Blindness from multiple cerebral gliomas mimicking metastatic brain disease

Multiple brain lesions are usually due to metastatic spread. The authors describe an unusual case of a 56-year-old male presenting with visual loss secondary to multiple intracranial lesions, with infiltration of the optic chiasm and an incidental renal lesion. Open biopsy of the brain lesion confirmed glioblastoma multiforme.     

Coexistence of thyroid carcinoma and secondary hyperparathyroidism

Summary Background Reports on the coexistence of secondary hyperparathyroidism (sHPT) and thyroid carcinoma are very rare. Methods A case of secondary hyperparathyroidism and concomitant papillary thyroid carcinoma (follicular variant) is described, and compared to data from the literature. Results 1 out of 26 patients undergoing parathyroidectomy for secondary hyperparathyroidism had papillary thyroid microcarcinoma (follicular variant) associated with regional lymph node metastases. Head and neck were not irradiated during the patient’s case history. Dialysis had been performed for 23 years prior to simultaneous near-total thyroidectomy, total parathyroidectomy and autotransplantation. The prolonged high parathyroid hormone levels, or massive hemosiderin deposits may have caused the development of carcinoma. The incidence rate of occult thyroid microcarcinoma in all autopsies of our geographical region and period was 4.5 per cent. Conclusions Careful exploration of the thyroid gland, and liberal indication for biopsy of suspicious thyroid areas is mandatory in each sHPT patient who is operated on, in order to exclude possible thyroid carcinomas.      

Papillary carcinoma of the thyroid occurring as multiple vascular tumors

A case of advanced papillary carcinoma in a 16-year-old boy is presented. While this case is typical of the indolent and locally invasive character of papillary carcinoma, it is remarkable for the extent of tumor involvement appearing as reactive lymphadenopathy. The pronounced tumor vascularity and the similarity of the needle biopsy specimen to chemodectoma both conflicted with the initial diagnostic impression. The correct diagnosis was confirmed only with definitive surgical therapy.     

A case of multiple metastatic brain tumors with repeated intracerebral hemorrhages

We report a case of multiple metastatic brain tumors with repeated intracerebral hemorrhages. A 73-year-old man suffered from a cerebellar hemorrhage. Subsequent hemorrhages repeatedly occurred in the right temporal lobe, the 4th ventricle, the midbrain, and the septum pellucidum. Three months after admission, CT revealed enhanced masses with surrounding edema in the cerebellar vermis and midbrain, suggesting brain tumors. We eventually diagnosed these masses in an autopsy as metastatic brain tumors of lung adenocarcinoma. Intravascular embolization with tumor cells was a probable cause of the multiple repeated intracerebral hemorrhages.     

Two cases of intraoperative cerebral hemorrhage caused by undiagnosed metastatic brain tumors

The authors report two cases of intraoperative cerebral hemorrhage caused by metastatic brain tumors. Delayed recovery from general anesthesia and neurological deficit were found in these patients. Brain CT in case 1 showed bilateral subdural hemorrhage and parenchymal massive hemorrhage in case 2. It is thought that the causes of hemorrhage are due to the changes in morphology of vessels, deterioration in cerebral circulatory regulated system, and increased intracranial pressure caused by tumors. Since the incidence of metastatic brain tumor has increased with prolonged survival time induced by progress in cancer therapy, preoperative brain examination and careful attention to vital signs during anesthesia are needed.     

Treatment of metastatic brain tumors: effect of surgery of multiple metastatic brain tumors and systemic metastasis with special reference to quality of life]

To assess the efficacy of surgical resection of brain metastases from patients with multiple brain metastases or/and with other systemic metastases, the authors analysed treatment results of 90 cases of metastatic brain tumors. The patients were divided into three groups. Group A (nine cases): Patients with single brain tumor and their primary cancers were well controlled. Their brain tumors were removed surgically and followed by radiation. Their mean survival time was 17.0 months, and 14.6 months were independent (Karnofsky score greater than or equal to 70) in cases of lung cancer. Five patients (55.6%) improved by treatment. Group B (21 cases): Patients with multiple brain metastases or/and with systemic metastases. Their brain tumor(s) which gave rise to neurological symptoms were surgically removed in order to improve their quality of life. In cases of lung cancer, mean survival time was 9.5 months and 7.1 months were independent. 11 patients (52.3%) improved by treatment. Group C (60 cases): Patients treated conservatively. Their mean survival time was 4.9 months and 2.7 months were independent in cases of lung cancer. Only 13 patients (21.7%) improved by treatment. However 23 (38.3%) deteriorated in their quality of life during treatment. Two patients of this group had single brain tumor and their primary cancers were controlled well. They refused surgery. Their mean survival time was 13.0 months, and 7.0 months were independent. These times were statistically shorter than group A. Seven patients had similar systemic and neurological states as those in group B. Their mean survival time was 5.0 months and 3.0 months were independent. These times were also statistically shorter than those in group B.(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidemiology of metastatic brain tumors

Metastatic tumors are the most common brain tumors in adults, and their incidence is increasing. An accurate understanding of the epidemiology of metastatic brain tumors is useful for health care professionals to allocate appropriate clinical, diagnostic, therapeutic, and research resources. Reported incidences in the literature are derived from epidemiologic population-based studies; clinical studies from surgical, radiological, and autopsy series; and reviews of hospital and clinical medical records. Despite these various sources of information, an accurate incidence of metastatic brain tumors is difficult, and current figures are estimates at best. Here, we review the available data regarding the epidemiology of metastatic brain tumors.     

Management of metastatic brain tumors

Background: Brain metastases are the most common neurological complication of systemic cancer. They represent a serious cause of morbidity and mortality and a significant challenge for neurosurgeons. They outnumber all other intracranial tumors combined and, with advances in technology and treatment of systemic cancer, are on the increase as cancer patients live longer. Methods: We have reviewed the major factors that influence the occurrences of metastases in the central nervous system: primary cancer, patient age and sex, clinical aspects of presentation, basic diagnostic modalities, diagnostic imaging (computed tomography and magnetic resonance imaging), and treatment considerations. In discussing these different aspects, we emphasize the efficacy of different treatment options, including recent information regarding multiple metastases that broadens the scope of surgical implications. The criteria we present are directed toward considerations made by general surgeons, as well as those made by neurosurgeons. Conclusions: Although radiotherapy remains the main therapeutic modality, surgical excision has increasingly shown advantages in certain settings, as has stereotactic radiosurgery. Chemotherapy is less effective, but its advantages are reviewed, as are the implications of recurrent metastases.     

Pulmonary and brain metastases from well-differentiated thyroid carcinoma

Total thyroidectomy is the surgical treatment of choice for differentiated thyroid carcinoma. Despite this surgical treatment, locoregional and distant metastases can develop. Postoperative follow-up should include determination of serum thyroglobulin levels and radioactive iodine (131I) and thallium (201Tl) whole body scans. These techniques are more reliable in patients who have undergone total thyroidectomy. We stress the importance of routine medical follow-up after surgical treatment of thyroid cancer, even in the absence of symptoms.     

高压氧对脑肿瘤、脑动脉瘤术后康复疗效的观察

目的：探讨高压氧（HBO）治疗脑肿瘤、脑动脉瘤术后康复的临床疗效。方法选取我院2009年12月~2013年12月收治的脑肿瘤、脑动脉瘤术后患者200例,根据治疗方法不同分为两组,将100例HBO治疗的脑肿瘤、脑动脉瘤术后患者设为观察组,将病情相似未作HBO治疗的100例患者设为对照组,两组均常规药物治疗。采用头颅彩色多普勒超声检查患者脑血管痉挛（CVS）情况,并采用神经功能缺损评分和日常生活活动能力评定评判患者临床恢复情况,并对临床疗效进行对比分析。结果两组患者治疗前NF评分和Barthel评分比较差异无统计学意义（P＞0.05）;观察组患者治疗后NFD评分和Barthel评分与对照组治疗后比较差异均有统计学意义（P＜0.05）;两组患者治疗前大脑中动脉流速及CVS比较差异无统计学意义（P＞0.05）;观察组患者治疗后大脑中动脉流速及CVS与对照组治疗后比较差异均有统计学意义（P＜0.05）。结论HBO综合治疗效果显著,能够减少神经功能缺损评分,提高患者生活质量,值得推广使用。     

Radiosurgery for metastatic brain tumors

Since the life span of patients with metastatic brain tumors is quite limited, the aim of the treatment is to prolong their useful quality of life with minimally invasive therapeutic modalities. Although gamma knife radiosurgery (GKR) is widely used and accepted as a standard therapeutic modality for treating metastatic brain tumors today, there are still several problems to be clarified. The indication of GKR for metastatic brain tumors is based on the size, number of metastases, the state of primary cancer, systemic metastases, general condition of the patient, the radiosensitivity of primary cancer, the effective dose, etc. Although these problems have already been widely documented, the following recent papers have analyzed them more clearly. It seems that GKR is suitable for a single and solitary metastatic tumor of < 3 cm in diameter, with a Karnofsky Performance Score of > 70%,and there appears to be no limitation concerning the histology of the primary cancer and different radiosensitivity. The papers selected also cover the effect of GKR when combined with surgery and/or whole brain radiotherapy, and the limitations of GKR in the treatment of metastatic brain tumors.     

Radiosurgery for metastatic brain tumors

Since the life span of patients with metastatic brain tumors is quite limited, the aim of the treatment is to prolong their useful quality of life with minimally invasive therapeutic modalities. Although gamma knife radiosurgery (GKR) is widely used and accepted as a standard therapeutic modality for treating metastatic brain tumors today, there are still several problems to be clarified. The indication of GKR for metastatic brain tumors is based on the size, number of metastases, the state of primary cancer, systemic metastases, general condition of the patient, the radiosensitivity of primary cancer, the effective dose, etc. Although these problems have already been widely documented, the following recent papers have analyzed them more clearly. It seems that GKR is suitable for a single and solitary metastatic tumor of <3 cm in diameter, with a Karnofsky Performance Score of >70%, and there appears to be no limitation concerning the histology of the primary cancer and different radiosensitivity. The papers selected also cover the effect of GKR when combined with surgery and/or whole brain radiotherapy, and the limitations of GKR in the treatment of metastatic brain tumors.     

Treatment of metastatic brain tumor from renal cell carcinoma

Twenty-eight patients with metastatic brain tumor from renal cell carcinoma were treated at the National Cancer Hospital, Tokyo, between 1962 and March 1989. In 13 patients, the median time interval between the initial diagnosis and pulmonary metastasis was 18 months, and the interval between pulmonary metastasis and brain metastasis was 13 months. In 10 patients, whose initial diagnosis was pulmonary metastasis, the median interval between pulmonary metastasis and brain metastasis was also 13 months. There were 2 patients who presented brain metastasis initially. The median survival time from the diagnosis of brain metastasis was 17 months for the patients whose brain tumors were surgically resected, but only 4 months for the patients who didn't receive surgery. The median survival time of the patients who received postoperative radiation was 20 months, while it was 10.5 months for the patients who received radiation therapy alone. Repeated serial CT scans of 7 patients with measurable brain metastases revealed partial response (PR) to radiotherapy in 2 patients (28.6%), no change (NC) in 4 patients (57.2%), and progressive disease (PD) in one patient (14.3%). BrdU labeling indices of resected brain metastases were about 2%, and the doubling time calculated on repeated serial CT scans was about 20 days. As these lesions are rather resistant to radiotherapy and grow relatively slowly they should be resected as much as possible.     

Intracranial hemorrhages in metastatic brain tumors

Ten cases of brain metastases with significant intracranial hemorrhage are examined. The most frequent primary tumors were melanoma and lung carcinoma; bleeding was more commonly intratumoral and intracerebral. The clinical onset was acute in 6 cases and gradual in 4; the average survival time was 2 months. Intracranial bleeding in patients with brain metastases can present as a "stroke syndrome" and it remarkably reduces the survival time.     

Metastatic brain tumors with simultaneous multiple cerebral hemorrhages: a case report

We encountered a case of multiple metastatic brain tumors with simultaneous multiple cerebral hemorrhages. A 45-year-old male suffered from sudden left hemiplegia and was admitted to our hospital. CT scans on admission revealed multiple cerebral hemorrhages with surrounding brain edema in the right frontal lobe, left frontal lobe, right occipital lobe and right basal ganglia. On full-body examination, renal cell carcinoma of the left kidney and multiple metastatic tumors in the lung, liver and vertebral body were identified. We continued conservative therapy, but the patient's condition worsened and he died 36 days later. The autopsy findings indicated that all hemorrhages had occurred in the necrotic tissue associated with the metastatic brain tumors. Simultaneous multiple cerebral hemorrhages caused by metastatic brain tumors are very rare, and the differential diagnosis of cerebral hemorrhage due to metastatic brain tumor and hypertensive cerebral hemorrhage is difficult. The present case indicates that metastatic brain tumor should be taken into consideration in cases with simultaneous multiple intracerebral hemorrhages.