Rupture of an intracerebral aneurysm after carotid endarterectomy: a case report.

Coincidental intracerebral aneurysm and internal carotid artery stenosis is a rare combination. This case report describes the development of an intracerebral aneurysm in the presence of an internal carotid artery stenosis in an 58-year old women. Furthermore, the management of intracerebral aneurysm in combination with an internal carotid artery stenosis is discussed as well as the role of potential important hemodynamic factors involved in the development and rupture of these aneurysms.

Metastatic medulloblastoma in an adult; treatment with temozolomide.

Medulloblastoma is a malignant brain tumour most frequently seen in children. Treatment of this tumour type usually consists of surgery followed by radiotherapy. Relapses of medulloblastoma are sensitive to chemotherapy and treatment with chemotherapeutics in children has increased the survival rates. A medulloblastoma at adult age is extremely rare, and there is no overall accepted treatment, especially not in the case of a relapse. Recently improvement of survival was reported in patients with glioblastoma treated with a combination of radiotherapy and concomitant temozolomide. This observation encouraged us to decide to treat an adult patient with a recurrent medulloblastoma with temozolomide. This female patient showed a recurrence of a medulloblastoma 7 years after the initial presentation with metastatic spread along the neuraxis and progressive neurological deterioration. Treatment with temozolomide resulted in relief of clinical symptoms and stabilization of tumour growth for 8 months.

New clinical, pathological and molecular prognostic models and calculators in patients with locally diagnosed anaplastic oligodendroglioma or oligoastrocytoma. A prognostic factor analysis of European Organisation for Research and Treatment of Cancer Brain Tumour Group Study 26951.

BACKGROUND: The prognosis of patients with anaplastic oligodendrogliomas (AOD) and oligoastrocytomas (AOA) is variable. Biomarkers might be helpful to identify more homogeneous disease subtypes and improve therapeutic index. The aim of this study is to develop new clinical, pathological and molecular prognostic models for locally diagnosed anaplastic gliomas with oligodendroglial features (AOD or AOA). METHODS: Data from 368 patients with AOD or AOA recruited in The European Organisation for Research and Treatment of Cancer (EORTC) trial 26951 on adjuvant PCV (Procarbazine, CCNU, Vincristine) chemotherapy in anaplastic oligodendroglial tumours were used to develop multifactor models to predict progression free survival (PFS) and overall survival (OS). Different models were compared by their percentage of explained variation (PEV). Prognostic calculators were derived from these new models. RESULTS: Treatment (for PFS only), younger age, confirmed absence of residual tumour on imaging, frontal location, good World Health Organisation (WHO) performance status, absence of endothelial abnormalities and/or necrosis, 1p/19q codeletion and Isocitrate dehydrogenase 1 (IDH1) mutation were independent factors that predicted better PFS and OS. CONCLUSIONS: We identified important prognostic factors for AOD and AOA and showed that molecular markers added a major contribution to clinical and pathological factors in explaining PFS and OS. With a positive predictive value of 92% for PFS and 94% for OS, our models allow physicians to precisely identify high risk patients and aid in making therapeutic decisions.

Primary non-Hodgkin's lymphoma in multiple vertebrae presenting as a lumbar radicular syndrome: A case report.

STUDY DESIGN: A case report is presented. OBJECTIVE: To report and discuss a case of primary non-Hodgkin's lymphoma in 10 different vertebrae in the spine of a 25-year-old woman. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, a case of primary bone lymphoma in several vertebrae has not been reported previously. METHODS: Primary bone lymphoma was diagnosed using magnetic resonance images and biopsy of one spine lesion. There was no other localization of the lymphoma. RESULTS: With chemotherapeutic treatment, the lymphoma was in remission for 16 months. The patient then died of complications associated with acute lymphatic B-cell leukemia. CONCLUSIONS: The incidence of primary bone lymphoma in a population with non-Hodgkin's lymphoma is less than 1%. A case with multiple localizations of lymphoma in the spine has never been reported before.