Metastasis of carcinoma to meningioma and glioma

Summary A case of frontal meningioma harbouring a metastasis from a previously treated breast carcinoma, and a case of metastatic carcinoma into a frontal glioma are reported.     

A case of an anaplastic meningioma metastasizing to the mediastinal lymph nodes

Context: Grade II and III (World Health Organization classification) meningiomas rarely develop in the spinal cord. However, we experienced a case with an anaplastic meningioma that developed in the spinal cord at the cervicothoracic junction and metastasized to the mediastinal lymph nodes. No such cases have previously been reported.

Findings: The patient was a 68-year-old man who developed back pain that did not affect his daily living. He developed left lower limb paralysis, and was admitted after magnetic resonance imaging (MRI) revealed an intramedullary tumor at the level of cervical vertebra 7 and thoracic vertebra 1. Positron emission tomography revealed tracer uptake in the intramedullary tumor and the mediastinal lymph nodes, suggesting a metastatic spinal cord tumor or malignant lymphoma. A lymph node biopsy was then performed. Although the tumor was highly malignant, its primary site was not identified. Detailed examinations by several other departments revealed no abnormalities. On hospital day 30, his left lower limb paralysis deteriorated, and MRI revealed that the tumor had grown. Thus, laminaplasty, laminectomy, and tumor resection were performed. The tumor was an anaplastic meningioma that resembled mediastinal lymph node tissue, and other tumor lesions were not found. These findings suggested that an anaplastic meningioma had metastasized to the mediastinal lymph nodes. The patient did not respond to radiotherapy, and he was transferred to another hospital.

Conclusion: In cases of intramedullary spinal tumors with metastasis without other potential primary tumor lesions, early diagnosis and treatment should be performed while considering anaplastic meningioma.     

Intracranial/Extracranial meningioma arising in the hypoglossal canal: case report.

A case of a patient with a posterior fossa meningioma extending through the hypoglossal canal to the cervical region as described in this article has not been previously described in the literature. Investigations and surgical management are outlined and pathological classifications are discussed. A literature review including recent reports of extracranial meningiomas is presented. Extracranial meningiomas are exceedingly rare and a high index of suspicion is necessary to make the diagnosis.     

Hemangiopericytomatous meningioma metastasized to the liver: Report of a case and review of the literature

A 54-year-old male was admitted to our hospital for treatment of a liver tumor which was pointed out by screening ultrasonography. Computed tomography revealed a tumor in the right lobe of the liver measuring 7 cm in diameter. Angiography revealed a hypervascular tumor. A hepatocellular carcinoma or hypervascular metastatic tumor was suspected. A right hepatic lobectomy was performed. The patient had previously undergone operations for a hemangiopericytomatous meningioma in the occipital fossa in 1972 and 1977. The histological findings of the liver tumor were identical to those for hemangiopericytomatous meningioma, so the etiology was considered to be liver metastasis from the previous meningioma. Nineteen cases of extracranial metastasis of hemangiopericytomatous meningioma have been reported in the literature, but hepatic resections of this metastasizing tumor have been very rare.     

Metastasis of breast carcinoma to intracranial meningioma. Case report

A case of metastasis from breast carcinoma found within a cerebral meningioma is reported. Histological diagnosis of the cerebral tumor prompted radiological investigation that visualized the asymptomatic malignant systemic tumor and excluded other metastases elsewhere. The pathogenetic aspects of this exceptional occurence are discussed in the light of the relevant literature.     

Spinal interdural meningioma developing between two layers of the dura mater. Case report

Meningiomas seldom occur in children. Here a case is reported of spinal cord compression from an interdural meningioma developing between two layers of the spinal dura mater in a young child.     

Surgical management of a meningioma in the retrosellar region

Summary.  Lesions ventral to the brainstem in the retrosellar and interpeduncular region are major challenges to the surgeon because of their location at great depth in the centre of the cranial base. We report the operative management of a patient with a meningioma in an unusual location, extending from the upper clivus, retrosellar and interpeduncular region into the suprasellar area up to the level of the foramen of Monro.  A 41-year-old man presented with a 3-month history of progressive visual disturbance, episodic headache and signs and symptoms of endocrinological disturbance. Magnetic resonance imaging (MRI) studies showed a homogeneously enhancing tumour ventral to the brainstem with large cranio-caudal extension from the upper clivus to the suprasellar area.  Operative removal was planned in two stages. First, through a right lateral suboccipital retrosigmoid craniectomy the caudal portion of the tumour at the upper clivus and prepontine region was removed. Second, the residual suprasellar part of the tumour was removed totally through a fronto-lateral craniotomy on the right side one week later.  When a tumour is very large or involves different areas of the skull base, it is necessary to decide between removal in one stage, which requires a complex and time consuming skull base approach, or in multiple stages. Our case demonstrates how a retrosellar meningioma extending to the suprasellar region can be totally removed using two simple skull base approaches without the risk of compromise to venous drainage and without the need for extensive bone removal as described in other skull base approaches. Published online March 3, 2003  Correspondence: Makoto Nakamura, M.D., Department of Neurosurgery, Nordstadt Hospital, Haltenhoffstr. 41, 30167 Hannover, Germany.     

Thoracic spine intra- and extradural dumbbell-shaped meningioma: Case report and extensive review of the literature with 21 cases

Introduction

Spinal dumbbell-shaped meningioma is a rare condition usually mistaken preoperatively for schwannoma. The present study reported a case of dumbbell-shaped meningioma, with an extensive review of literature.

局部转染CTLA-4Ig抑制大鼠异体复合组织移植急性排斥反应的研究

目的：观察腺病毒介导融合基因细胞毒性T淋巴细胞相关抗原-4（cytotoxic T-lymphocyte associated antigen-4,CTLA-4Ig）局部转染大鼠同种异体移植的复合组织对急性排斥反应的抑制作用。方法：以近交系Brown Norway大鼠为供体,Lewis大鼠为受体,采用腹部游离皮瓣作为异体复合组织移植（composite tissue allotransplantation,CTA）模型。将受者分为3组,A组（空白对照组）：异体皮瓣离体保存时不感染腺病毒,只灌注PBS溶液;B组（阴性对照组）：异体皮瓣离体保存时灌注携带增强型绿色荧光蛋白的重组腺病毒（Ad—EGFP）;C组（基因治疗组）：异体皮瓣离体保存时灌注AdCTLA-4Ig。术后观察各组移植皮瓣的排斥情况及存活天数,进行组织病理学检查,并观察CTLA-4Ig在移植组织中的表达情况及对急性排斥反应的抑制作用。结果：①A组、B组皮瓣移植物平均生存时间分别为（7．8±1．5）天和（7．1±1．6）天,C组移植皮瓣平均存活时间为（10．4±2．3）天,C组存活期长于A组和B组,差异有统计学意义（P〈0．01）;②移植皮瓣病理学检查：术后第7天,A组与B组移植皮瓣均发生严重急性排斥反应,而C组排斥反应较A组和B组轻微,但C组术后第11天也表现出严重急性排斥反应;③移植前后血清白细胞介素2（interleukin-2,IL-2）水平：各组移植术后早期发生急性排斥反应时,IL-2均有明显升高,但实验组血清IL-2水平在第3天、第7天时均明显低于两对照组（P〈0．01）。结论：建立了一种新的异体复合组织移植局部基因转染模型,皮瓣灌注AdCTLA-4Ig能获得融合基因在移植复合组织中的表达,局部产生的CTLA-4Ig能抑制急性排斥反应的发生,延长移植物存活时间。     

Rhabdoid transformation of recurrent meningioma in the cervical cord: a case report

We report a case of persistent local recurrence of rhabdoid meningioma in the cervical spinal cord. Recently, the meningioma has been reported to be undergoing rhabdoid transformation, but the clinical course is still unclear. Histopathological examination of the tumor showed that it was composed of both meningothelial cells and rhabdoid cells. At each recurrence of the tumor, the population of the rhabdoid cells had increased and the ability to grow had also increased, confirmed by the MIB-1 labeling index. This case showed that phenotypic change of the cells with rhabdoid morphology may affect meningiomas and that such changes are associated with aggressive biological and clinical behavior. This newly classified tumor should be recognized in the differential diagnosis of meningioma.     

CT动态血管成像术前评估脑膜瘤

目的探讨基于CT动态血管成像的4D-CTA对术前评估脑膜瘤的价值。方法对34例颅内脑膜瘤患者行颅脑CT动态容积扫描。分别对图像进行3D-CTA、4D-CTA相关后处理,对比3D-CTA、4D-CTA显示肿瘤大小、肿瘤供血动脉以及肿瘤与颅骨、过路动脉、周围静脉系统关系的差异。结果 3D-CTA、4D-CTA显示肿瘤大小及肿瘤供血动脉类型差异均无统计学意义(P均0.05)。3D-CTA显示70.59%(24/34)有明确引流静脉,低于4D-CTA所示94.12%(32/34,P0.05)。3D-CTA、4D-CTA显示肿瘤与颅骨关系的准确率分别为91.18%(31/34)和97.06%(33/34),肿瘤与过路动脉关系的准确率分别为87.50%(21/24)、95.83%(23/24),差异均无统计学意义(P均0.05)。结论 CT动态血管成像能够准确显示脑膜瘤大小、供血动脉及其与周围组织的关系,为术前评估脑膜瘤提供更全面的信息。     

Quality of life in patients after meningioma resection

OBJECTIVES: To evaluate quality of life in patients after tumour resection, to assess different dimensions of quality of life, to compare a newly designed questionnaire with the Nottingham Health Profile. SUBJECTIVE: A non-selected neurosurgically treated series of patients with meningiomas was investigated with reference to quality of life as a judgement of one's own needs and concerns and subjective disease dependent perception. METHODS: A postal survey was sent out to 155 patients who underwent resection of a meningioma between 1977 and 1993 at our clinic. The survey consisted of the specifically designed "Innsbruck Health Dimensions Questionnaire for Neurosurgical Patients" IHD(NS) and the Nottingham Health Profile NHP. The data were put into categories and analysed statistically (Chi-square, Mann Whitney U, Kruaskal-Wallis H-tests). RESULTS: 82 patients (53 female, 29 male) responded (response rate 59%). 10 had died and 7 had moved. The majority of patients (50/61% on NHP and 49/59.7% on IHD) had mild to moderate impairment of quality of life. 20% of the patients showed moderate to severe impairment of the dimensions: physical handicap and energy level. Physical impairment correlated to tumour size. This group was characterised by mainly belonging to the over 70ies age group and taking anti-epileptics. CONCLUSIONS: The quality of life impairments in most patients after tumour resection can be classified as mild to moderate. However, other disease and age effects are difficult to distinguish without a control group. The IHD(NS) correlated well with the NHP questionnaire.     

Extracranial meningioma in the scalp skin 25 years after epidural hematoma surgery: A case report

Introduction and importanceExtracranial meningiomas are rare, accounting for 1–2% of all meningiomas with just published in the form of a case report or series. They are categorized as primary or secondary tumors. In this paper, we present a case of extracranial meningioma in the scalp skin, which is believed in Vietnam's first case.Case presentationA 38 years old male with a history of brain epidural hematoma surgery in 1995 presented a subcutaneous protruding mass, which revealed approximately 3-centimeters from an incision scar in the left frontoparietal scalp. The tumor was firm, mobilized with contrast enhancement on magnetic resonance image. The complete surgical excision of the whole mass was performed, and histological examination revealed a WHO grade I meningioma.Clinical discussionEpidemiology, classification, diagnosis, treatment as well as prognosis of extracranial meningioma were discussed. We also hypothesized the emergence of extracranial meningioma after an epidural hematoma surgery.ConclusionExtracranial meningioma is quite rare, but it could be presented after a traumatic brain injury. Neurosurgery was the first choice, safe and effective treatment.     

A primary meningioma of the lumbar spine with neck metastasis

Context: Approximately 25% of all primary spinal cord tumors are meningiomas, and 80% of these tumors occur in the thoracic region. Few meningiomas of the lumbar spine have been presented. Extracranial metastasis of meningioma occurs extremely rare, only in about 0.1% of meningiomas. Even metastasis, the sites are seldom seen in deep soft tissue. We reported a woman original meningioma in the lumbar spine with distal deep neck metastasis.Findings: A 59-year-old patient suffered from severe right drop foot, numbness, and radicular pain for the previous 6 months. Computed tomography (CT) disclosed a huge, macrolobulated retroperitoneal soft-tissue lesion with a size of 14.9 × 10.8 × 17.7 cm. Magnetic resonance imaging (MRI) further revealed a solid spinal intracanal tumor with moderate enhancement involving the right paraspinal region at the L2∼L5 level and the right iliac fossa. A meningioma was diagnosed with histological proof. Four months later, another metastatic meningioma in her left neck. She was managed conservatively without neurologic dysfunction.Conclusions: To the best of our knowledge, such a large meningioma of the lumbar spine has not previously been reported in the literature. In this study, we demonstrated a rare spinal meningioma located in the lumbar spine primarily with secondary soft tissue metastasis.     

移植物局部转染CTLA4Ig基因对大鼠小肠移植排斥反应的预防作用

目的探讨CTLA4Ig基因在移植小肠局部转染表达及表达产物对排斥反应的预防作用。方法大鼠小肠移植前,经肠系膜上动脉给供肠灌注脂质体包裹的CTLA4IgcDNA重组质粒,术后应用组织免疫学及逆转录聚合酶链反应(RTPCR)检测移植小肠中CTLA4Ig转基因产物的表达,并行组织病理学检查,同时设立无CTLA4Ig基因转染的对照组。结果对照组(n=8)的移植小肠在术后7～14d全部坏死;实验组(n=18)7只受鼠的移植小肠于术后56～90d坏死,11只受鼠的移植小肠于术后90d时仍存活良好。对照组移植物组织切片见单核细胞广泛浸润,肠壁肌层及黏膜出血坏死,绒毛及隐窝结构消失;实验组存活超过90d者组织切片仅见少量单核细胞浸润,黏膜轻度增厚,但无明显的肠绒毛缩短及隐窝细胞减少等改变。组织免疫学及RTPCR结果显示,在移植后28d内移植小肠中有CTLA4Ig转基因产物的表达,但第56d及90d则检测不到其表达。结论经肠系膜上动脉体外灌注脂质体包裹的CTLA4IgcDNA重组质粒可有效转染移植小肠,CTLA4Ig基因在移植小肠局部转染对术后的排斥反应具有预防作用。     

Mixed tumour of schwannoma and meningioma components in a patient with NF-2

Summary The authors present the case of an intracranial tumour consisting of both schwannoma and meningioma within the same tumour, in a patient with neurofibromatosis-2 (NF-2). A pre-operative diagnosis of this mixed tumour was not made. However, retrospectively, a meningiomatous area was found inside the acoustic neurinoma on magnetic resonance (MR) images. Predominant schwannoma with a minor component of meningioma was confirmed by histopathological and immunohistochemical examinations. The transitional zones of these two different tumours were macroscopically sharp but microscopically interdigitated. The patient had another meningioma and schwannoma in a separate section of the cranial cavity. Based on this patient, it is suggested that the collision of two kinds of tumours is the most likely hypothesis to explain the development of mixed components of schwannoma and meningioma within the same tumour.     

利用腺病毒载体导入CTLA4Ig基因对大鼠同种心脏移植免疫抑制作用的研究

目的　探索CTLA4Ig基因在实验动物体内的表达以及对大鼠同种心脏移植后的免疫抑制作用。方法　利用腺病毒作载体 ,将CTLA4Ig基因导入同种心脏移植的受体鼠体内 ,以编码 β 半乳糖苷酶的有复制缺陷的腺病毒重组体 (Adex/LacZ)为对照 ,观察该基因在实验动物体内的表达以及对同种异体心脏移植后的免疫抑制作用。逆转录多聚酶链反应 (RT PCR)法检测CTLA4Ig基因在大鼠体内的表达 ,并用流式细胞仪来测定血中CTLA4Ig蛋白质的浓度变化。 结果　导入的CT LA4Ig基因能够在大鼠肝脏中表达 ,血中CTLA4Ig的浓度明显高于对照组 (P <0 .0 5 ) ,而且移植后心脏的存活时间显著长于对照组 (P <0 .0 1)。结论　CTLA4Ig基因能在大鼠体内良好表达并明显拮抗同种移植排斥反应     

Prevention of Acute Lung Allograft Rejection in Rat by CTLA4Ig

CTLA4 immunoglobulin (CTLA4Ig), which binds with a high affinity to B7-1 and B7-2, interrupts T-cell activation by inhibiting costimulatory signal. CTLA4Ig has been used in hopes of achieving antigen-specific tolerance induction in several solid organ transplants. In lung allograft rejection, however, its use has been controversial in terms of its effect on prevention of rejection. In the present study, the effect of murine CTLA4Ig on rat-lung allograft rejection was investigated. Rat left-lung transplantation was performed in an RT1 incompatible donor (Brown Norway; BN)-recipient (F344) combination. All allografts (n = 12) without any treatment were rejected within 7 days after transplantation. A single injection of murine form CTLA41g at a dose of 100 microg intraperitoneally (ip) or intravenously (iv) on day 1 post-transplantation achieved long-term graft survival (>90days) in 2/5 (40%) and 3/8 (38%), respectively. Moreover, 6/7 (86%) allografts in rats that received iv injection of 500 microg CTLA4Ig survived more than 90days. Allograft survival in the CTLA4Ig 500 microg iv recipient group was significantly longer than that in the no-treatment control or control immunoglobulin group (p <0.01). Four out of seven recipients bearing functional allografts for more than 90 days with the CTLA4Ig treatment accepted donor-specific skin grafts, whereas all third-party skin grafts (n=3) were rejected. Prevention of rat-lung allograft rejection could be achieved by intravenous administration of CTLA4Ig, resulting in long-term allograft survival with acceptance of donor-specific skin grafts.