Separation of the tumor and brain surface by “water jet” in cases of meningiomas

In the surgery of meningiomas one of the most delicate problems is the separation of the tumor from the brain surface. The authors generally recommend microsurgery to preserve the brain surface anatomically and functionally. For this purpose we have developed a new surgical technique according to our concepts of tissue care. After excavating the tumor from inside the tumor brain surface was separated by repeated “water jets” into the tumor arachnoideal space. The “water jet” was produced by an ordinary bulb syringe. The front pressure of the jets was 300–1000 mm of water and the side pressure 100–300 mm of water. In the tumorarachnoideal space the spreading water (phys. NaCl) separates the brain from the tumor with utmost care. We operated on 55 meningiomas of different types with the “water jet” technique. The immediate results were anatomically excellent. Intraoperative and postoperative acute and late edemas appeared only in a few cases. The functions of the nearby brain were generally preserved. The surgery was uneventful when the tumor surface was smooth and the tumor was spherical. When the tumor surface was uneven, one part of the tumor extended under the dura as a thin layer or the tumor was multilobulated with expanded vessels between the lobules, more microseparation was necessary. We compared the results of the “water jet” technique with the results of the “pre-water jet” series. The surgery with the “water jet” technique was much shorter and its results were better than those of microsurgery alone.     

Primary intracranialRhabdomyosarcoma: Case report and review of the literature

Summary Invasion of the meninges is a relatively common complication of head and neck rhabdomyosarcoma (RMS), while RMS arising primarily within the brain or meninges is rare. We report the case of an 11-year old child with a primary “primitive” frontal lobe tumor, subsequent leptomeningeal spread and fatal intratumoral hemorrhage; the diagnosis of RMS was discovered only at postmortem examination. The literature contains a total of 34 reported cases of primary intracranial RMS. This tumor has been observed to arise in a variety of central nervous system (CNS) locations in patients of all ages, but most commonly within the posterior fossa of children. Leptomeningeal dissemination and spontaneous intratumoral hemorrhage are important clinical features. Postoperative chemotherapy and craniospinal radiation may improve the anticipated poor prognosis of patients treated with surgery and radiation alone. The diagnosis of RMS may be missed unless electron microscopic and specific immunohistochemical studies are applied to “undifferentiated” or “primitive” CNS tumors.     

Cancer-related identity and positive affect in survivors of prostate cancer

Introduction Despite a shift in the cancer culture and language used to describe individuals diagnosed with this disease, the extent to which individuals with cancer adopt a particular cancer-related identity and the impact of these identities in relation to their well-being is virtually unknown. Materials and methods Using a cross-sectional study design and a metropolitan tumor registry, a mail questionnaire to examine post-treatment quality of life was sent to prostate cancer (PCa) survivors. The sample consisted of 490 PCa survivors, ranging in age from 49–88 (M = 69.7; SD = 7.8), one to eight years after diagnosis. The outcome measure used in these analyses was the PANAS to assess positive and negative affect. Results The most frequently reported cancer-related identity was “someone who has had PCa” (57%). The least reported self view was “victim” (1%). Twenty-six percent of men self-identified as “survivors” while 6% thought of themselves as “cancer conquerors.” Only 9% self-identified as a “patient.” Multivariate analyses, adjusted for potential confounders, show respondents who identified themselves as “survivors” or “cancer conquerors” reported significantly higher scores on positive affect than men who self-identified as “patients” (p < .001). Conclusions Although the majority of respondents identified themselves as “someone who has had cancer,” identifying as a “survivor” or “someone who has conquered cancer” appears to have adaptive value for positive mood. Implications for cancer survivors Those who perceive themselves as survivors of prostate cancer may derive some benefit in well-being associated with this self assessment.     

Decreased rate of infection in glioblastoma patients with allelic loss of chromosome 10q

Introduction Chromosome 10q allelic loss commonly occurs in glioblastoma. Disruption of PTEN, one of three known 10q tumor suppressor genes, affects the immune system by increasing tumor expression of immunosuppressive protein B7-H1 and by increasing tumor release of Th2-inducing cytokines. While the former might impair antitumor cellular immunity, a consideration for immunotherapy, the latter could cause 10q-maintaining tumor patients to experience comparatively higher rates of bacterial infections, a source of morbidity and mortality in glioblastoma patients. Methods We retrospectively reviewed 58 glioblastoma patients whose tumors were designated “normal-10q” (n = 16) or “LOH-10q” (n = 42) using loss of heterozygosity (LOH) assays of microsatellite markers in constitutional/tumor DNA pairs. Records were reviewed for symptomatic, microbiologically or radiographically confirmed infections in the first 2 years after diagnosis. Results Infection occurred more frequently in “normal-10q” than “LOH-10q” patients (56% vs. 14% of patients experiencing infection; P = 0.001). “Normal-10q” patients more commonly developed all four infection types studied (urinary tract = 38% vs. 13%, craniotomy wound = 19% vs. 0%, pneumonia = 19% vs. 5%, sepsis = 6% vs. 3%). “Normal-10q” and “LOH-10q” patients had similar survival, ages, chemotherapy treatment rates, and frequency of patients on dexamethasone 1 month after radiation therapy (P = 0.4–0.98), making these factors unlikely to explain the observed difference in infection rates. Conclusion While tumor mutations may inhibit antitumor immunity, the effects of these mutations on systemic immunity remain undetermined. We found higher infection rates after glioblastoma diagnosis in patients whose tumors maintained chromosome 10q than in patients whose tumors had allelic 10q loss. Differing effects of this genetic alteration on antitumor and systemic immunity may warrant further investigation, potentially providing insight into mechanisms of antitumor immunity and host defenses against local and systemic infections.     

An enhanced risk-group stratification system for more practical prognostication of clinically malignant gastrointestinal stromal tumors

Background Recent breakthroughs regarding the oncogenesis of gastrointestinal stromal tumors (GISTs) have led to the wider use of imatinib mesylate in the treatment of advanced GISTs. However, the role of imatinib in an adjuvant setting has yet to be established, mainly owing to the lack of an accurate system to prognosticate recurrences and/or metastases. The aims of this study were to identify factors prognostic for an unfavorable postoperative outcome, and to enhance the current NIH-consensus risk-group stratification system (Fletcher's system). Methods A retrospective review was conducted in 303 consecutive patients who had undergone surgical resection of primary GISTs during the study period (1987–2003). In addition to Fletcher's system, which is based on morphologic variables (tumor size and mitotic count), with four risk groups: very low risk, low risk, intermediate risk, and high risk, the predictive potential of any major preoperative, intraoperative, or postoperative clinical factor was statistically evaluated. Results In addition to tumor size and mitosis, four operative variables were found to affect disease-free survival: peritoneal dissemination, metastasis, invasion, and tumor rupture. Patients presenting with at least one of these “clinically malignant factors” had an unfavorable outcome (i.e., they were potential candidates for adjuvant therapy). We therefore modified Fletcher's system by adding a new patient group, termed the “clinically malignant group,” (patients having at least one of the “clinically malignant factors”). With this modification, the outcomes of patients in the “new” very-low-risk and low-risk groups remained favorable, but the outcomes of patients in the “clinically malignant group” and the “new” high-risk group bceame unfavorable. Conclusion This modified Fletcher's system, enhanced by the addition of “clinically malignant factors,” can distinguish patients with a possible unfavorable outcome from those who require no therapy other than surgery. Patients in the “clinically malignant group” could be potential candidates for adjuvant therapy using imatinib.     

Genetic diagnosis of cancer

The terms “genetic diagnosis” and “presymptomatic/prenatal diagnosis” are often considered synonymous. However, unlike the genetic diagnosis generally invoked in hereditary diseases, “genetic diagnosis of cancer” can mean at least three different types of diagnosis based on genetic methods, in addition to pre-symptomatic/prenatal diagnosis or identification of inherited cancer risk. These three approaches include (1) detection of cancer cells using DNA samples isolated from blood, stool, sputum, or urine; (2) genetic diagnosis of malignancy or benign status; and (3) characterization of individual cancer cells to examine (a) how widely they have spread, (b) whether the tumor is metastatic, and (c) whether the cells are sensitive to anti-cancer drugs or irradiation. Information concerning genetic abnormalities in cancer cells, accumulated in these ways, can be applied to clinical settings where it should provide useful indicators for better management of cancer patients. In this review we discuss recent progress and future prospects for the “genetic diagnosis of cancer.”     

Clinicopathological features from long-term observation of a papillary tumor of the pineal region (PTPR): a case report

Papillary tumor of the pineal region (PTPR) was recently added to the 2007 WHO classification of tumors of the central nervous system as a rare pineal tumor. We present a case of a 17-year-old man who developed a 3-cm pineal tumor that was incompletely excised following two operations. The pathological findings presented were extensive epithelial papillary structures surrounding vessels mimicking “perivascular pseudo-rosettes,” leading to a diagnosis of “papillary ependymoma.” Subsequently, the residual tumor recurred on three separate occasions. Immunohistochemical studies showed the tumor was positive for cytokeratin 18 (CK 18), microtubule-associated protein (MAP 2), neuron-specific enolase (NSE), neuronal nuclei (NeuN), and transthyretin, consistent with mature neuronal differentiation. Given these findings, the diagnosis of PTPR was made. The patient’s survival time of 218 months is the longest reported to date for this tumor.     

Consumer Beware: A Systematic Assessment of Potential Bias in the Lay Electronic Media to Examine the Portrayal of “PARP” Inhibitors for Cancer Treatment

This study examined how the lay electronic media covers poly-ADP-ribose polymerase, or “PARP,” inhibitors, a class of cancer agents currently under clinical investigation. Of 771 internet links, 51 targeted the lay public. Independent review by two investigators yielded the following categorizations: 36 (71%) were “overly positive”, 15 (29%) “neutral”, and none “overly negative”. “Overly positive” articles used: (l) overstated benefit, (2) included quotations from enthusiastic scientists, and (3) discussed single or small patient subsets. They used such phrases as “the holy grail of cancer research”, “the most exciting development in cancer research in a decade or more…. it could save thousands of lives”, and “we were surprised and delighted…. it’s the kind of thing you don’t really think will happen”. Healthcare providers should be aware of the foregoing when discussing PARP inhibitors—and perhaps other novel therapies—with cancer patients.     

IN SILICO EXPRESSION ANALYSIS OF HUMAN NOVEL GENE UBAP1 IN MULTIPLE CANCERS

Loss of heterozygosity (LOH) on human chromosome 9p2l-22 is one of the most frequent genetic alterations in many common sporadic cancers, including breast cancer, lung cancer, bladder cancer, melanomas, gliomas and nasopharyngeal carcinoma. So it was postulated that there might be some other unknown tumor susceptibility or suppressor genes, which are correlated with the occurrence of these cancers[1-5]. In order to obtain the novel genes associated with human nasopharyngeal carcinoma (NPC) o…     

Mixed germ cell tumor and hemangioblastoma in the cerebellum: report of a rare coexistence

We report a case of a cerebellar tumor consisting of a mixed germ cell tumor (GCT) and a hemangioblastoma. A 22-year-old man presented with myoclonus and cerebellar ataxia. Magnetic resonance imaging showed a tumor mass in the left cerebellar hemisphere. The tumor was totally removed, and the histological diagnosis was an undetermined neoplasm. Ten months later, the patient returned with cerebellar hemorrhage at the site of the previous tumor. An emergency craniotomy was performed, and a tumor mass adjacent to the hematoma was resected. Microscopic examination revealed a mixed GCT consisting of a germinoma, choriocarcinoma, and mature teratomatous component. An area of hemangioblastoma was also found in the same tumor mass. A retrospective examination of the histological sample from the first operation indicated a germinoma. A primary GCT of the posterior fossa is very rare, and there are no other reports of the coexistence of a GCT and a hemangioblastoma. A metastatic GCT lesion of extracranial origin should be considered when the intracranial GCT is non-germinomatous and arises in an unusual site. The most probable hypothesis for the histogenesis of this case was a hemangioblastoma complicated by a “tumor-to-tumor” metastatic lesion of testicular GCT with “burnout” of the primary site.     

乳腺肿块微血管密度与血氧近红外光参数的相关性研究

Objective: To detect the reliability of near-infrared parameters of blood oxygen of mammary gland phyma from the microvessel density of tumor. Methods; 181 cases of mammary gland phyma who had accepted the examination of the near-infrared TBO-I dual-wave length mammary gland phyma detector were classified by near-infrared parameters of blood oxygen, and were performed the pathologic examination to ascertain whether the tumor was benign or malignant. Among these cases, intratumoral microvessel density of 20 cases of malignant phyma and 20 cases of benign phyma were confirmed by S-P immunohistochemical method, then the relationship between near-infrared parameters and microvessel density were analyzed by medical statistics. Results: (1) The microvessel density and blood concentration of 28 cases of the "high blood" tumor were 24.56 ± 8.110 and 1.891 ± 0.850 respectively. The microvessel density and blood concentration of 12 cases of the "low blood" tumor were 17.98 ± 8.729 and 0.698 ± 0.283 respectively. There was significant difference between the "high blood" and "low blood" tumors (P ＜ 0.05). (2) The intratumoral microvessel density and blood concentration were linearly correlated respectively, and the linear correlation coefficient r = 0.4208 (P ＜ 0.05) in 40 cases of mammary gland phyma.Conclusion: The intratumoral microvessel density and blood concentration of benign or malignant mammary gland phyma were linearly correlated. Blood concentration (one of near-infrared parameters) is reliable to be used as diagnosis criterion of malignant mammary gland phyma.     

Mid-region parathyroid hormone-related protein (PTHrP) binds chromatin of MDA-MB231 breast cancer cells and isolated oligonucleotides “in vitro”

We have previously shown that PTHrP(38–94)-amide restrains growth and invasion “in vitro”, causes striking toxicity and accelerates death of some breast cancer cell lines, the most responsive being MDA-MB231 whose tumorigenesis was also attenuated “in vivo”. PTHrP(38–94)-amide contains the domain implicated in the nuclear import of PTHrP. Although the nucleus was identified as a destination for mid-region PTHrP, evidence for direct DNA-binding capability is lacking to date. Here, we examined the localization of PTHrP(38–94)-amide within MDA-MB231 cells and within metaphase spread preparations and characterized its DNA-binding properties, employing a combination of immunocytochemical, cytogenetic, “whole genome”/conventional PCR, EMSA and DNase footprinting techniques. The results obtained: (i) show that PTHrP(38–94)-amide gains access to the nuclear compartment of MDA-MB231 cell; (ii) demonstrate that PTHrP(38–94)-amide is a DNA-binding peptide; and, (iii) represent the first data to date on the potential molecular targets in both cellular chromatin and isolated oligonucleotides “in vitro”.     

Evaluation of Cancer Patient Education and Services

On their first visit to the Regional Cancer Program, all patients are provided with the “Information for Patients and Families” binder that was designed by an interdisciplinary cancer patient education team. Patients were asked to complete a survey to evaluate the usefulness of this binder. Timely delivery of the “Information for Patients and Families” binder validates a higher level of satisfaction with oncology services because patients are better informed and this translates into a reduction of psychosocial problems. As a result of this study, a decision was made to provide the binder earlier in the patient’s journey (e.g., post surgery for thoracic and brain tumor patients).     

Stereotactic radiosurgery eligibility and selection bias in the treatment of glioblastoma multiforme

Several single institution studies have shown a survival advantage when a stereotactic radiosurgery (SRS) boost followed fractionated external beam radiation (FracRT) in the treatment of glioblastoma (GBM). RTOG 93-05 employed SRS before FracRT and demonstrated no survival benefit. We examined the effect of SRS eligibility before and after FracRT on patient outcome in a group of patients treated with conventional therapy without SRS. From 1998 to 2008, 106 patients with GBM treated definitively at the University of Utah were divided into groups based on eligibility for SRS: ineligible (“Never”), eligible before FracRT (“All Pre”), eligible before FracRT only (“Pre Only”), or eligible before and after FracRT (“Always”). Overall (OS) and progression-free survival (PFS) based on SRS eligibility was assessed. Eleven patients were alive at the time of analysis with a median follow-up of 42.3 months. Median OS for groups “All Pre” (n = 29), “Always” (n = 17), “Pre Only” (n = 12), and “Never” (n = 77) were 13.6, 13.6, 12.4, and 9.2 months, respectively. Of the 29 patients in group “All Pre,” 12 (41.4%) were ineligible for SRS following FracRT. PFS did not significantly differ between groups. SRS for GBM can only be of benefit to selected patients with minimal focal postoperative disease. Following FracRT, over a third of initially SRS-eligible patients demonstrated more extensive disease in our experience. It is possible inclusion of such patients in a series of SRS for GBM could mask a benefit in remaining patients. No significant difference in OS or PFS based on SRS-eligibility status was found.     

Detection of Human Papilloma Virus Type 16 E6 mRNA in Laryngeal Squamous Cell Carcinoma by In Situ Hybridization

Objective:We supposed that it will be a promising strategy to "prevent" multidrug resistance (MDR) instead of "reversing" it.This study was designed to investigate the potency of curcumin to prevent the acquired drug resistance induced by adriamycin (ADM) in native K562 cells.Methods:K562 cells were pretreated with curcumin or 0.5% DMSO for 24 h and then were co-incubated with ADM.P-glycoprotein (P-gp) and mdr1 mRNA levels were analyzed separately by flow cytometry and quantitative real-time RT-PCR.The intracellular Rh-123 accumulation was also detected by flow cytometer.Finally,we performed a MTT assay to determine the ADM-induced cytotoxicity with or without pretreatment of curcumin.Results:P-gp and mdr1 mRNA expressions were elevated in the ADM alone group.While in the curcumin pretreated groups,the induced P-gp and mdr1 mRNA levels gradually decreased with increasing curcumin concentrations,and the Rh-123 accumulation level was almost recovered close to the control group’s.Finally,the MTT colorimetric assay verified the enhanced effect of curcumin on ADM-induced cytotoxicity.Conclusion:Our present study suggested that curcumin exhibits the novel ability to prevent the up-regulation of P-gp and its mRNA induced by ADM.The prevention capacity is also functionally associated with the elevated intracellular drug accumulation and parallel enhanced ADM cytotoxicity.We revealed a novel function of curcumin as a potential drug resistance preventor.     

Primary leptomeningeal meningiomatosis with widespread whorl formation

We report a 10-year-old girl with a primary leptomeningeal tumor. She presented with a 5-week history of increased intracranial pressure, progressive cranial nerve deficits, and spinal compression signs. She had previously had a granulosa cell tumor, a benign estrogen-producing ovarian tumor, which was resected 6 months before the initial neurological symptoms developed. At autopsy, the brain and spinal cord showed diffuse neoplastic involvement of the leptomeninges. The tumor was composed of small cells with a high nucleus/cytoplasm ratio, which were immunoreactive for vimentin but not for epithelial membrane antigen or cytokeratin. In addition, the tumor contained many small cellular whorls with desmosome-like junctional complexes between the cells, suggesting that the tumor was a meningioma, basically of the meningothelial type. The term ‘meningeal meningiomatosis’ has been used synonymously with “primary meningeal sarcomatosis”. The present tumor was considered to be a rare example of “meningeal meningiomatosis” of true meningothelial cell origin.     

Patterns of failure after stereotactic radiotherapy of intracranial meningioma

The aim of this work is to evaluate patterns of failure in patients with recurrent meningioma after stereotactic radiotherapy. Of 411 patients with intracranial meningioma treated with radiotherapy at our institution, 22 patients with local tumor progression diagnosed by magnetic resonance imaging (MRI) after radiotherapy (RT) were identified and further investigated. The histologic grade of the meningiomas was World Health Organization (WHO) grade I in 54.5%, WHO grade II in 27.3%, and WHO grade III in 9.1% of cases. Fourteen patients had received fractionated stereotactic RT; five patients underwent intensity-modulated RT. The median total dose was 57.6 Gy at 1.8 Gy/fraction, five times weekly. Local recurrences were divided into the dosimetric categories “central” (“in-field”) and “marginal” (“out-field”). Median follow-up was 59.5 months. Eleven local failures were found to be central, and 11 were marginal. Recurrence-free survival (P < 0.05) and site of local recurrence (P < 0.05) depended statistically significantly on histology. Median recurrence-free survival was 46 months for patients with benign meningioma (WHO grade I) and 31.5 months for patients with higher-grade meningioma (WHO grade II/III). In the WHO grade I group, three recurrences were central and nine were marginal, whereas in the WHO grade II/III group seven recurrences were central and one was marginal. Median time to local tumor progression and site of local recurrence significantly depended on histological grade of meningioma. Regarding site of failure, improvement of dose coverage for benign meningiomas and dose escalation for high-grade tumors might further improve therapy outcome.     

Dysembryoplastic Neuroepithelial Tumor: Radiological Findings (including PET,SPECT, and MRS) and Surgical Strategy

In order to elucidate the radiological features of dysembryoplastic neuroepithelial tumor (DNT), and to clarify the optimal surgical strategy for this tumor, the authors retrospectively analyzed 20 cases of DNT treated at our institution.Magnetic resonance (MR) imaging (all cases), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) (eight cases), ictal/interictal Tc99m-HMPAO single photon emission computed tomography (SPECT) (seven and five cases respectively) and proton magnetic resonance spectroscopy (1H MRS) (one case) were performed preoperatively. Invasive monitoring/intraoperative electrocorticography (ECoG) was performed in four cases in order to determine the epileptogenic zone. A well-demarcated lobulating tumor located in the cortical with/without subcortical area was the typical MR finding. 18F-FDG PET showed glucose hypometabolism in all cases. Ictal Tc99m-HMPAO SPECT showed hyperperfusion of the lesion in three cases and interictal Tc99m-HMPAO SPECT showed hypoperfusion of the lesion in one case. 1H MRS showed nonspecific findings. Gross total resection was performed in all cases. Histologically, associated cortical dysplasia was found in 11 cases. The mean duration of follow-up after surgery was 37.9 months, and the overall seizure free rate was 90%. Follow-up MR imaging was performed in 14 cases (mean duration of follow-up: 21.6 months) and showed no recurrence of tumor in any of these cases. lnvasive monitoring/intraoperative ECoG and the presence of cortical dysplasia showed no significant relationship with seizure control rate (p=1.25 and p=1.62 respectively).     

Lexical access speed is significantly correlated with the return to professional activities after awake surgery for low-grade gliomas

Awake surgery with intraoperative brain mapping is highly recommended for patients with diffuse low-grade gliomas in language areas, to maximise the extent of resection while preserving the integrity of functional networks and thus quality of life. The picture-naming test “DO.80” is the gold standard for language assessment before, during, and after surgery. Cognitive functioning is correlated with quality of life, itself linked with return to work. Our objective was to evaluate the significance of measuring naming speed, and its correlation with the return to professional activities. Two complementary studies are reported. In the first retrospective study, eleven patients were examined post-operatively. Five patients were selected because they were not able to resume their professional activities (“no return group 1”). They were compared with a control group of six patients who are working normally after surgery (“return group 1”). The eleven patients performed a global language and neuropsychological assessment, with a post-operative median follow-up of 35 months. In a subsequent prospective study, twelve patients were examined pre-operatively and post-operatively. Six patients who were not able to return to work (“no return group 2”) were compared with a control group of six patients who were working normally after the surgery (“return group 2”). The twelve patients performed a pre and post-operative language assessment, with a median follow-up of 9 months. Our results show, for the first time, that naming speed is significantly correlated with a major criterion of quality of life: the return to professional activities. There were no differences between the two groups regarding other measures of cognition. Assessing naming times, and not only naming accuracy, is essential in the management of low-grade glioma patients, before, during, and after surgery, to preserve their quality of life by resuming their previous professional activity. Our results have fundamental implications concerning the comprehension of language processing and its relationship with cognitive functioning.