represents a source of knowledge to train machine learning algorithms for scientific research or computer-aided diagnosis. However, the requirement of manual data annotations and the heterogeneity of images and annotations make it difficult to develop algorithms that are effective on images from different centers or sources (scanner manufacturers, protocols, etc.). The objective of this article is to explore the opportunities and the limits of highly heterogeneous biomedical data, since many medical data sets are small and entail a challenge for machine learning techniques. Particularly, we focus on a small data set targeting meningioma grading. Meningioma grading is crucial for patient treatment and prognosis. It is normally performed by histological examination but recent articles showed that it is possible to do it also on magnetic resonance images (MRI), so non-invasive. Our data set consists of 174 T1-weighted MRI images of patients with meningioma, divided into 126 benign and 48 atypical/anaplastic cases, acquired using 26 different MRI scanners and 125 acquisition protocols, which shows the enormous variability in the data set. The performed preprocessing steps include tumor segmentation, spatial image normalization and data augmentation based on color and affine transformations. The preprocessed cases are passed to a carefully trained 2-D convolutional neural network. Accuracy above 74% was obtained, with the high-grade tumor recall above 74%. The results are encouraging considering the limited size and high heterogeneity of the data set. The proposed methodology can be useful for other problems involving classification of small and highly heterogeneous data sets.


Assuntos
Neoplasias Meníngeas , Redes Neurais de Computação , Humanos , Aprendizado de Máquina , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética
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