Neuropeptides in the human superior cervical ganglion.

Superior cervical ganglia from 7 human cadavers (3-7 h post mortem) were immunostained for tyrosine hydroxylase (TH), dopamine-beta-hydroxylase (DBH) and 14 different neuropeptides. The results show that ganglionic cells contain TH, DBH, neuropeptide Y (NPY), somatostatin, vasoactive intestinal polypeptide (VIP) and calcitonin gene-related peptide (CGRP). These substances were present predominantly within large ganglionic cells. Inside the ganglion, the number and topographical distribution of various types of immunoreactive cells differed from one another. NPY and CGRP immunoreactivities were found in some TH-positive cells, but that co-localization never exceeded the 30% of the TH cells. Leu-enkephalin showed a weak immunoreactivity, which was restricted to fibers or varicosities. Neuropeptides like substance P, dynorphin A and B, cholecystokinin, galanin, corticotropin-releasing factor, thyrotropin-releasing hormone, angiotensin II and neurotensin showed no immunoreactivity in the human superior cervical ganglion.

Histological subtypes and prognostic problems in meningiomas.

The incidence of the various histological subtypes of meningiomas was examined in 1238 patients with surgically treated meningiomas, about 80% arising within the cranial cavity. The histological classification used was that of Courville (1950) and Rubinstein (1972), but "angioblastic" meningiomas were segregated into 3 groups: highly vascularized meningiomas, hemangioblastomas, and hemangiopericytomas. Endotheliomatous and transitional forms constituted 85% of the total (71.5% of intracranial tumors), fibroblastic forms 6.6 and 7.5%, respectively, and highly vascularized (endotheliomatous or transitional) meningiomas 5.2% of the intracranial tumors, while true "angioblastic" meningiomas (hemangioblastomas and hemangiopericytomas) amounted to 2.8% of the total (3.1% of the intracranial tumors). 1.2% were "atypical" (so-called malignant) meningiomas; true meningeal sarcomas were excluded. The incidence of recurrence in patients surviving at least 5 years after apparently complete removal of the tumor was 13% for all sites, and 14.2% for intracranial tumors, but almost twice as high after partial removal. There were no significant differences in the recurrence rate and intervals between first and second operation according to the various histological subtypes of meningiomas, except for hemangiopericytomas which recurred with significantly higher frequency and, together with atypical meningiomas, at much shorter intervals than the others. The prognostic significance of some histological criteria in "non-angiomatous" meningiomas was examined in 211 patients surviving at least 5 years after apparently complete removal of the tumor. Among the recurrences, there was a significantly higher degree of cellularity and increased mitotic rate and, probably, of cortical invasion, while nuclear pleomorphism, increased vascularity, and focal necroses showed no definite differences. The presence of mitotic figures alone appeared to be of no prognostic value. While most recurrent meningiomas did not change their basic morphological type significantly, about 12.5% of the recurrences appeared to have a different rate of growth as suggested by increased cellularity and mitotic rates. In 2 cases an isomorphic (benign) meningioma became a true spindle cell sarcoma.

Primary meningeal melanocytoma of the pineal region. Case report.

A unique case of a meningeal melanocytoma located in the pineal region is presented. This 48-year-old man presented with a round pineal region tumor that caused triventricular hydrocephalus and exhibited slow clinical progression. During surgery a black encapsulated tumor was found and totally removed. On histopathological examination, the tumor proved to be a meningeal melanocytoma. In this report cell culture data are presented and the relevant literature is reviewed. The problems of histopathological diagnosis and management of patients with melanocytomas are also discussed.

Third ventricle germinoma after total removal of intrasellar teratoma. Case report.

A unique case is presented of a third ventricle germinoma developing 3 years after total removal of an intrasellar teratoma. The third ventricle germinoma was not considered to be a recurrence or dissemination of the mature intrasellar teratoma but to have been transformed from multicenter germ cells present in the midline of the brain with different temporal development. The relevant literature is reviewed and the problems of management of patients with germ-cell tumors are discussed.

Central neurocytoma with malignant course. Neuronal and glial differentiation and craniospinal dissemination.

Central neurocytoma is a benign neuronal tumor of young adults in the lateral cerebral ventricles with characteristic X ray and light microscopic findings. In many respects typical central neurocytoma is reported below, with recurrence in the third month requiring reoperation. Death ensued in the fifth postoperative month. Subsequent histology proved progressive vascular proliferation and increasing, unusual glial differentiation of the neuronal tumor. At autopsy tumorous seeding blocked the liquor circulation. A thin tumorous layer covered the surface of all ventricles, the cerebellum and medulla oblongata. The GFAP positive cells out-numbered the synaptophysin positive ones. Increase of GFAP positivity and vascular proliferation of the central neurocytoma may be alarming signs suggesting a malignant course in addition to the other atypical features.

Transformation of a human mixed GH-PRL adenoma cell population in response to long-term bromocriptine treatment.

A child was operated 3 times because of a recurrent growth hormone- and prolactin-producing pituitary adenoma. Between the operations she was treated for five years with bromocriptine. The characteristics of the tumour cell population collected after the last operation was now examined by electron microscopy, immunocytochemistry, and in tissue culture and compared to those of the primary tumour cells reported earlier. A prominent change was the reversal of the proportion of the densely and sparsely granulated cells in favour of the GH-type, densely granulated cells. These cells, some of them coexpressing PRL, did not essentially change their characteristics either in vivo or in culture. On the other hand, pleomorphous cells with smaller cytoplasmic area and prominent lysosomal structures represented the sparsely granulated population containing PRL or both PRL and GH. The morphological alteration of the PRL-type cells was also reflected in vitro. Hence, while GH-type cells prevail, at least a sub-population of PRL-type cells survives long-term bromocriptine administration. A shift in the incidence of the two cell types in favour of the GH-type cells explains the change in the endocrine status of the patient.

Effect of vasoactive intestinal polypeptide (VIP) on growth hormone (GH) and prolactin (PRL) release and cell morphology in human pituitary adenoma cell cultures.

Six GH adenomas and three prolactinomas were investigated by light- and electron-microscopic morphological and immunocytochemical methods and the effect of vasoactive intestinal polypeptide (VIP) on growth hormone (GH) and prolactin (PRL) secretion was tested in vitro. The tumour cells of the acromegalic patients revealed both GH and PRL immunoreactivity while prolactinomas showed only PRL activity. All the adenomas stained immunocytochemically also for VIP. By electron microscopy, the tumours included two densely and two sparsely granulated GH, two mixed GH/PRL, and three sparsely granulated PRL adenomas. The dissociated cells were explanted, and cultured in vitro. The cultures in micro test plates were treated with VIP at different concentrations between 10(-5)-10(-12) M. GH and PRL contents in the culture media were measured by radioimmunoassay. GH release was significantly stimulated by VIP in a dose-dependent manner over the whole concentration range, while VIP was effective on the PRL release only at 10(-6)-10(-7) M concentration. The cells of a mixed adenoma were grown in Petri dishes and used for ultrastructural and immunocytochemical studies. The cytoplasmic structure of the cells treated with VIP corresponded to that of active hormone-secreting cells with large ergastoplasmic fields and Golgi zones containing secretory granules. Massive exocytotic events were encountered mainly in the GH-type cells. GH and PRL double immunocytochemistry showed the predominance of GH cells, many of them containing low amounts of PRL as well. Cells predominantly containing PRL were spread among them, they also might contain GH as well. Some of the cells contained only a single immunoreactive hormone. The intensity of gold labelling of the secretory granules appeared higher in the VIP-treated cells than in the untreated control ones which showed a cytoplasmic structure characteristic of glandular cells with low secretory activity. As all the adenoma cells both contained and reacted to VIP, our results are in agreement with an autocrine or paracrine effect of this peptide. The fine structure of the cells in the cultures treated with VIP supply an additional argument to the assumption that VIP may serve as a growth factor for these cell types.

Association of primary cerebral lymphoma with meningioma: report of two cases.

Two cases of association of primary malignant cerebral non-Hodgkin's lymphoma with clinically silent meningiomas are reported. In one case, the malignant lymphoma of the left frontal lobe was diagnosed radiographically and the small parasagittal meningioma was detected at autopsy. In the other case, both CNS neoplasms, a parasagittal meningioma and a multifocal periventricular and brainstem lymphoma, were only detected at autopsy. In both cases, the small meningiomas were located at the cerebral convexity. The concurrence of the slowly growing meningiomas and the highly malignant cerebral lymphomas, seen in two among about 140 confirmed cases of primary CNS lymphomas, is probably coincidental. No other neoplasms were found outside of the CNS.

Primary intracranial malignant lymphomas a fine structural cytochemical and CSF immunological study.

Cytochemical and electron microscopical studies in six cases of primary intracranial malignant lymphomas, four of which were diagnosed by biopsy, confirmed their ultrastructural identity with extraneural malignant lymphomas classified as immunoblastomas and immunocytomas. Demonstration of transformation of 'blast-like' cells (immunoblasts) toward rough E. R. developing cells in all these tumours argue for the B-dell origin of these types of cerebral lymphomas, previously referred to as reticulum cell sarcomas/microgliomas. CSF studies showed increased levels of B cells with surface IgG in two cases of immunoblastoma, and increased IgG levels with light chains in two cases each immunoblastoma and of pleomorphic immunocytoma, while one case of immunoblastoma showed a normal T cell to B cell ratio with increased monoclonal and surface, IgM suggesting some morphological and immunological heterogeneity of these lymphomas.

[The ultrastructural localization and distribution of free cholesterol (3-beta-hydroxisterol) in human cerebral tumours (author's transl)]. / Uber die ultrastrukturelle Lokalisation und Verteilung des freien Cholesterins (3-beta-Hydroxysterol) in menschlichen Gehirntumoren

According to the examination of the ultrastructure of the human gliomas and the ultrastructural localization of their free cholesterol, it can be established that the main part of the free cholesterol is present in the cells in a structural fixed form and that multiplication of the free cholesterol, occurring due to cell degeneration in the vacuoles and cysts, can be brought in connection with the disintegration of these structures.

Primary spinal intramedullary malignant lymphoma. A case report.

A rare case of primary malignant intramedullary lymphoma, localized in the cervical part of the spinal cord, is presented. The onset of clinical symptoms was associated with herpes zoster infection. Surgery led to the histological diagnosis. The clinical investigations excluded the presence of lymphoma in other sites in the central nervous system and in the extraneural organs. Postoperative irradiation and chemotherapy effected relict of neurological symptoms.

Secretory component of cystic craniopharyngiomas: a mucino-histochemical and electron-microscopic study.

Ten cases with cystic craniopharyngioma were investigated. Histologically, eight of them belonged to the adamantinomatous group and two were squamous epithelial type. Histochemical investigation revealed mucin secretion in microcysts, and electron microscopy demonstrated zymogen granules in the epithelial cells. When the protein content of the cyst fluid was analyzed by polyacrylamide-gel electrophoresis, the electrophoretic pattern and immunological properties were found to be similar to the normal human serum control. The results of the morphological study suggest that cystic craniopharyngiomas have a secretory component in addition to the classical histological structures.

[The role and importance of CT-guided stereotaxic brain biopsy in neurosurgery. Experiences with 523 cases]. / CT vezérelt stereotaxiás agyi biopszia jelentösége és szerepe az idegsebészetben. Tapasztalataink 523 eset kapcsán.

Between 1989 and 1996, 523 stereotactic biopsies of different intracranial lesions were performed at our institution. In 96.3% of the cases accurate histological diagnosis was made. In 59 cases the drainage of the abscess or cyst was carried out. In 48 cases the lesion was axial, in 27 parasellar, 7 pineal and 37 infratentorial. In the rest of the cases the lesion was in the supratentorial hemispheres. Transient neurological deficits were observed in 3.4% of the cases and craniotomy with haematoma evacuation had to be carried out in one case following the biopsy. There was no mortality associated with the interventions in our material. Our experience supports that CT guided biopsy is a safe and efficient method for obtaining histological diagnosis in different intracranial lesions and showed to be very useful in planning te appropriate treatment for each patient.

[Surgical treatment of pituitary apoplexy]. / A hypophysis apoplexia sebészi kezeléséröl.

Hypophysis apoplexy is a clinical syndrome characterized by the sudden development of headache, visual disturbance, associated with nausea, vomiting, signs of meningeal irritation and ophthalmoplegia. The symptoms are caused by the hemorrhage of a hypophyseal adenoma. This leads to the swelling of the tumor and compression of the perisellar structures. The authors processed the clinical and pathological characteristics of 28 cases occurring among the patient material of the National Institute of Neurosurgery of the past 10 years. According to the experiences the most important factor of a successful treatment of hypophyseal apoplexy is an early diagnosis and quick admittance to an institute of neurosurgery of satisfactory conditions. Thereafter a steroid hormone therapy of large doses and decompression operation performed by transnasal-transsphenoidal approach leads in the majority of cases to recovery.

Extracranial spreading of glioblastoma multiforme.

On the basis of 4 observations, the formation of extracranial metastases of multiform glioblastomas is dealth with which complied with all the criteria established by Weiss (histological identification of a primary brain tumour, connection of clinical data between cerebral tumour and metastases, ruling out of another primary tumour not belonging to the neuraxis by a complete autopsy). All 4 patients were--in some cases several times--trephined, subjected to postoperative irradiation and some of them were also treated with chemotherapeutics. The postoperative survival time was between 16 and 24 months, the average age of the patients was 35 years which was strikingly low. 3 patients showed infiltrations of bones and neighbouring soft parts, in one case the tumour penetrated into the sinus, in one patient paranasal sinuses and orbitae were affected, two cases showed metastases in the vertebral column and in one case metastases were found in the cervical gland nodes. One glioblastoma accompanied by a fibrosarcoma showed a particularly extensive extracranial formation of metastases. As regards the reasons for the formation of extracranial metastases of intracranial tumors many hypotheses have been established which are critically discussed by the authors.

Primary lymphomas of the central nervous system; in vitro culture observations.

Out of 960 human brain neoplasms seven primary lymphomas were cultured and grown up to twenty eight days. The monolayers had common cytological characteristics; /i/ immediately after plantation a high density of uniform cells was observed; /ii/ many cells were lost during subsequent medium changes; /iii/ the monolayers contained lymphocyte-like cells in different numbers. According to their individual characteristics the cultures could be classified into three categories: 1./ In the cultures of three tumours lymphocyte-like cells predominated. These tumours had low proliferative capacity in vitro. 2./ Cultures of three other tumours consisting mainly of tissue macrophages had a high proliferative capacity in vitro. 3./ Cultures of a single tumour showed the combined features of the former two categories: both lymphocyte-like cells, and tissue macrophages were present. These cultures showed the highest proliferative activity. On the basis of these findings it is quite possible that beside other methods, tissue culture technique may be useful in the classification of brain lymphomas.

Prognosis of benign cerebellar astrocytomas in children.

Between 1954 and 1975, in the Children's Department of our Institute, 137 patients under the age of 14 were treated for cerebellar astrocytoma. Histological re-examination--in accordance with Gjerris and Klinken--showed that only 128 cases could be included into the group of benign cerebellar astrocytomas. The short follow-up period in one part of our material does not allow the establishment of significant differences between the so-called 'juvenile' and 'diffuse' type of astrocytomas. From our investigations, it seems that the only significant factor in the recurrences and in the survival time is the involvement of the brain stem. This involvement is more frequent in the diffuse type. However, we could find long-term survivors in both histological groups.

Membranous changes in primary malignant CNS lymphomas.

Ultrastructural studies of 17 primary malignant CNS lymphomas revealed 6 tumors with abnormal intracytoplasmic and/or intranuclear membranous structures, most frequently associated with the endoplasmic reticulum or perinuclear envelope. In most cases, tubuloreticular inclusions and paired cisternae were present. Less frequent were accumulation of microtubules, concentric lamellar bodies, and rod-like or paracrystalline intranuclear inclusions. The specificity and significance of these membranous structures remain questionable because of their frequent occurrence in a variety of normal and pathological conditions. Some of these changes may be considered as cellular reactions to viral infections, others may indicate cellular activity or degeneration.