Glioneuronal tumor with neuropil-like islands of the spinal cord with diffuse leptomeningeal neuraxis dissemination

A 54-year-old Caucasian female presented with a 1 year history of intermittent numbness of the left leg progressing to bilateral, lower extremity sensory loss that advanced to include impaired vibration and proprioception. The subsequent thoracic spine magnetic resonance imaging (MRI) scan revealed a heterogeneous, avidly enhancing, centrally situated spinal cord mass involving T7 through T10 in association with thick linear enhancement of the anterior and posterior cord surfaces extending both superiorly and inferiorly. Both the cervical and lumbar spine MRI demonstrated diffuse leptomeningeal disease as well. A brain MRI revealed focal leptomeningeal enhancement in the left and right sylvian fissures, the suprasellar cistern, and the posterior fossa; a pattern consistent with metastatic disease. The patient underwent a T6–T10 laminectomy for tumor biopsy and debulking. Histology revealed a WHO grade III glioneuronal tumor with rosetted neuropil-like islands. Synaptophysin and neurofilament (NF) positive staining was noted within the neural appearing component, whereas, glial fibrillary acidic protein (GFAP) immunopositivity was evident in the fibrillary astrocytoma component of the tumor. The Ki-67 labeling index was 7%. This tumor pattern, now included in the 2007 World Health Organization (WHO) classification of central nervous system tumours as a pattern variation of anaplastic astrocytoma (Kleihues et al. In: Louis et al. (eds) WHO classification of tumours of the central nervous system, 2007), was first described in a four-case series by Teo et al. in 1999. The majority of subsequently reported cases described them as primary tumors of the cerebrum. Herein, we report a unique example of a spinal glioneuronal tumor with neuropil-like islands with associated leptomeningeal dissemination involving the entire craniospinal axis.     

Gender differences in triggering of acute myocardial infarction

The frequencies of potential triggers of acute myocardial infarction differ between men and women. There is a possibility that anti-ischemic drugs protect against trigger-related infarctions.     

Pulp Sensitivity: Influence of Sex,Psychosocial Variables,COMT Gene,and Chronic Facial Pain

Introduction

The purpose of this study was to evaluate the associations of variability in pulp sensitivity with sex, psychosocial variables, the gene that encodes for the enzyme catechol-O-methyltransferase (COMT), and chronic painful conditions (temporomandibular disorders [TMDs]).

Rapid dissolution of right atrial thrombus in a patient with congestive cardiomyopathy

The AA describe a patient with congestive cardiomyopathy, probably alcoholic, who exhibited signs and symptoms of congestive heart failure and a pericardial rub, due to a right atrial thrombus (4 X 2 cm). The thrombus dissolved completely and the symptoms decreased markedly after 14 days of oral anticoagulant therapy alone. We suggest that anticoagulant therapy should be considered before surgery, if an intracardiac mass with no signs of pulmonary embolism is found in a patient with cardiomyopathy.     

Adjuvant thyroid remnant ablation in patients with differentiated thyroid carcinoma confined to the thyroid: a comparison of ablation success with different activities of radioiodine (I-131)

Objective

To assess efficiency of various I-131 activities on thyroid remnant ablation in thyroid cancer patients. The significance of patients?? characteristics, pathologic features and levels of Tg were analyzed.

Patients and methods

This study included 259 consecutive differentiated thyroid cancer patients, with disease confined to the thyroid, treated with I-131 after total thyroidectomy. Patients were divided into the three groups: 80 patients receiving low [1110?C1850?MBq (30?C50?mCi)], 121 intermediate [2775?MBq (75?mCi)] and 58 high [3700?MBq (100?mCi)] postoperative I-131 activities. Six to eight months after the application of radioiodine, measurements of TSH, Tg, anti-Tg antibodies (in hypothyroid state) together with ultrasound exam and whole-body scintigraphy were performed.

Results

The ablation was significantly more effective (after the first application) in patients receiving 100?mCi of I-131??89.7?% than in patients receiving lower activities (P?=?0.016). There was no significant difference in ablation rate between the 30?C50?mCi (77.5?%) and 75?mCi (70.2?%) groups. In the group receiving 30?C50?mCi, patients with solitary tumors had significantly higher ablation rate (P?=?0.038). In patients receiving 75?mCi ablation rates were higher among older patients (P?=?0.005), with infiltration of the single lobe (P?=?0.005), and with solitary tumor (P?=?0.012). The rates of successful ablation after the second application of I-131 (after 12?C16?months) amounted to 96, 97 and 96?% in the 30?C50, 75 and 100?mCi groups, respectively. The activity of I-131 and age were independent factors for thyroid ablation failure after the first application of I-131 (model of binary logistic regression).

Conclusion

The results of remnant ablation were satisfactory with all activities applied. Although after the first application of I-131 the activity of 100?mCi is significantly more effective in thyroid ablation than the administration of 30?C50?mCi and 75?mCi, the ablation rates between all the three groups are similar (almost equal) after the second application. Thus, the activity to be administered may depend on patients?? characteristics and a detailed consideration of the merits and demerits of each I-131 activity.