The biology of human brain tumours

Summary The immune responses of patients with brain tumours and the role of immunotherapy are discussed, and the specific proteins synthesized by nervous tissues and their tumours are reviewed. The significance of growth factors such as the nerve growth factor, the glial maturation factor, and the tumour angiogenesis factor in the biology of brain tumours and their therapeutic implications is discussed.     

Klinische und histologische Erfahrungen bei 54 bösartigen Parotistumoren

Zusammenfassung Die Verfasser berichten über histologische und klinische Ergebnisse bei 54 Patienten mit bösartigen Parotistumoren (davon 23 Rezidivfälle), die in den Jahren 1952 bis 1966 in der Chirurgischen Abteilung des

---

Clinical and histological findings in 54 patients with malignant parotid tumours

Summary The authors report on the histological and clinical findings in 54 patients with malignant parotid tumours (23 of them recurrencies), which were treated in the Institute of Oncology, Budapest, in the years 1952 to 1966. Apart from 22 malignant mixed tumours there were 32 carcinomas.An improvement of results is possible only by combining radical operation at an early stage with radiotherapy. Operative methods and complications are briefly discussed. The authors results are compared with those of others. Of 22 patients with malignant mixed tumours 41 % reached the 5-year mark, 9.1 % were considered as 5-year-cures. Amongst the patients with parotid carcinoma 51.6 survived for 5 years, whereas 35.4 % remained free of recurrent tumour for 5 years.

     

Granular cell tumour of the ulnar nerve in a young adult.

Granular cell tumours in peripheral nerve trunks are extremely rare. We report a case of a granular cell tumour of the ulnar nerve just distal to the elbow in a 16-year-old man. The appearance of the intraneural tumour could not be differentiated by magnetic resonance imaging (MRI) from more common nerve tumours. At exploration it was impossible to excise the tumour radically. Microscopic examination showed a clearly benign tumour and no malignant transformation has been found at follow-up after three and a half years.     

Granular cell tumour of the ulnar nerve

Although granular cell tumours have been demonstrated to have a neural origin, they rarely arise in peripheral nerve trunks. We report a case of granular cell tumour of the ulnar nerve in a 51-year-old man. Though dissectable from the nerve, this intraneural tumour showed microscopic involvement of focal nerve fibres. This tumour tended to infiltrate the nerve in the same manner as a neurofibroma.     

Facial neurothekeoma in a 10-year-old child

Neurothekeoma is a rare and benign tumour that occurs most frequently on the head and neck. It is classified as a nerve sheath tumour and epidemiologically occurs in young adults. It is rare to find these tumours occurring in children. The following report describes a case of neurothekeoma in a young girl, its treatment and a review of the literature. Specific histological analysis may reveal atypical and aggressive features, which, in turn, affect resection and reconstructive options.     

Progress in musculoskeletal oncology from 1922 – 2012

Since 1922 surgical approaches toward limb salvage in bone and soft tissue tumours have been documented. There is the famous “Umkippplastik” of Sauerbruch, the “Tikhoff-Linberg” inter-scapulo-thoracic resection or in 1943 a metallic tumour prosthesis for the hip joint in the United States (Moore, Bohlman). Since 1960 acrylic prostheses and metallic prosthesis with bone cement have been in use. Cement-free implants and the first modular ceramic prostheses were implanted in the 1970s in Vienna. At the same time successful chemotherapy in bone sarcomas was introduced by Gerald Rosen and Norman Jaffe. This was mainly the decade of custom-made prostheses. In the 1980s modular tumour prostheses with cone connection to be adopted to the needs of the patient were built intra-operatively. Since 1981 biannual international meetings (ISOLS) have pushed forward the field of bone tumour treatment to allow also tumour resection in wide borders for spine and pelvic tumours. New hope for resistant tumours could be monoclonal antibodies or even dendritic cell therapy.     

Vascular primary pulmonary leiomyosarcoma

Pulmonary leiomyosarcomas can be highly vascular tumours which provide a challenge in their management. Computerised Tomography (CT) scan of a 27 year old gentleman demonstrated a vascular 12 × 10 cm tumour in the region of middle lobe. We proceeded with a right pneumonectomy after embolization of the major feeder vessels to the tumour.     

Influence of tumour depth, blood absorption and autofluorescence on measurements of exogenous fluorophores in tissue

We investigated the influence of tumour depth and differences in blood concentration and autofluorescence between tumour and normal tissue on the fluorescence of a tumour-localising agent. Carotenoporphyrin, CP(Me)₃, was injected into rats and nude mice with intradermal tumours. On the tumours an incision was made, uncovering 2 mm² of the tumour, and fluorescence measurements, including excitation-emission maps and fluorescence ratios, were made on skin, covered and uncovered tumour. The measured fluorescence ratio in the uncovered tumour showed a three- to tenfold increase compared to the covered tumour. We used a one-dimensional layered tissue model to analyse the data. In conclusion, even with a high tumour-selectivity deeper lying tumours cannot always be detected, particularly if the tumour has a high blood concentration or low autofluorescence intensity.     

Meningiomas: Correlation between MRI characteristics and operative findings including consistency

Summary The findings on magnetic resonance imaging (MRI) in 73 surgically verified intracranial meningiomas were correlated with their histology and consistency during resection.T 1-weighted imaging was least useful since most of the tumours were iso-intense, similar to cortical grey matter regardless of histology or tumour consistency. The signal intensity on T 2-weighted images was found to best correlate with both the histology and consistency of the meningioma. Generally, the low intensity portion of the tumour on T 2-weighted images indicated a more fibrous and harder character, while the higher intensity portions indicated a more soft character. Most of the fibroblastic meningiomas showed the features of a hard tumour while angioblastic tumours showed the features of soft tumours.Tumours predicted to be harder on MR imaging generally took longer to resect than softer ones, and this relationship was shown best for the larger tumours. Using linear regression analysis, it appears that operative time for soft tumours is more affected by factors other than tumour consistency. Blood loss during surgery was also unrelated to the consistency of the tumour.These results suggest that the histology and consistency of meningiomas may be predictable from findings on T 2-weighted imaging, and this may also predict the difficulty and time required for resection.     

肿瘤标志物TSGF及CEA对肿瘤的诊断价值探讨

目的 比较恶性瘤特异性生长因子（TSGF）和癌胚抗原（CEA）在肿瘤诊断中的价值。方法 将患者分成恶性肿瘤组和非恶性肿瘤组两组,非恶性肿瘤又可分为炎症组和非炎症组;检测各组血清TSGF及CEA水平。结果 TSGF和CEA在恶性肿瘤、非恶性肿瘤、炎症及非炎症组中的阳性检出率分别为67．41％和38．84％、24．56％和2．63％、32．35％和5．88％及18．25％和0％,二者在恶性肿瘤组中的阳性率明显高于其它组（P＜0．005）;在恶性肿瘤组中,TS－GF的阳性率高于CEA（P＜0．005）。结论 血清TSGF的检测为我们提供了一个较好的肿瘤检测手段,它具有敏感性高及广谱性的优点。CEA对肿瘤检测的特异性较TSGF高。两者联合检测可提高肿瘤的诊断率。     

Hypoglossal schwannoma—successful reinnervation and functional recovery of the tongue following tumour removal and nerve grafting

Objective  Hypoglossal nerve schwannomas are rare tumours that usually cause ipsilateral hypoglossal palsy. This report describes such lesions in two patients and suggests nerve grafting as part of the treatment regimen. Method  Two patients with intra- and extra-dural hypoglossal schwannomas respectively were treated by direct surgery via a postero-lateral approach to the posterior fossa, hypoglossal canal and carotid sheath. Following tumour removal, sural nerve grafting was used to reconstruct the nerves. Unexpectedly, muscle bulk and motor function returned within 6 months in both patients. Conclusion  Nerve grafting was highly successful in achieving functional recovery following surgery for hypoglossal nerve schwannomas.     

Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry

We conducted a review of the Leeds Regional Bone Tumour Registry for primary bone tumours of the spine since establishment in 1958 until year 2000. To analyse the incidence of primary tumours of the spine and to record the site of occurrence, sex distribution, survival and pathology of these tumours. Primary tumours of the spine are particularly rare, accounting for between 4 and 13% of published series of primary bone tumours. The Leeds Bone Tumour Registry was reviewed and a total of 2,750 cases of bone tumours and tumour-like cases were analysed. Consultants in orthopaedic surgery, neurosurgery, oncology and pathology in North and West Yorkshire and Humberside contribute to the Registry. Primary bone tumours of the osseous spine constitute only 126 of the 2,750 cases (4.6%). Chordoma was the most frequent tumour in the cervical and sacral regions, while the most common diagnosis overall was multiple myeloma and plasmacytoma. Osteosarcoma ranked third. The mean age of presentation was 42 years and pain was the most common presenting symptom, occurring in 95% of malignant and 76% of benign tumours. Neurological involvement occurred in 52% of malignant tumours and usually meant a poor prognosis. The establishment of Bone Tumour Registries is the only way that sufficient data on large numbers of these rare tumours can be accumulated to provide a valuable and otherwise unavailable source of information for research, education and clinical follow-up.     

Retroperitoneal Peripheral Nerve Sheath Tumour of Triton Type—A Case Report

The malignant peripheral nerve sheath tumour is the malignant counterpart to benign soft tissue tumours such as neurofibromas and schwannomas. Malignant Triton Tumour is a histological variant of malignant peripheral nerve sheath tumours with rhabdomyosarcomatous differentiation. They are known to develop in cases of neurofibromatosis type 1 (von Recklinghausen’s disease). Malignant peripheral nerve sheath tumor is biologically an aggressive tumour for which the treatment of choice is surgery. Here we report a rare case of malignant peripheral nerve sheath tumour, not associated with neurofibromatosis type 1 and arising in the retroperitoneum.     

DNA profile and tumour progression in patients with superfical bladder tumours

Summary 229 patients with Grade 1–2 tumours (WHO), all category Ta or T1 (UICC) and surgically treated, were followed clinically and by flowcytofluorometric DNA-analysis (FCM). The tumours were characterised by their DNA profile. 175 cases were found to be diploid and fiftyfour cases showed aneuploidy. The mean follow-up time with continous FCM analysis was 2.6 years. During this period 19 patients showed tumour progression and 11 of these patients died. No progressive cases were found among 175 patients with repeatedly diploid DNA patterns. Thus tumour progression was exclusively linked to an aneuploid DNA pattern. In these case the degree of ploidy determined the frequency of progression: while 50% of the cases with triploid — hypotetraploid DNA pattern showed progression, only 10% of tumours with a tetraploid amount of DNA were found to be progressive. The degree of ploidy in 33 cases with recurrent aneuploid tumours was in general found to be constant. A fairly high degree of consistency was also found in the number of cells in S-phase, expressing proliferative properties. This indicates that superficial bladder tumours can be well characterised by their DNA profiles, that is the degree of ploidy and the proliferation pattern.     

On the etiology of glomus tumours

Summary Three unusual cases of solitary glomus tumours of the glomangioma type are described, and the etiology of solitary and multiple glomus tumours is discussed. This paper points out that the clinical entity of solitary glomus tumour is morphologically not a uniform structure, but has a varying histological appearence. Three histological types: mucous hyaline, solid and angiomatous (glomangiomas) have been described. The present findings of transition forms between solitary and multiple glomus and the reported variable relationship of multiple glomus tumours to the vascular system imply the possibility that the majority of solitary and a part of multiple glomus tumours arise by modification of the glomus bodies. The other theory which seeks to explain formation of the glomus tumours through the nevoid malformation of cutaneous blood vessels, seems to be relevant for the multiple glomus tumours with established vascular anastomoses and for the angiomatous forms of solitary glomus presented in this publication.Presented in part at the Fifth Meeting of the International Workshop on Vascular Anomalies (Hemangiomas and Vascular Malformations in the Field of Plastic Surgery), Milano, Italy. May 25th–26th 1984     

Peripheral nerve tumour composed of neurilemmoma and haemangioma elements

Summary Five cases of a peripheral nerve tumour with both neurilemmoma and haemangioma components are reported.Three tumours were intraspinal, one tumour originated in the acoustic nerve, and one was in the brachial plexus.Because of rapid progression these mixed tumours should be considered in the differential diagnosis of intraspinal malignancies.     

Sensitivity of individual tumours to photodynamic therapy

Subcapsular tumour heterotransplantation in mice kidney can be used not only for testing the sensitivity of individual tumour cells to cytostatics and ionizing radiation but also to photodynamic therapy (PDT). PDT was used to treat three experimental tumour models and four human mammary gland carcinomas which were transplanted subcapsularly in mouse kidney; the treatment consisted of irradiation with 2×120J/cm² at the 48th and 72nd hours after the administration of Photofrin II. On the 5th day after the last treatment (day 8 after the transplantation) a different inhibition of tumour growth was observed. The antitumour activity of the PDT was most strongly expressed in the four mammary gland tumours. The poorest effect was observed in the pigmented melanoma in hamsters. A correlation between tumour differentiation and the antitumour effect of PDT was established. Individual human tumours with the same localization show different degrees of sensitivity to PDT.     

Heterotransplantation of the cultured cell from a human giant cell tumour of bone

Summary We have transplanted cultured cells derived from a human giant cell tumour of bone (G-1 cell) into immunologically suppressed mice. The resulting growths were morphologically and cytokinetically analyzed. We have obtained information on the cytokinetic influences of anti-cancer agents on heterotransplanted tumours using the double labelling method.Tumour formation was noted in 56 out of 76 mice, i.e. 76%. In 3 mice which had been kept under observation the large tumours led to death.The heterotransplanted tumours of G-1 cells had morphologically malignant and non-epithelial characteristics. The cells appeared to have undergone malignant change during their long period of cultivation.Using the double labelling method, 5-FU was found to prolong the DNA synthetic time and decrease the cell birth rate of G-1 cells in vivo. Accordingly, 5-FU is the most effective anti-cancer agent to G-1 cells.In order to improve the prognosis in a malignant bone tumour the most effective anti-cancer agent should be determined by testing on a heterotransplanted tumour derived from the patient.

---

Résumé Les auteurs ont greffé des cellules cultivées à partir d'une tumeur osseuse à cellules géantes humaine (cellule G-1) sur des souris ayant subi une suppression immunitaire. Les tumeurs résultantes ont été analysées sur le plan morphologique et cytocinétique. Grâce à la technique du double marquage, on a obtenu des informations concernant les influences cytocinétiques des agents anticancéreux sur les tumeurs hétérotransplantées.Des tumeurs se sont développées chez 56 souris sur 76, soit 76%. Chez trois animaux soumis à une observation prolongée, on a constaté que les volumineuses tumeurs qui se sont formées ont entraîné la mort.Les tumeurs hétérotransplantées des cellules G-1 étaient morphologiquement malignes et non épithéliales. Les cellules ont apparemment subi une transformation maligne pendant leur longue période de culture.A l'aide du double marquage on a trouvé que le 5-fluoro-uracile prolongeait le temps de synthèse de l'ADN tandis qu'il diminuait le taux de division des cellules G-1 in vitro. Le 5-fluoro-uracile est donc l'agent anticancéreux le plus efficace à l'égard des cellules G-1.Pour améliorer le pronostic d'une tumeur osseuse maligne, on devrait déterminer l'agent anticancéreux le plus efficace en le testant sur une tumeur hétérotransplantée dérivée du malade.

     

Carotid body tumours: the University of Alberta Hospital experience

At the University of Alberta Hospital between 1950 and 1988, 17 patients who had a diagnosis of carotid body tumour were seen; 15 of them were followed up for an average of 8 years (range from 1 to 38 years). In 14 patients the tumour was removed surgically. There were no operative deaths and no strokes occurred. The most frequent complication was cranial nerve deficit. Of the 15 patients followed up, 10 (67%) manifested a deficit of the facial, vagus or hypoglossal nerve. The primary tumour was diagnosed histologically as a benign neoplasm in all 14 patients operated on, but in 3 distant metastases developed or there was invasive local recurrence. Patients with malignant tumour were significantly (p less than or equal to 0.01) younger than those with a benign tumour. Carotid body tumours can be managed safely with respect to stroke complications, but cranial nerve injuries continue to be a problem. Malignant tumours are difficult to distinguish from benign tumours except that they tend to occur in younger patients. Prompt surgery and close follow-up is particularly important in patients with carotid body tumour.     

Sural nerve schwannoma: A case report

A 54-year old female with lateral ankle and foot pain was referred to an orthopaedic specialist clinic. Examination and investigations revealed a painful mass surrounding the sural nerve. Surgical excision confirmed the diagnosis of a sural nerve schwannoma. The following case report discusses this patient’s presentation in further depth, as well as information about schwannomas, their frequency in the lower limb, and recommendations for investigation and management.Level of clinical evidence6