Revisiting anaplastic astrocytomas I: An expansive growth pattern is associated with a better prognosis

Purpose

To study whether anaplastic astrocytomas that are nonenhancing and/or well‐circumscribed (expansive) are associated with a better prognosis.

Materials and Methods

We retrospectively identified 59 patients with pathologically confirmed World Health Organizaiton (WHO) grade III anaplastic astrocytoma who underwent craniotomy at our institution from 1995 through 2006. We assessed prognostic variables including age, enhancement (EAA—34 patients) vs. nonenhancement (NEAA—25 patients), MR growth patterns (expansive [28 patients] vs. mixed/infiltrative [31 patients]), recursive partitioning analysis (RPA) class, resection extent, and addition of chemotherapy. Primary outcome measure was survival.

Results

Kaplan‐Meier curves showed improved survival in NEAA, expansive tumors, and RPA 1 class patients. Within RPA class I patients, expansive growth pattern remained a significant advantage in survival time. Examining extent of resection also showed that patients with gross total resections (GTR) had a better prognosis. A multivariate (Cox proportional hazards) analysis showed that patient age and expansive tumor phenotype affected outcome, whereas RPA class, enhancement, and GTR did not.

Conclusion

Circumscribed growth in histologically proven anaplastic astrocytoma, which has not been emphasized in past studies, has a considerable survival advantage. J. Magn. Reson. Imaging 2008;28:1311–1321. © 2008 Wiley‐Liss, Inc.     

Case Report: Fatal Fulminant Hepatic Failure due to Cyproterone Acetate

Cyproterone acetate is a normally well-tolerated drug that is used widely for the treatment of prostatic carcinoma. Liver toxicity due to its use is not well known. We describe two cases of fatal fulminant hepatitis related to the use of cyproterone acetate.     

Primary extraosseous cemento-ossifying fibroma of the auricle.

BACKGROUND: A mass of the auricle is uncommon. An enlarging lesion may be the result of a reactive process, or a benign or malignant neoplasm. The literature is reviewed, and a case of extraosseous cemento-ossifying fibroma of the auricle is presented. METHODS: A 22-year-old white man presented with a 3-month history of an enlarging 2 cm mass in the right concha cavum. An incisional biopsy demonstrated cemento-ossifying fibroma. The lesion was resected en bloc, and the patient did well. There is no evidence of recurrence. RESULTS: Pathological examination of the excised mass revealed a well-circumscribed but unencapsulated spindle cell lesion with foci of osteoid and cementum deposition. It did not involve the auricular cartilage, and there was no connection with the overlying epidermis. CONCLUSIONS: This is a case report of an extraosseous cemento-ossifying fibroma of the auricle. This benign tumor should be completely excised because local recurrence may otherwise result.     

Rhinorrhea is increased in Parkinson's disease

We have observed that rhinorrhea is increased in people with Parkinson's disease (PD) but only a single publication supports this. We performed two separate case control studies to assess the prevalence of rhinorrhea in PD in Rhode Island. One was cross‐sectional and the other in consecutive de novo patients. We further questioned subjects as to whether rhinorrhea might be associated with olfactory impairment. We found that rhinorrhea affects about half of PD patients in Rhode Island, is an early feature, being present at the time of presentation, was significantly more common than in controls and was associated with self‐perceived reduced olfaction. These observations confirm that rhinorrhea is a common problem and raise the questions as to whether some olfactory impairment found in PD could be confounded by rhinorrhea and also whether rhinorrea may be a premotor symptom. © 2007 Movement Disorder Society     

MR imaging of the normal and abnormal clivus

We retrospectively reviewed 330 T1-weighted sagittal images, 80 T2-weighted sagittal images, and 83 gadopentetate-dimeglumine-enhanced scans of normal adults to determine the MR appearance of the normal adult clivus. MR images of 21 patients with an abnormal clivus (19 with tumor invasion and two with marrow reconversion) were also evaluated restrospectively and compared with those of the control group to assess MR features distinguishing the two groups. Our study revealed that a normal adult clivus consisted of low- and high-intensity portions mixed in various proportions on T1-weighted images. The low-intensity portion was isointense or hyperintense relative to the pons and always contained foci of bright signal intensity. The low-intensity tumor of a pathologic clivus tended to be hypointense relative to the pons (17/19), and was completely devoid of foci of bright signal intensity. The normal adult clivus was approximately isointense relative to the pons on T2-weighted images. Clival tumors were grossly hyperintense relative to the pons on T2-weighted images in 11 of 17 patients. In the remaining six patients, either a portion of or the entire lesion was isointense relative to the pons and, therefore, was not detectable on T2-weighted images. A normal adult clivus can enhance to some degree (19/83). Clival tumors were found to enhance intensely. A clivus of very low signal intensity (signal void) on T1- or T2-weighted images was always abnormal. The clivus with marrow reconversion was uniformly hypointense relative to the pons on T1-weighted images and isointense relative to normal marrow on T2-weighted images.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of intention to learn novel, environmental sounds on the novelty P3 and old/new recognition memory.

Brain electrical activity was recorded while 32 young adults listened to frequent tones, infrequent target tones, and infrequent novel environmental sounds (some of which repeated). Subjects in the incidental group were not informed about the novel sounds, while subjects in the intentional group were informed and, in addition, were asked to memorize them for a subsequent memory test. Following the novelty oddball task, all subjects were given an old/new sound recognition memory task. The novelty P3 showed a more anterior scalp distribution and an effect of repetition in the incidental compared to the intentional group, suggesting that pre-categorizing the novel sounds influenced how they were processed. For the intentional group only, a subsequent memory effect was elicited by novel sounds that were subsequently recognized compared to those that were not, although both groups showed robust old/new ERP effects during the recognition task. The robust subsequent memory effects in the intentional group were associated with greater recognition accuracy of familiar environmental sounds relative to the incidental group. These data suggest that the encoding activity reflected in the ERP subsequent memory effect may have engendered an advantage in subsequent recognition memory performance.     

Book Review: SCI & Sexuality. The Research and Training Center on Independent Living,University of Kansas/Life Span Institute,Lawrence KS. 1999. 32 pp.

Sexuality and Disability -