Age factor and implication of human papillomavirus type-specific prevalence in women with normal cervical cytology.

The prevalence and genotype distribution of human papillomavirus (HPV) infection in women with normal cervical cytology varies widely according to the population studied. Two non-overlapping population-based cohort studies of women aged ≥30 years for the periods 2008-2009 (n=5026) and 2004-2005 (n=10 014) were analysed. The prevalence rate of HPV was 11·0% (95% CI 10·5-11·6). HPV infection was significantly associated with age, menopausal status, and inversely associated with hormone replacement therapy. There was an increasing trend of α3/α15, α5/α6, and multiple HPV infections with increasing age. The five most common types were HPV52, 18, 53, 58 and 70, while HPV16, 31, 33 ranked 21st, 25th, and 16th, respectively, in the merged cohort with normal cytology (n=14 724). HPV16, 31, and 33 were significantly associated with abnormal cytology, which could have resulted in their rarity in the total merged cohort (n=15 040).

Development and evaluation of a loop-mediated isothermal amplification assay for rapid detection of chicken anaemia virus.

AIM: Chicken anaemia virus (CAV) causes an economically important viral disease in chickens worldwide. The main aim of this study was to establish a rapid, sensitive and specific loop-mediated isothermal amplification (LAMP) assay for detecting CAV infection. METHODS AND RESULTS: A set of four specific LAMP primers were designed based on the nucleotide sequence of the CAV VP2 gene, which encodes a nonstructural protein. These were used for the amplification of a specific target region of the VP2 gene. LAMP amplicons were successfully amplified and detected by DNA electrophoresis and by direct naked eye SYBR Green I visualization. A sensitivity test systematically demonstrated that the LAMP assay was superior to a conventional PCR assay with a minimum concentration limit of 100 fg compared to 10 ng for the conventional PCR. The specificity of the LAMP assay for CAV detection is consistent with conventional PCR. Using this established LAMP assay, infected and uninfected clinical samples obtained from an experimental farm were fully verified. CONCLUSIONS: A novel nucleic acid-based approach of LAMP assay was successfully developed for detecting CAV infection. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study, these results indicate that the developed LAMP assay herein for CAV detection is a time-effective, simple, sensitive and specific test that can be used as an alternative approach in the future for large-scaled diagnosis on the farm of CAV infection.

Prognostic factors and adjuvant therapy in uterine carcinosarcoma.

PURPOSE OF INVESTIGATION: The objective of this retrospective study was to investigate prognostic variables and impact of adjuvant therapy in uterine carcinosarcoma. METHODS: The clinical information and pathological confirmation were reviewed for cases with uterine carcinosarcoma from 1984 to 2005. A total of 45 patients were eligible for analysis. RESULTS: The median follow-up for survivors was 84 months. Five-year overall survival and progression-free survival (PFS) rates were 36.5% and 33.8%, respectively for Stage I-IV. Distant site metastasis with/without pelvic failure occurred in 83.3% of those with recurrence/progression. By multivariate analysis, older age (p = 0.001) and more than half of myometrial invasion (p = 0.002) were significant predictors of death, while only myometrial invasion (p = 0.022) was significantly associated with PFS. Stratified analyses demonstrated a monotonic trend of chemotherapy or chemoradiation to decrease death. CONCLUSIONS: Our results suggested that age and depth of myometrial invasion were significant prognostic factors, and chemotherapy or chemoradiation seemed to be beneficial for uterine carcinosarcoma.

Tumour necrosis factor-alpha converting enzyme in human gestational tissues from pregnancies complicated by chorioamnionitis.

Chorioamnionitis increases the risk of preterm labour and is associated with adverse neonatal outcomes including cerebral palsy. Tumour necrosis factor-alpha (TNF-alpha) derived from the gestational tissues (placenta, fetal membranes and maternal decidua) is thought to play a pivotal role in the induction of cytokine response in chorioamnionitis. Tumour necrosis factor-alpha converting enzyme (TACE) is essential for the release of TNF-alpha. Our aim was to determine whether the expression of TACE is increased in human gestational tissues from pregnancies complicated by chorioamnionitis, and whether lipopolysaccharide (LPS) causes increased expression of TACE in the human gestational tissues in vitro. The immunostaining of TACE was generally more intense, in particular in the syncytiotrophoblast and stromal cells, in villous samples from pregnancies complicated by chorioamnionitis than those from normal pregnancies. Increased immunoreactivity of TACE was also noted in the amnion and choriodecidua. In parallel, there was an increased infiltration of monocytes/macrophages within the villous stroma and choriodecidua. As a complement to our in vivo findings, LPS significantly increased the levels of mRNA and protein of TACE in a dose-dependent response in villous and fetal membrane explant cultures. Together, our results imply a potential role of TACE in the pathogenesis of chorioamnionitis.

Multidetector computed tomography assessment on tumor size and nodal status in patients with locally advanced breast cancer before and after neoadjuvant chemotherapy.

AIMS: To evaluate the utility of multidetector computed tomography (MCT) in assessing tumor size and nodal status in patients with advanced breast cancers before and after the neoadjuvant chemotherapy. METHODS: Twenty-eight proven locally advanced breast cancer patients with 30 tumors were enrolled in this study. MCT was used to assess tumor size and axillary lymph nodes before and after the neoadjuvant chemotherapy. The correlation between tumor size on MCT and gross tumor size was tested. RESULTS: The MCT measurements documented complete response in 3, partial response in 18, non-response in 8 and progressed in 1. The mean tumor diameters on pathology and post-chemotherapy MCT were 3.6cm (S.D.=+/-2.9cm) and 3.1cm (S.D.=+/-2.6cm), respectively. The Pearson correlation coefficient was 0.76 (p<0.001). The sensitivity, specificity, positive predictive valve, negative predictive valve and accuracy of MCT in diagnosing the axillary lymph node metastases after pre-operative neoadjuvant chemotherapy were counted, respectively, to 72%, 40%, 85.7%, 22.2% and 66.7%. All the 5 downstaged axillary nodal statuses from node-positive to node-negative on MCT had micrometastases. CONCLUSION: MCT can be used to evaluate tumor size and nodal status in patients with advanced breast cancer. As there is a baseline MCT before chemotherapy for comparison, we are potentially aware of the possibility of false negative nodal micrometastases on the post-chemotherapy MCT.

Adenocarcinoma of the glandular stomach following 3-methylcholanthrene, N-nitrosodiethylamine, or N-nitrosodimethylamine feeding in carcinogen-susceptible inbred Syrian.

Invasive adenocarcinoma of the glandular stomach was induced in 3 BIO 87.20 inbred Syrian hamsters by the administration of 1 ppm N-nitrosodiethylamine or N-nitrosodimethylamine in the drinking water, and in 2 BIO 15.16 and 5 BIO 72.29 inbred Syrian hamsters by gavage of 3-methylcholanthrene. In contrast, many other similarly treated inbred Syrian hamster lines did not develop carcinoma of the glandular stomach. The glandular stomachs of rats and mice are resistant to polycyclic hydrocarcon carcinogenesis; however, the glandular stomachs of certain inbred Syrian hamsters develop adenocarcinoma after polycyclic hydrocarbon gavage. This work demonstrated the importance of genetic factors.

Detection of human papillomavirus types 16 and 18 mRNA in peripheral blood of advanced cervical cancer patients and its association with prognosis.

PURPOSE: To evaluate the feasibility of detecting human papillomavirus E6 (HPVE6) gene mRNA in the peripheral blood of patients with locally advanced cervical cancer, and the relationship of the circulating HPV viral-specific mRNA with clinicopathologic factors and prognosis of locally advanced cervical cancer. PATIENTS AND METHODS: The presence of types 16 and 18 HPVE6 gene mRNA was determined by reverse transcription followed by nested polymerase chain reaction. Thirty-five patients with locally advanced cervical cancer who were positive for HPV type 16 or 18 DNA were included in the study. All patients received external-beam radiation therapy followed by intracavitary brachytherapy. RESULTS: Eighteen (51.4%) of 35 HPV DNA-positive cervical cancer patients had HPV-specific mRNA in their peripheral blood cells, compared with none of 17 HPV DNA-negative cervical cancer patients and none of 12 control volunteers. The presence of HPVE6 gene mRNA in peripheral blood was associated with bulky tumor volume (> 4 cm) and pelvic lymph node metastasis (tumor volume, P = .03; lymph node status, P = .03). After a median follow-up of 22 months, patients who were positive for peripheral-blood HPVE6 gene mRNA had a significantly higher risk of recurrence than those who were negative (10 of 18 v three of 17, P = .02; mean recurrent time, 20.7 months v 12.6 months, P = .02). There was also a statistically significant association of peripheral-blood HPVE6 gene mRNA positivity with distant metastasis (eight of 18 vone of 17; P = .01). CONCLUSION: Results of this study seem to suggest that the presence of HPVE6 gene mRNA in peripheral blood may provide an early marker that identifies patients who are at risk for metastasis.

Differential expression of telomerase activity in human cervical cancer and cervical intraepithelial neoplasia lesions.

PURPOSE: Telomeres are tandem arrays of repeated DNA sequences located at the ends of eukaryotic chromosomes, and are synthesized by the enzyme telomerase. Loss of telomeric DNA may play an important role in the development of human cancers. However, very little is known about the status of telomerase during human cervical cancer development. PATIENTS AND METHODS: Telomerase activity was measured by telomere repeat amplification protocol (TRAP) assay in 24 cervical cancers, one carcinoma in situ (CIS), and 20 cervical intraepithelial neoplasia (CIN) lesions. Adjacent nontumor cervical tissue from the same 24 cervical cancer patients and normal cervical tissues from 11 control individuals also were examined for the presence of telomerase activity. RESULTS: Twenty two of the 24 (91.7%) cervical cancer specimens and the single CIS tissue were strongly positive for telomerase activity. Relatively weak but distinctive telomerase activity also was detectable in one of four CIN-I (25%), two of eight CIN-II (25%), and two of eight CIN-III (25%), respectively. However, telomerase activity was not found in the 24 corresponding nontumor cervical tissues from the same cervical cancer patients and the 11 normal cervical tissues from control individuals. CONCLUSION: The majority of cervical cancers contain strong telomerase activity. Significant proportions of noncancerous CIN tissues also contain telomerase activity, although weaker than that in cervical cancer. It seems that there is a progressive increase of telomerase activity in association with an increased degree of cervical malignancy. These results seem to suggest that the expression of telomerase may play a crucial role in cervical cancer carcinogenesis.

Randomized trial of neoadjuvant cisplatin, vincristine, bleomycin, and radical hysterectomy versus radiation therapy for bulky stage IB and IIA cervical cancer.

PURPOSE: To compare the efficacy of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy with that of radiotherapy (R/T) for bulky early-stage cervical cancer. PATIENTS AND METHODS: Women with previously untreated bulky (primary tumor >/= 4 cm) stage IB or IIA non-small-cell carcinoma of the uterine cervix were randomly assigned to receive either cisplatin 50 mg/m(2) and vincristine 1 mg/m(2) for 1 day and bleomycin 25 mg/m(2) for 3 days for three cycles followed by radical hysterectomy (NAC arm) or receive primary pelvic radiotherapy only (R/T arm). The ratio of patient allocation was 6:4 for the NAC and R/T arms. Women with enlarged para-aortic lymph nodes on image study were ineligible unless results of cytologic or histologic studies were negative. RESULTS: Of the 124 eligible patients, 68 in the NAC arm and 52 in the R/T arm could be evaluated. The median duration of follow-up was 39 months. Thirty-one percent of patients in the NAC arm and 27% in the R/T arm had relapse or persistent diseases after treatment, and 21% in each group died of disease. Estimated cumulative survival rates at 2 years were 81% for the NAC arm and 84% for the R/T arm; the 5-year rates were 70% and 61%, respectively. There were no significant differences in disease-free survival and overall survival. CONCLUSION: NAC followed by radical hysterectomy and primary R/T showed similar efficacy for bulky stage IB or IIA cervical cancer. Further study to identify patient subgroups better suited for either treatment modality and to evaluate the concurrent use of cisplatin and radiation without routine hysterectomy is necessary.

Mucicarminophilic histiocytosis. A polyvinylpyrrolidone (PVP) storage disease simulating signet-ring cell carcinoma.

In Taiwan, a peculiar type of cell with mucicarmine-positive bubbly or vacuolated cytoplasm was sporadically observed in a variety of surgical specimens removed for neoplastic or non-neoplastic conditions. They closely mimicked signet-ring cell carcinoma. Study of 14 such cases and review of the related literature led to the conclusion that the peculiar cells were storage histiocytes containing polyvinylpyrrolidone (PVP). Because they were shown to be mucicarmine-positive, we designated them " mucicarminophilic histiocytes." Particulate bodies sometimes observed in association with mucicarminophilic histiocytes were believed to be the extracellular counterpart of the cytoplasmic vacuoles. Our survey also revealed that PVP-containing intravenous injection fluids had been used in Taiwan as recently as 5 years ago. For surgical pathologists, PVP-containing mucicarminophilic histiocytes should not be mistaken for signet-ring cell carcinoma or signet-ring cell lymphoma. Mucicarminophilic histiocytes can be identified by the positive mucicarmine, colloidal iron, Gomori methenamine silver, Congo red, Sudan black B, Fontana-Masson argentaffin, and Victoria blue; but negative periodic acid-Schiff, alcian blue, and Giemsa stains.

Clear cell papulosis of the skin. A new entity with histogenetic implications for cutaneous Paget's disease.

A new skin condition characterized by multiple white papular eruptions was observed in two young brothers. Histologic study revealed many benign pagetoid clear cells in the basal layer of the acanthotic epidermis with decreased pigmentation. These cells contained cytoplasmic mucin and were positive for keratin AE1/AE3, carcinoembryonic antigen, and epithelial membrane antigen. The staining pattern was identical to that of extramammary Paget's disease. The presence of mucin granules and cytoplasmic filaments corresponding to AE1/AE3 were confirmed ultrastructurally. Comparative histochemical and immunohistochemical studies with normal eccrine sweat glands, Toker's nipple clear cells, and Paget cells of mammary and extramammary Paget's disease suggest that these clear cells are an aberrant derivative of sweat-gland epithelial cells in the epidermis. AE1/AE3 is an excellent marker for the "clear cells" of both the condition described and the cells in the nipple. The term "clear cell papulosis" is proposed for this new entity. The clear cell identified provides evidence for the existence of potential precursor cells in the epidermis for cutaneous Paget's disease.

Mesonephroid blastoma. A previously undescribed renal tumor of childhood.

We describe a renal tumor arising in a 4 1/2-year-old boy and characterized by the formation of epithelial tubules in a primitive mesenchymal stroma. We call attention to certain unique structural features of this tumor, which set it apart from Wilms' tumor. The tissue components regularly observed in Wilms' tumor were absent from the primary neoplasm despite exhaustive search, suggesting that this case should be considered distinct from nephroblastoma. However, a metastasis appeared that was formed entirely by undifferentiated nephrogenic cells. Based on structural appearance, histogenesis from mesonephros is tentatively proposed. No precedent was found in the literature of a tumor of this description.

Distant metastasis of gastric cancer is associated with elevated expression of the antimetastatic nm23 gene.

To understand the clinical significance of nm23 gene expression in gastric cancer patients, the Nm23-H1 protein level of fresh resected specimens from a total of 37 gastric cancer patients was measured by Western blot analysis. The elevated nm23 expression group (Nm23-H1 protein level in tumor tissue greater than the 75th percentile value of patients) was significantly associated with the histologically differentiated type (P = 0.036). This group had a higher incidence of distant (hematogeneous) metastasis (P = 0.0023) and a lower 2-year disease-free survival rate (P = 0.033) than the non-elevated group. The result was not consistent with the previous assumption that nm23 is an antimetastatic gene for gastric cancer.

The composition of bone marrow for a dual-energy quantitative computed tomography technique. A cadaver and computer simulation study.

RATIONALE AND OBJECTIVES: The authors have been developing a dual-energy quantitative computed tomography (DE-QCT) technique that requires calibration standards that mimic the x-ray attenuation properties of bone, red marrow, and yellow marrow. To resolve questions regarding the compositions of red and yellow marrow that appear in the literature, the authors performed chemical analyses of bone marrow samples. The newly derived compositions were used in a simulation study to test the accuracy of the DEQCT technique. METHODS: Red marrow samples were extruded from the vertebrae of cadavers of young boys. Yellow marrow samples were removed directly from the femurs of cadavers of elderly women. The fat, protein, water, and mineral contents of these samples were determined. The compositions of 12 mixed marrow samples extruded from cadaver vertebrae also were measured. A computer simulation study was performed in which calibration standards with the new compositions were employed to estimate the fat and bone contents of spongiosas containing the 12 mixed marrows. RESULTS AND CONCLUSIONS: The red marrow samples contained 3% to 6% fat, 6% to 8% protein, 82% to 86% water, and 0.5% to 1% mineral. The yellow marrow samples contained 71% to 92% fat, 1% to 2% protein, 7% to 26% water, and 0.2% to 0.4% mineral. The simulation study yielded good results in three cases and mediocre to poor results in nine cases. An alternative approach was tried in which an average fat-free marrow was derived from the compositions of the 12 mixed marrows, and this substance, fat, and bone were used as the calibration standards. The DEQCT technique with these standards was applied to simulated spongiosas containing the 12 original mixed marrows plus nine additional mixed marrows. All of the estimates were in good agreement with the true compositions. The rms error of the mass fractions of fat was 0.03, and the rms error of the bone concentrations was 3.7 mg/mL.

Neoadjuvant chemotherapy with cisplatin, vincristine, and bleomycin and radical surgery in early-stage bulky cervical carcinoma.

Neoadjuvant chemotherapy consisting of 2-3 courses of cisplatin, vincristine, and bleomycin was used in the primary treatment of 36 consecutive patients with locally advanced early-stage cervical carcinoma [International Federation of Gynecology and Obstetrics (FIGO) stages Ib or IIa; tumor size, greater than or equal to 4 cm]. The effectiveness of the preoperative chemotherapy was evaluated in the surgical specimens. Among the 33 evaluable patients, the overall clinical response rate was 84.8%, which included a complete response in 8 patients (24.2%) and a partial response in 20 subjects (60.6%). No residual tumor was found in the surgical specimens obtained from 2 complete responders. This therapy induced varying degrees of tumor shrinkage and rendered radical surgery feasible in all evaluable cases despite the initial bulky size of the lesions. No significant difference was observed in the response rate according to age and disease stage. Lymph-node metastases were found after chemotherapy in 18.2% (6/33) of the patients. Grade II and III hematological toxicities occurred in 23.3% of the 90 chemotherapy cycles completed. Nausea and vomiting occurred to a mild to moderate degree in 75 (83.3%) cycles. These preliminary results suggest that the administration of induction chemotherapy involving two to three courses of cisplatin, vincristine, and bleomycin prior to surgery is effective in reducing the tumor volume and in providing better circumstances for surgical removal of the early yet bulky cervical tumors and results in tolerable toxicity. This protocol is now undergoing prospective randomized trials to test its impact on long-term survival.

Prognostic study of gastric cancer without serosal invasion: reevaluation of the definition of early gastric cancer.

BACKGROUND: Early gastric cancer, a term defined by Japanese researchers in the 1960s, is equivalent to pT1 tumor stage regardless of nodal status. Recently, there were suggestions to exclude node-positive pT1 gastric cancer from this entity and to consider node-negative pT2 gastric cancer as early gastric cancer. STUDY DESIGN: A survival analysis was conducted of 294 patients who underwent resection for gastric cancers confined within the gastric wall (pT1, n = 164; pT2, n = 130) between 1986 and 1992. RESULTS: The cumulative 5-year survival rate was 93.5% for pT1 patients and 67.9% for pT2 patients, with an overall survival of 82.5%. There was a significant difference in the 5-year survival rate between node-positive and node-negative pT1 patients (72.8% versus 95.6%; p = 0.0095). The 5-year survival rate of node-negative pT2 patients (80.4%) was significantly worse than that of node-negative pT1 patients (p = 0.011) but was not significantly better than that of node-positive pT1 patients (p = 0.4). If excellent prognosis is a prerequisite for the definition of early gastric cancer, then node-positive pT1 cancer and node-negative pT2 cancer should not be considered early gastric cancer. CONCLUSIONS: In the 1990s, now that new imaging techniques such as endoscopic ultrasonography has been introduced, the preoperative staging of gastric cancer can be made more accurately than in the 1960s, when the term "early gastric cancer" was defined. Because the prognosis of early gastric cancers, if subcategorized by nodal status, is not homogeneously excellent, a reevaluation of the definition of early gastric cancer may be necessary.

Amyloid beta peptide enhanced bradykinin-mediated inositol (1,4,5)trisphosphate formation and cytosolic free calcium.

Deposition of amyloid beta protein (A beta) and alteration in signal transduction systems may have pathophysiological significance in Alzheimer's disease (AD). This study tested the hypothesis that bradykinin (BK) receptor-mediated signal transduction systems in PC12 cells are altered after treatment with A beta at a concentration not toxic to cells. Exposure to varying doses of A beta 25-35 (1-10 microM) for 18 hrs significantly reduced the number of viable cells, while lower concentrations (0.01-0.1 microM) and control peptide in scramble sequence had no effect. In addition, prolonged exposure of PC12 cells to a sublethal dose of A beta 25-35 (0.1 microM) affected the receptor-mediated signal transduction pathways. BK induced both accumulation of Ins(1,4,5)P3 and elevation in cytosolic free calcium concentration ([Ca2+]i) in the control cells. These responses were further enhanced in the cells treated with A beta. Under similar conditions, A beta-treated cells also demonstrated alterations in the number and affinity of BK receptors. Alternatively, extracellular addition of A beta elevated [Ca2+]i rapidly, without detectable alterations in Ins(1,4,5)P3. This rapid elevation was dependent on extracellular calcium, suggesting that A beta induced calcium influx. Taken together, the results demonstrated that treatment with a sublethal dose of A beta peptide for 18 hrs enhanced BK receptor mediated Ins(1,4,5)P3 formation and mobilization of intracellular calcium, associated with a modification in BK receptors. Changes in the balance of these receptor-mediated signals prior to cell injury could be an important underlying mechanism for A beta peptide-induced degenerative alteration in AD.

Are adenocarcinomas and adenosquamous carcinomas different from squamous carcinomas in stage IB and II cervical cancer patients undergoing primary radical surgery?

The aim of this study was to define clinicopathologic features and to investigate prognostic factors in early-stage cervical adenocarcinomas and adenosquamous carcinomas in patients undergoing primary radical surgery. One hundred thirty-four patients with stage IB or II cervical adenocarcinoma or adenosquamous carcinomas treated at a single institution were reviewed and compared to squamous carcinomas (N = 757) treated in the same period. Among adeno-adenosquamous carcinomas, stage II disease, parametrial extension, and deep cervical stromal invasion (>2/3) were associated with increased risk of pelvic lymph node metastases, while only clinical stage II, DNA index >1.3 (by flow cytometry), and pelvic node metastases were significantly associated with decreased survival by multivariate analyses. The five-year recurrence-free and overall survival rates of patients with adeno-adenosquamous vs squamous carcinoma were 72.2% vs 81.2% (P = 0.0109), and 74.1% vs 82.8% (P = 0.0136), respectively by Mantel-Cox test. After controlling confounding factors, histologic type (adeno-adenosquamous vs squamous) was confirmed as an independent prognostic factor for recurrence-free survival [relative risk (RR): 1.2792; 95% confidence interval (CI): 1.0628-1.5399, P = 0.0092) and overall survival (RR: 1.2594, 95% CI: 1.0467-1.5155, P = 0.0146) in the whole series (N = 891). Although pattern of relapse by histologic type was not significantly different, patients with recurrent adeno-adenosquamous carcinoma did significantly worse than those with recurrent squamous carcinoma. In conclusion, the prognosis of adeno-adenosquamous carcinoma of the cervix is slightly worse than squamous tumors. Since salvage of recurrent adeno-adenosquamous carcinoma after primary radical surgery is generally ineffective using conventional treatment, innovative strategies are necessary for the high-risk group after primary surgery and all recurrent adeno-adenosquamous carcinomas regardless of size or site.

Malignant thyroid teratoma of an adult: a long-term survival after chemotherapy.

Adult primary malignant teratoma of the thyroid is a rare disease that has a poor outcome despite aggressive therapy. A 32-year-old woman underwent a simple lobectomy of the thyroid for a progressively enlarged nodule in August 1990. Pathologic assessment of the tumor revealed a malignant teratoma. The physical examinations and image studies failed to find tumor in other sites. She subsequently received 6 courses of chemotherapy with cisplatin, etoposide, and bleomycin. She experienced a complete response to chemotherapy and remained disease-free for 6.5 years. This tumor must be included in the differential diagnosis of a thyroid tumor and may be treated as a testicular germ-cell tumor for which chemotherapy may be recommended.

Cerebral edema associated with meningioma.

Cerebral edema associated with meningiomas is a rather common phenomenon. A patient with a small meningioma presented with severe cerebral edema, out of proportion to the size of the tumor. During surgery the meningioma was removed and the adjacent edematous brain tissue biopsied. The histopathological study showed conspicuous plasma cell and lymphocyte infiltration in both the tumor and the cerebral edematous tissue. The pathological findings are presented, and the possible mechanism for cerebral edema associated with meningioma is discussed.