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3-39-02 Nonhemorrhagic pituitary macroadenoma producing reversible internal carotid artery occlusion: Case report
s195
Neuro-oncology
focal accumulation locating the tumour region, while the SPECT scintigraphy with Tc-99m-ECD detected perfusion absence of a greater extent involving an area greater than the tumour area on the covered-over images. The comparison with X-ray CT and NMR revealed that the perfusion absence area was even a bit greater than the oedema area in the comparative examinations. In 20 pts with brain tumour without symptoms of the surrounding oedema, the SPECT scintigraphy with Tc-99m-MIBI revealed an increased focal accumulation in the tumour region. SPECT with Tc-99m-ECD detected perfusion absence of an extent smaller than the tumour region, or even focally increased perfusion in the tumour region. Conclusion: SPECT scintigraphy of brain with Tc-99m-MIBI and Tc-99m-ECD is a method to be chosen for detection of brain tumours, specially if they are accompanied by brain oedema, it enables insight into the surrounding oedema extent and enables follow-up of successfulness of the anti-oedematous therapy.
partners. However, malignant cells do not respond to these normal signalling mechanisms resulting in an uncontrolled proliferation. This fact is particularly critical in brain tumours, since these tumours grow in a cavity with rigid walls. Consequently, accurate and fast methods for the assessment of cell proliferation as well as the effect of therapeutic modalities are of significant interest with regard to brain turnours. On the basis of previous animal experiments on normal brain tissue (Alperfn et al 1966), we have designed a method for in vitro assessment of human glioma cell proliferation. The procedure is based on the production of tumour tissue mini-units (
3-39-04
39
Neuro-oncology
A. Cabahas, National
3-39-01
Local and systemic chemotherapy can improve survival in glioblastoma (GBM) patients
A. Boiardi, A. Silvani, A. Pozzi, G. Broggi, A. Salmaggi. Neumbgico
“C. Besta”,
lsfiruro Nazionale
Milan, ltaly
The treatment of malignant glial tumor is still disappointing. The aim of our study is to evaluate the tolerability and efficacy of an aggressive treatment with the administration of local intratumoral chemotherapy delivered in adjunction with systemic chemotherapy and radiotherapy and additional surgery when necessary. 54 pts had been sequentially selected for systemic chemotherapy, and 29 of them also had the treatment through an Ommaya catheter at tumor recurrence, (64%) were given a second surgery and all patients were offered a second-line chemotherapy protocol (PVC). CHT protocol consisted of BCNU 120 mg/m* + CDDP 90 mg/m’ systemically delivered plus repited local injection with bleomicyn and mitoxantrone. The disease free and ST of the whole group of pts was 13.3 f 10 mons and 22.2 f 9.5 mons respectively. Considering the treatment through the Ommaya reservoir, 23 pts were treated with intratumoral chemotherapy and 31 without local treatment, the mean ST was 23.6 f 5 and 15.7 f 4 respectively and the log-rank was 0.042. The therapeutic approach of combined local and systemic chemotherapy and radiotherapy demonstrated good tolerability and limited side effects. We feel confident that the addition of intratumoral chemotherapy despite conceptual reservations was a determining factor in the prolongation of ST in our selected patients.
13-39-02
1 Nonhemorrhagic pituitary macroadenoma producing reversible internal carotid artery occlusion: Case report
Carlos
Eduardo Cavalcanti ‘, Adelman Nogueira De Castro Junior 2. ’ Chief, Neuro-Surgeon, Centm MBdico Maranhense, Renascenca, S2o Luis, MA, USA, ‘Neuro-Surgeon, Centro M.&lico Maranhense, Renascenca, Scio Luis, MA, USA
The authors relate 01 case, with a diagnosis of nonhemorrhagic pituitary macroadenoma producing reversible occlusion of the internal carotid artery. the obstruction of the internal carotid artery by a pituitary tumor is a rare case, particular-y in the absence of hypophyseal apoplexy. the neuroradiological correlation becames fundamentally important to demonstrate the complete Occlusion or thrombosis of the affected vessels. The complete restoration of blood flow of the internal carotid artery after surgery becomes imperative for the complete symptomatological regression.
Rapid assessment human
gliomas
of cell proliferation
using
a mini-unit
rate in
method
V. ldoyaga Vargas’ , S. Yakisich ‘, J. Boethius 2, I. Ohlsson Lindblom 2, A. Siden 3, M. Cruz 4. ’ lnstituto de Investigaciones Bioquimicas Fundacidn Campomar, Bs. As, Argentina, ‘Departm&t of Neurosbrgery; Karolinska Hospital, Kamlinska Institute, Sweden, 3 Department of Neurology Huddinge Hospital Kamlinska Institute, Sweden, 4 Unit of Applied Biochemistry Clinical Research Center, Karolinska Institute, Sweden
Cell proliferation in normal tissue is regulated within the social context of the cell environment and is finely tuned to signalling mechanisms from neighbouring
V. Chan, F. Rosado,
Medical
Center
L. Rodriguez.
IMSS, MBrida,
Department
of Neumlog~
Mbxiw
The Non-Hodgkin lymphoma may affect the central nervous system as a primary tumor or as a metastasis of a systemic lymphoma. The Primary Central Nervous System Non-Hodgkin Lymphoma (PCNSL) is more frequent in patients with AIDS. We reported four Non-AIDS patients with PCNSL studied in our hospital between 1993 and 1996. All were women whose median age was 44 years. All of them tested HIV negative in three tests, and had intracranial elevated pressure; 60% showed progressive hemiparesis and 60% developed focal seizures. The computed tomography showed supratentorial neoplasmas in all patients, with variable density and some degree of enhancement. The radiological diagnoses was Meningioma or Astrocitoma, not PCNSL. A cerebral resection was given to the patients. The histologic diagnostic for diiuse-large B cell lymphoma, was given to them, according to the R.E.A.L. classification. Reactive T cells in tumors were frequently observed. We consider three cases as PCNSL and the other as a secondary infiltration of a frontal soff tissue lymphoma.
13-39-05
1 Ultrastructural study of meningioma electron microscopy
on scanning
S.M. Chiou, K.K. Liau ‘, M.C. Liao’, C. Kou2. Department of Neurosurgy; Chung Shan Medical & Dental CoNege Hospital, Taichung, Taiwan, ROC, ’ Department of Anatom)! Chung Shan Medical & Dental College Hospital, Taichung, Taiwan, ROC, 2Department of Pathology; Chung Shan Medical & Dental Co//ege Hospital, Taichung, Taiwan, ROC We evaluated ten fresh operative specimens of meningiomas by scanning electron microscope (SEM). Histologically (WHO 1979) there are 6fibroblastic 2 meningothelial, 1 angioblastic and 1 transitional subtypes. The ultrastructural differences between each subtype were analyzed. The fibroblastic type was characterized by the long, slender and cylindrical neurofibrfls tightly arranged in parallel as a forest. But the fibnls revealed as a leafy- or flower-liked platform in meningothelial one. In the angioblastic type, many microvessels intermixed with the neurofibrlls components that similar to the meningothelial one. The psammoma body in the transitional meningioma revealed as a whirled ball with some interwoven fibrils connected over its undulating surface. In conclusion, this SEM method could process on whole brain tissue without the need of thin section but its technique is relatively complicated. However, SEM offers a fairly high 3-D resolution for evaluating the surface topography of biological material. Their potential of enhance diagnosis and the predictive value of biologic activities in the future open the questions for discussion.
13-39-06 3-39-03
Primary central nervous system non-hodgkin lymphoma: Report in four patients without human immunodeficiency virus
] Cytochemical
R. Nano, C. Fenoglio,
D. Necchi,
markers of human glioblastoma M.G. Bottone,
cells
M. Ceroni I. Department
of Animal Biology; University of Pavia and Center of Study for Histochemistry, C.N.R., Pavia, Ita/,! ’ Neurologic Institut, “C. Mondino”, Neumphatology Lab., University of Pavia, /ta/y
High-grade astrocytoma and multiforme glioblastoma (GBM) are the most malignant and invasive astroglial-derived tumors. Histologically, marked cellular pleomorphism and atypia are seen in glioblastoma samples also within the same tumor sample. The present study was designed to contribute to analyze the mechanisms of malignant progression of cells by using cytochemical techniques in addition to morphology. We evaluated the presence of the enzymes nitric oxide synthase
Neuro-oncology
focal accumulation locating the tumour region, while the SPECT scintigraphy with Tc-99m-ECD detected perfusion absence of a greater extent involving an area greater than the tumour area on the covered-over images. The comparison with X-ray CT and NMR revealed that the perfusion absence area was even a bit greater than the oedema area in the comparative examinations. In 20 pts with brain tumour without symptoms of the surrounding oedema, the SPECT scintigraphy with Tc-99m-MIBI revealed an increased focal accumulation in the tumour region. SPECT with Tc-99m-ECD detected perfusion absence of an extent smaller than the tumour region, or even focally increased perfusion in the tumour region. Conclusion: SPECT scintigraphy of brain with Tc-99m-MIBI and Tc-99m-ECD is a method to be chosen for detection of brain tumours, specially if they are accompanied by brain oedema, it enables insight into the surrounding oedema extent and enables follow-up of successfulness of the anti-oedematous therapy.
partners. However, malignant cells do not respond to these normal signalling mechanisms resulting in an uncontrolled proliferation. This fact is particularly critical in brain tumours, since these tumours grow in a cavity with rigid walls. Consequently, accurate and fast methods for the assessment of cell proliferation as well as the effect of therapeutic modalities are of significant interest with regard to brain turnours. On the basis of previous animal experiments on normal brain tissue (Alperfn et al 1966), we have designed a method for in vitro assessment of human glioma cell proliferation. The procedure is based on the production of tumour tissue mini-units (
3-39-04
39
Neuro-oncology
A. Cabahas, National
3-39-01
Local and systemic chemotherapy can improve survival in glioblastoma (GBM) patients
A. Boiardi, A. Silvani, A. Pozzi, G. Broggi, A. Salmaggi. Neumbgico
“C. Besta”,
lsfiruro Nazionale
Milan, ltaly
The treatment of malignant glial tumor is still disappointing. The aim of our study is to evaluate the tolerability and efficacy of an aggressive treatment with the administration of local intratumoral chemotherapy delivered in adjunction with systemic chemotherapy and radiotherapy and additional surgery when necessary. 54 pts had been sequentially selected for systemic chemotherapy, and 29 of them also had the treatment through an Ommaya catheter at tumor recurrence, (64%) were given a second surgery and all patients were offered a second-line chemotherapy protocol (PVC). CHT protocol consisted of BCNU 120 mg/m* + CDDP 90 mg/m’ systemically delivered plus repited local injection with bleomicyn and mitoxantrone. The disease free and ST of the whole group of pts was 13.3 f 10 mons and 22.2 f 9.5 mons respectively. Considering the treatment through the Ommaya reservoir, 23 pts were treated with intratumoral chemotherapy and 31 without local treatment, the mean ST was 23.6 f 5 and 15.7 f 4 respectively and the log-rank was 0.042. The therapeutic approach of combined local and systemic chemotherapy and radiotherapy demonstrated good tolerability and limited side effects. We feel confident that the addition of intratumoral chemotherapy despite conceptual reservations was a determining factor in the prolongation of ST in our selected patients.
13-39-02
1 Nonhemorrhagic pituitary macroadenoma producing reversible internal carotid artery occlusion: Case report
Carlos
Eduardo Cavalcanti ‘, Adelman Nogueira De Castro Junior 2. ’ Chief, Neuro-Surgeon, Centm MBdico Maranhense, Renascenca, S2o Luis, MA, USA, ‘Neuro-Surgeon, Centro M.&lico Maranhense, Renascenca, Scio Luis, MA, USA
The authors relate 01 case, with a diagnosis of nonhemorrhagic pituitary macroadenoma producing reversible occlusion of the internal carotid artery. the obstruction of the internal carotid artery by a pituitary tumor is a rare case, particular-y in the absence of hypophyseal apoplexy. the neuroradiological correlation becames fundamentally important to demonstrate the complete Occlusion or thrombosis of the affected vessels. The complete restoration of blood flow of the internal carotid artery after surgery becomes imperative for the complete symptomatological regression.
Rapid assessment human
gliomas
of cell proliferation
using
a mini-unit
rate in
method
V. ldoyaga Vargas’ , S. Yakisich ‘, J. Boethius 2, I. Ohlsson Lindblom 2, A. Siden 3, M. Cruz 4. ’ lnstituto de Investigaciones Bioquimicas Fundacidn Campomar, Bs. As, Argentina, ‘Departm&t of Neurosbrgery; Karolinska Hospital, Kamlinska Institute, Sweden, 3 Department of Neurology Huddinge Hospital Kamlinska Institute, Sweden, 4 Unit of Applied Biochemistry Clinical Research Center, Karolinska Institute, Sweden
Cell proliferation in normal tissue is regulated within the social context of the cell environment and is finely tuned to signalling mechanisms from neighbouring
V. Chan, F. Rosado,
Medical
Center
L. Rodriguez.
IMSS, MBrida,
Department
of Neumlog~
Mbxiw
The Non-Hodgkin lymphoma may affect the central nervous system as a primary tumor or as a metastasis of a systemic lymphoma. The Primary Central Nervous System Non-Hodgkin Lymphoma (PCNSL) is more frequent in patients with AIDS. We reported four Non-AIDS patients with PCNSL studied in our hospital between 1993 and 1996. All were women whose median age was 44 years. All of them tested HIV negative in three tests, and had intracranial elevated pressure; 60% showed progressive hemiparesis and 60% developed focal seizures. The computed tomography showed supratentorial neoplasmas in all patients, with variable density and some degree of enhancement. The radiological diagnoses was Meningioma or Astrocitoma, not PCNSL. A cerebral resection was given to the patients. The histologic diagnostic for diiuse-large B cell lymphoma, was given to them, according to the R.E.A.L. classification. Reactive T cells in tumors were frequently observed. We consider three cases as PCNSL and the other as a secondary infiltration of a frontal soff tissue lymphoma.
13-39-05
1 Ultrastructural study of meningioma electron microscopy
on scanning
S.M. Chiou, K.K. Liau ‘, M.C. Liao’, C. Kou2. Department of Neurosurgy; Chung Shan Medical & Dental CoNege Hospital, Taichung, Taiwan, ROC, ’ Department of Anatom)! Chung Shan Medical & Dental College Hospital, Taichung, Taiwan, ROC, 2Department of Pathology; Chung Shan Medical & Dental Co//ege Hospital, Taichung, Taiwan, ROC We evaluated ten fresh operative specimens of meningiomas by scanning electron microscope (SEM). Histologically (WHO 1979) there are 6fibroblastic 2 meningothelial, 1 angioblastic and 1 transitional subtypes. The ultrastructural differences between each subtype were analyzed. The fibroblastic type was characterized by the long, slender and cylindrical neurofibrfls tightly arranged in parallel as a forest. But the fibnls revealed as a leafy- or flower-liked platform in meningothelial one. In the angioblastic type, many microvessels intermixed with the neurofibrlls components that similar to the meningothelial one. The psammoma body in the transitional meningioma revealed as a whirled ball with some interwoven fibrils connected over its undulating surface. In conclusion, this SEM method could process on whole brain tissue without the need of thin section but its technique is relatively complicated. However, SEM offers a fairly high 3-D resolution for evaluating the surface topography of biological material. Their potential of enhance diagnosis and the predictive value of biologic activities in the future open the questions for discussion.
13-39-06 3-39-03
Primary central nervous system non-hodgkin lymphoma: Report in four patients without human immunodeficiency virus
] Cytochemical
R. Nano, C. Fenoglio,
D. Necchi,
markers of human glioblastoma M.G. Bottone,
cells
M. Ceroni I. Department
of Animal Biology; University of Pavia and Center of Study for Histochemistry, C.N.R., Pavia, Ita/,! ’ Neurologic Institut, “C. Mondino”, Neumphatology Lab., University of Pavia, /ta/y
High-grade astrocytoma and multiforme glioblastoma (GBM) are the most malignant and invasive astroglial-derived tumors. Histologically, marked cellular pleomorphism and atypia are seen in glioblastoma samples also within the same tumor sample. The present study was designed to contribute to analyze the mechanisms of malignant progression of cells by using cytochemical techniques in addition to morphology. We evaluated the presence of the enzymes nitric oxide synthase