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Posttraumatic malignant lymphoma of the skull: A case report
Thursday, 10 July 1997 Cortical erosion was seen at the base of this mass. Craniectomy revealed invasion of the sagittal sinus wall by the tumor. The tumor was subtotally resected. After repairing the dura the wound was closed.Postoperative course was uneventful. The patient is healthy and symptom free at the end of 8 months postoperatively. Control CT done at 6 monthspostoperatively showed no enlargement of the remaining tumor.
I P.5-679 j Report of 7 cases of choroid plexus carcinoma Yang Yang, Yuguang Uu, JiangangWang, Chengyuan Wu, Shugan Zhu. Department of Neurosurgery, AffiliatedHospitalof Shandong Medical University. Shandong, PR China Choroid plexus carcinoma is rarely encountered clinically, oomprising only 0.04% of all kinds of intracranial primary neoplasms. The total numberof such lesion available in the literature is no more than 150 throughout the world and most reportson choroid plexuscarcinoma are sporadic. Seven patients with choroid plexus carcinoma were hospitalized to our department from June, 1972 to August, 1995. Clinically, symptoms and signs of increased intracranial presure presented in all the 7 patients and visual impairment was found in 6 of the 7. Other localizing signs varied from person to person. Space-occupying lesion was manifested by CT scan in 6 cases and by angiography in 1. Homogeneous enhancement was observed in 5 patients following intravenous administration of contrast. The tumorwas localized in one lateral ventricle in 5 cases, in the oorpus callosum with involvement of both lateralventricles in 1 case and in the posteriorcranialfossa with invasion of the left lowercranial nervesand encasement of a portion of the left vertebral artery in 1 case, respectively. Totalremoval with nakedeyewasachieved in 4, subtotal in 1 and gross total in 2 cases. The diagnosis of choroid plexuscarcinoma was histopathologically established in all the 7 cases. Oneof the patientsdied after operation, the other6 patients weredischarged with a satisfactoryrecovery. The discrepancy between our series and that of some other authorsis that all 7 patients in our group were above the age of 20 years. No discrepancy between the biological behaviorand the histological feature was observed the patientswith choroidplexuscarcinoma in our group, in oontrast to someauthors. In our group of adult patients, 5 had a neoplasm locatedin the lateral ventricle, 1 had a neoplasm involving both lateralventricles.
IP·5·680 I ofLhermitte-Duclos disease. Case report and review the literature A. Beier, J.P. Warnke. Paraeelsus Klinik Zwickau. Zwiekau. Germany Summary: Lhermitte-Duclos disease is a very rare event. Our experiences compared with the literature over the past 20 years are subjectof this paper. We reportabouta fourty-eight years old male patientwitha ten years history of neck pain, dizziness and headaches. Neuroradiological examinations (CCT and MRI) showed a lesion in the left fossa posterior, causing compression of the fourth ventricleand cerebellarhemlation into the foramen magnum. Due to the spaceoccupying characterof the lesionwe performed a microsurgical excision. The lesioncould be removed totally. Histological examinations revealed a DysplasticGangliocytoma "Lhermitte-Duclos". We want to discuss the unusual age of the patient, the unspecific first symptoms and the striking neuroradiological findings as seen in angiography and MRI. Comparing with the experiences of the literature microneurosurgery has dramatically improvedthe outcome. It is our believe that regardless the controversial discussion whetherLhermitte-Duclos is a tumoror a dysplasiamicrosurgical excisionis the treatment of choice.
IP-5-681 I Diagnosis and treatment of central neurocytoma Yoshimi Matsuoka, Takashi Vagi. TakeoGotoh, Akira Hakuba. Dept. of Neurosurgery, Osaka City University. Osaka, Japan Introduction: This study was oondueted to clarify the clinical significance of radiation therapy (RT) and the immunohistochemical diagnosis of centralneurocytoma. Method: The analysis is based on the author's 6 patientsand 91 patients of central neurocytoma reported in the literature, to give a total number of 97 patients. Results: Subjectsincluded49femaleand48 malepatients. Theaverageage at diagnosiswas 29.5 ± 10.5 years ranging from 15 to 64. Immunohistochemical staining for neuronal markers showed positive results for neuron-specific enolasein 68 out of 70 patients (97.1 %) and for synaptophysin in 42 out of 53 (79.2%). There were 72 patients in whom the status of the tumor had been recently evaluated by CT,MRI or autopsy. These 72 patientswere divided into 4 groups based on the treatment modality. In Group A (17 patients), total removal had
Tumours of the eNS - Miscellaneous
S253
been performed without RT; in Group B (16 patients), total removal with RT; in Group C (11 patients), less than total removal without RT; in Group D (28 patients), less than total removal with RT. Recurrence was found in 1 patient each in Groups A and C, and 2 patients in Group D. The efficacy of RT was evaluated in Group D (28 patients). Disappearance of the tumor was found in 12 patients (42.9%), shrinkage in 7 (25.0%), and the tumor remained unchanged in 9 (32.1%). One patient, who had shown tumor shrinkage, died of tumor recurrence 11 monthsafter the first operation (biopsy). The tumor had disappeared by subtotal removal and RT in another one patient, but who died of recurrence 26 monthsafter surgery. Discussion and Conclusion : 1. Because the resultsshow that central neurocytomas can be considered as benign tumorswith low proliferative potential, complete surgical excision should be curative, and RT is not necessary in such patients. 2. Since a high level of radiosensitivity has been confirmed in this study. RT should be appliedfor residual, recurrent, or histologically malignant central neurocytomas. 3. Central neurocytoma can be reliably diagnosed by using an immunohistochemical examination of neuron-specific enolaseand synaptophysin withoutan electron microscopic study.
I P-5-682I
Posttraumatic malignant lymphoma of the skull: A case report
Takeshi Ito, SatoruMurase, HidekiSakai,Kei Nakatani, Katsunobu Takenaka, Takashi Andoh, Noboru Sakai. Department of Neurosurgery, Gifu University Schoolof Medicine, 500 Tsukasamachi, Gifu City. Japan Introduction: Malignant lymphoma of the skull is extremely rare as a primary lesion, because bonyinvolvement of malignant lymphoma usuallyoccursin the latestageof systemicdisease. Wereporta caseof primarymalignantlymphoma of the skull presenting a mass lesionafter a trauma. Case: A 69-year-oid malepresented with a frontal subcutaneous mass after blunttraumaat the samesite. The mass had grown up to hen's egg-sizerapidly within severaldays after the trauma. On admission he showed no neurological deficitandcomplained of nopain. MRIrevealed that the tumorextended into the skull and the dura mater. The tumorwas removed subtotally. On histopathological and immunohistochemical examinations of the specimen, polymorphologic largeatypical cells werediffuselyseen, in which keratinand vimentin were positive, while S-100protein negative. Also the tumor cells were positive for B cell antigen CD20, CD45RAand negtive for T cell antigen CD3, CD43, CD45RO. Theseresultsshowedthatthe tumorwasa diffuselargecell and B cell type malignant lymphoma. Later, we heard that his son had been diagnosedalso with a malignant lymphoma of the lung previously. General examination. Gallium scintigram, CT scan of chest and abdomen, laboratory data inclUding tumor markers, showed that no other lesion of malignant lymphoma existed in our patient's body. Postoperative treatment with cyclophosphamide, adriamycin, vincristine and corticosteroids weregiven four courses. The patient is free from recurrence for the past 14 months. Conclusion: Although the number of reports on malignant lymphoma has increased recently, to our best knowledge, there are only 4 cases reported with a posttraumatic primarymalignant lymphoma of the skull.
I P-5-683I Biology and management of primary intracranial malignant lymphoma O. Kubo, Y. Tajika, Y. Muragaki, K. Takakura. Department of Neurosurgery, Tokyo Womens Medical College, Tokyo. Japan Background: Primarycentralnervoussystemlymphomas (PCNSL)are a group of rare neoplasms, estimated to account for around 1.4% of the primary brain tumors that are diagnosed in Japan. The prognosis of this tumor is still poor. In an attempt to clarify the biological characteristics and the clinical aspects of PCNSL. we analysed the results of immunohistochemical study and clinical management of 42 casesof PCNSL. Materials and Methods: Samples of all cases, obtainedfrom primaryoperative procedures (32 cases) or stereotactic biopsies(10 cases)wereavailablefor histological examination. Histological and immunohistochemical staining were done usingGFAP,leucocyte common antigen(LCA), B-cellmarker(L.26), T-cell marker (UCHL.1), CD44 (adhesion molecule) and Ki 67 (MIB-1). Results: The most frequent supratentorial site of involvement was the paraventricular deep nuclearregion. Pathological findings : According to the Working Formulation system, the predominant histological typesweresmall-eleaved,largecell, and diffusemixed type B-celllymphomas. The relation between prognosis and infiltration of reactive T-celland reactive astrocytes within tumors were studied. A large amount of T-cellsis seen in 50% cases, and these cases have a relatively good prognosis. The cases with GFAPpositive astrocytes-infiltration tend to invade and infiltrate. CD44is a polymorphic familyof cell adhesion molecules that seemsto be instrumental in the mechanism of tumor invasion and metastasis. All cases are CD44-positive. The invasivecases are also positive with immunostainine for CD44in the peripheral area. Radiation therapy was received by 35 patients,
I P.5-679 j Report of 7 cases of choroid plexus carcinoma Yang Yang, Yuguang Uu, JiangangWang, Chengyuan Wu, Shugan Zhu. Department of Neurosurgery, AffiliatedHospitalof Shandong Medical University. Shandong, PR China Choroid plexus carcinoma is rarely encountered clinically, oomprising only 0.04% of all kinds of intracranial primary neoplasms. The total numberof such lesion available in the literature is no more than 150 throughout the world and most reportson choroid plexuscarcinoma are sporadic. Seven patients with choroid plexus carcinoma were hospitalized to our department from June, 1972 to August, 1995. Clinically, symptoms and signs of increased intracranial presure presented in all the 7 patients and visual impairment was found in 6 of the 7. Other localizing signs varied from person to person. Space-occupying lesion was manifested by CT scan in 6 cases and by angiography in 1. Homogeneous enhancement was observed in 5 patients following intravenous administration of contrast. The tumorwas localized in one lateral ventricle in 5 cases, in the oorpus callosum with involvement of both lateralventricles in 1 case and in the posteriorcranialfossa with invasion of the left lowercranial nervesand encasement of a portion of the left vertebral artery in 1 case, respectively. Totalremoval with nakedeyewasachieved in 4, subtotal in 1 and gross total in 2 cases. The diagnosis of choroid plexuscarcinoma was histopathologically established in all the 7 cases. Oneof the patientsdied after operation, the other6 patients weredischarged with a satisfactoryrecovery. The discrepancy between our series and that of some other authorsis that all 7 patients in our group were above the age of 20 years. No discrepancy between the biological behaviorand the histological feature was observed the patientswith choroidplexuscarcinoma in our group, in oontrast to someauthors. In our group of adult patients, 5 had a neoplasm locatedin the lateral ventricle, 1 had a neoplasm involving both lateralventricles.
IP·5·680 I ofLhermitte-Duclos disease. Case report and review the literature A. Beier, J.P. Warnke. Paraeelsus Klinik Zwickau. Zwiekau. Germany Summary: Lhermitte-Duclos disease is a very rare event. Our experiences compared with the literature over the past 20 years are subjectof this paper. We reportabouta fourty-eight years old male patientwitha ten years history of neck pain, dizziness and headaches. Neuroradiological examinations (CCT and MRI) showed a lesion in the left fossa posterior, causing compression of the fourth ventricleand cerebellarhemlation into the foramen magnum. Due to the spaceoccupying characterof the lesionwe performed a microsurgical excision. The lesioncould be removed totally. Histological examinations revealed a DysplasticGangliocytoma "Lhermitte-Duclos". We want to discuss the unusual age of the patient, the unspecific first symptoms and the striking neuroradiological findings as seen in angiography and MRI. Comparing with the experiences of the literature microneurosurgery has dramatically improvedthe outcome. It is our believe that regardless the controversial discussion whetherLhermitte-Duclos is a tumoror a dysplasiamicrosurgical excisionis the treatment of choice.
IP-5-681 I Diagnosis and treatment of central neurocytoma Yoshimi Matsuoka, Takashi Vagi. TakeoGotoh, Akira Hakuba. Dept. of Neurosurgery, Osaka City University. Osaka, Japan Introduction: This study was oondueted to clarify the clinical significance of radiation therapy (RT) and the immunohistochemical diagnosis of centralneurocytoma. Method: The analysis is based on the author's 6 patientsand 91 patients of central neurocytoma reported in the literature, to give a total number of 97 patients. Results: Subjectsincluded49femaleand48 malepatients. Theaverageage at diagnosiswas 29.5 ± 10.5 years ranging from 15 to 64. Immunohistochemical staining for neuronal markers showed positive results for neuron-specific enolasein 68 out of 70 patients (97.1 %) and for synaptophysin in 42 out of 53 (79.2%). There were 72 patients in whom the status of the tumor had been recently evaluated by CT,MRI or autopsy. These 72 patientswere divided into 4 groups based on the treatment modality. In Group A (17 patients), total removal had
Tumours of the eNS - Miscellaneous
S253
been performed without RT; in Group B (16 patients), total removal with RT; in Group C (11 patients), less than total removal without RT; in Group D (28 patients), less than total removal with RT. Recurrence was found in 1 patient each in Groups A and C, and 2 patients in Group D. The efficacy of RT was evaluated in Group D (28 patients). Disappearance of the tumor was found in 12 patients (42.9%), shrinkage in 7 (25.0%), and the tumor remained unchanged in 9 (32.1%). One patient, who had shown tumor shrinkage, died of tumor recurrence 11 monthsafter the first operation (biopsy). The tumor had disappeared by subtotal removal and RT in another one patient, but who died of recurrence 26 monthsafter surgery. Discussion and Conclusion : 1. Because the resultsshow that central neurocytomas can be considered as benign tumorswith low proliferative potential, complete surgical excision should be curative, and RT is not necessary in such patients. 2. Since a high level of radiosensitivity has been confirmed in this study. RT should be appliedfor residual, recurrent, or histologically malignant central neurocytomas. 3. Central neurocytoma can be reliably diagnosed by using an immunohistochemical examination of neuron-specific enolaseand synaptophysin withoutan electron microscopic study.
I P-5-682I
Posttraumatic malignant lymphoma of the skull: A case report
Takeshi Ito, SatoruMurase, HidekiSakai,Kei Nakatani, Katsunobu Takenaka, Takashi Andoh, Noboru Sakai. Department of Neurosurgery, Gifu University Schoolof Medicine, 500 Tsukasamachi, Gifu City. Japan Introduction: Malignant lymphoma of the skull is extremely rare as a primary lesion, because bonyinvolvement of malignant lymphoma usuallyoccursin the latestageof systemicdisease. Wereporta caseof primarymalignantlymphoma of the skull presenting a mass lesionafter a trauma. Case: A 69-year-oid malepresented with a frontal subcutaneous mass after blunttraumaat the samesite. The mass had grown up to hen's egg-sizerapidly within severaldays after the trauma. On admission he showed no neurological deficitandcomplained of nopain. MRIrevealed that the tumorextended into the skull and the dura mater. The tumorwas removed subtotally. On histopathological and immunohistochemical examinations of the specimen, polymorphologic largeatypical cells werediffuselyseen, in which keratinand vimentin were positive, while S-100protein negative. Also the tumor cells were positive for B cell antigen CD20, CD45RAand negtive for T cell antigen CD3, CD43, CD45RO. Theseresultsshowedthatthe tumorwasa diffuselargecell and B cell type malignant lymphoma. Later, we heard that his son had been diagnosedalso with a malignant lymphoma of the lung previously. General examination. Gallium scintigram, CT scan of chest and abdomen, laboratory data inclUding tumor markers, showed that no other lesion of malignant lymphoma existed in our patient's body. Postoperative treatment with cyclophosphamide, adriamycin, vincristine and corticosteroids weregiven four courses. The patient is free from recurrence for the past 14 months. Conclusion: Although the number of reports on malignant lymphoma has increased recently, to our best knowledge, there are only 4 cases reported with a posttraumatic primarymalignant lymphoma of the skull.
I P-5-683I Biology and management of primary intracranial malignant lymphoma O. Kubo, Y. Tajika, Y. Muragaki, K. Takakura. Department of Neurosurgery, Tokyo Womens Medical College, Tokyo. Japan Background: Primarycentralnervoussystemlymphomas (PCNSL)are a group of rare neoplasms, estimated to account for around 1.4% of the primary brain tumors that are diagnosed in Japan. The prognosis of this tumor is still poor. In an attempt to clarify the biological characteristics and the clinical aspects of PCNSL. we analysed the results of immunohistochemical study and clinical management of 42 casesof PCNSL. Materials and Methods: Samples of all cases, obtainedfrom primaryoperative procedures (32 cases) or stereotactic biopsies(10 cases)wereavailablefor histological examination. Histological and immunohistochemical staining were done usingGFAP,leucocyte common antigen(LCA), B-cellmarker(L.26), T-cell marker (UCHL.1), CD44 (adhesion molecule) and Ki 67 (MIB-1). Results: The most frequent supratentorial site of involvement was the paraventricular deep nuclearregion. Pathological findings : According to the Working Formulation system, the predominant histological typesweresmall-eleaved,largecell, and diffusemixed type B-celllymphomas. The relation between prognosis and infiltration of reactive T-celland reactive astrocytes within tumors were studied. A large amount of T-cellsis seen in 50% cases, and these cases have a relatively good prognosis. The cases with GFAPpositive astrocytes-infiltration tend to invade and infiltrate. CD44is a polymorphic familyof cell adhesion molecules that seemsto be instrumental in the mechanism of tumor invasion and metastasis. All cases are CD44-positive. The invasivecases are also positive with immunostainine for CD44in the peripheral area. Radiation therapy was received by 35 patients,