Intracytoplasmic lumina in meningioma: an ultrastructural and immunohistological study.

Three surgically removed meningotheliomatous meningiomas with hyaline inclusions or pseudopsammoma bodies were studied. Ultrastructurally, the lumina seemed to be predominantly intracytoplasmic, defined by a systemic unit membrane; they displayed abundant microvilli and contained granular or filamentous material, vacuoles, vesicular bodies, and lamellar structure. The cytoplasm surrounding the intracytoplasmic lumina was electron-dense and contained tonofilaments and desmosomal junctions. All three meningiomas showed expression of carcinoembryonic antigen, cytokeratin, and epithelial membrane antigen in the cells surrounding the hyaline bodies. Keratin, alpha-1-antitrypsin, and immunoglobulin M showed weak positive staining. There was widespread vimentin except in the cells with hyaline inclusions. Glial fibrillary acidic protein and S100 were negative. These results provide additional confirmation of immunohistochemical data that can serve as evidence for epithelial and secretory differentiation in meningiomas.

Paraganglioma of the cauda equina. Case report.

An unusual, well demarcated, and encapsulated neoplasm of the cauda equina is presented. At first, the tumor was considered to be a variant of myxopapillary ependymoma, but the reaction for glial fibrillary acidic protein was negative. At the ultrastructural level, the neoplastic cells contained many small dense core vesicles, and the diagnosis of paraganglioma was established. The literature and histogenesis of paraganglioma of the cauda equina is reviewed.

Cerebral histoplasmoma. Case report.

A 55-year-old man presented with dementia and seizures of recent onset. A computerized tomography scan revealed a ring-like lesion in the left occipital lobe, which on resection was found to be a histoplasmoma. Cerebral histoplasmoma is rare and simulates a metastatic brain tumor. Only eight cases of this entity have been reported.

Neurosarcoidosis resembling meningioma: MRI characteristics and pathologic correlation.

A 37-year-old woman had visual changes. Magnetic resonance imaging showed an extraaxial mass in the anterior clinoid region that was presumed to be meningioma. There was no evidence of systemic or leptomeningeal disease. Pathologic findings were consistent with sarcoidosis. Isolated mass-like neurosarcoidosis, without systemic or leptomeningeal disease is difficult to diagnose preoperatively.

Juvenile Alzheimer's disease with cerebellar involvement.

We describe a sporadic case of Alzheimer's disease with cerebellar involvement in a man, who died at age 32 years after an illness lasting seven years, which was marked by progressive dementia and ataxia. The brain was quite atrophic and showed numerous senile plaques of all types and neurofibrillary tangles in the cerebral cortex with some involvement of the basal ganglia and diencephalon. There was cerebellocortical atrophy with numerous large, kurulike plaques. In addition, widespread severe congophilic angiopathy was noted.

Sudden unexpected death associated with atlanto-occipital fusion.

A case of sudden, unexplained death in a 24-year-old male is presented. There were two previous spells of loss of consciousness. There was remarkable narrowing of the foramen magnum with indentation of the medulla. The atlas was partly fused with the occipital bone and a portion of abnormal bone compromised the foramen magnum from anterior reducing its anteroposterior dimensions to 16 mm (n 25-35 mm). Close clinical examination of this area in patients with acute intermittent symptomatology, or at the time of autopsy in cases of sudden unexpected death is stressed.

Fatal athletic injuries.

Death during athletic training or competition often brings public media attention. Recent endeavors to attract amateur athletic competitions to Marion County, Indiana prompted a review of athletic fatalities. Trauma during training, arteriosclerotic heart disease, and congenital heart defects cause most fatalities. A prospective study has been initiated to investigate and document these deaths.

Evaluation of left coronary artery anatomy in vitro by cross-sectional echocardiography.

This study was undertaken to provide a better anatomic description of the location and course of the left coronary artery within a commonly used ultrasonic tomographic plane. Twenty-three hearts were excised at autopsy and scanned in vitro. The locations of the left main (LMCA), left anterior descending (LAD), and left circumflex (LCCA) coronary arteries were confirmed by direct cannulation, by Cardio-Green injection, and by subsequent dissection. While the proximal LMCA was recorded in all specimens, the entire LMCA was visible in only 70%. Proximal portions of the LAD and LCCA were also identifiable in 70% of examinations, and their spatial positions were defined. In most recordings, the first branch of the LAD OR LCCA arose distal to the segment seen echocardiographically. The spatial orientation of the ultrasonic beam relative to the LAD and LCCA and the presence of other overlying cardiac structures limit the imaging of these vessels by cross-sectional echocardiography to only their most proximal portions.

Primary lymphoma of the central nervous system: a clinicopathologic analysis of 26 cases.

We analyzed 26 cases of primary lymphoma of the central nervous system. There were 14 males and 12 females ranging in age from 5-76 years (median age 51 years, mean age 50.2 years). None had received organ transplantation or immunosuppressive therapy. The most common presenting symptoms were headache, mental changes, nausea, vomiting, and convulsions. The main neurological findings were hemiparesis, papilledema, visual field defects, and cranial nerve palsies. The most common finding in the cerebrospinal fluid (CSF) was high protein content; CSF cytology was positive in only one case. Computerized tomography was done in 14 cases; all showed a contrast-enhancing lesion. Angiography generally revealed an avascular mass. The most common location above tentorium was the frontal lobe; in four cases the tumor was infratentorial (cerebellum, 3 cases). In five cases there was diffuse involvement of the brain; all had severe dementia and diagnosis was not made until the autopsy. Histologically, the most common type was diffuse histiocytic or immunoblastic lymphoma according to Rappaport and the Working Formulation classification respectively. Radiation therapy alone in five patients gave a median survival of 17 months. Five patients received radiation and chemotherapy, and median survival was 16 months. Two patients developed ocular lymphoma 8 and 36 months later that was treated by radiation.

Foreign body giant cell reaction associated with epidermoid tumor: CT and MR findings.

A patient with a known epidermoid tumor presented with a new large ring-enhancing mass adjacent to the cyst. Histopathology showed foreign body giant cell reaction adjacent to the epidermoid cyst. The CT and MR imaging appearances are described. The neuroimaging findings are identical to malignant degeneration to squamous cell carcinoma.