Plasma cell granulomas of the brain: pediatric case presentation and review of the literature

Plasma cell granulomas (inflammatory pseudotumors) are benign inflammatory masses that have been observed in virtually every organ system but are most often described in the lung. Rare cases have been reported in which the brain and spinal cord are affected. We present the case of a 5-year-old girl with personality and behavioral changes, discovered to be harboring an intracerebral plasma cell granuloma. The literature on plasma cell granuloma of the central nervous system is discussed with emphasis on the clinical, radiological, and pathological features of these lesions.     

Meningeal/vascular alterations and loss of extracellular matrix in the neurogenic zone of adult BTBR T+ tf/J mice,animal model for autism

Autism spectrum disorders are characterized by impaired social and communication skills and seem to result from altered neural development. We sought to determine whether the anatomy of the meninges and extracellular matrix (ECM) is altered in an animal model of autism, the BTBR T+ tf/J mouse. This mouse displays white matter tract anatomical defects and exhibits several symptoms of autism. Immunofluorescence cytochemistry for laminin, a major ECM marker, was performed on series of coronal sections of the adult BTBR T+ tf/J brain and the anatomy was analyzed in comparison to B6 wild type mice. Laminin immunoreactivity visualized meninges, blood vessels and the subventricular zone (SVZ) stem cell-associated ECM structures, which I have named fractones. All BTBR T+ tf/J mice observed showed the same forebrain defects. The lateral ventricle volume was severely reduced, the falx cerebri elongated, the arteries enlarged and the choroid plexus atrophied. Compared to B6 mice, fractone numbers in BTBR T+ tf/J mice were reduced by a factor three in the SVZ of the anterior portion of the lateral ventricle. This represents the primary neurogenic zone during adulthood. Fractones were reduced by a factor 1.5 in posterior portions of the lateral ventricle. Moreover, fractone size was reduced throughout the lateral ventricle SVZ. These results show hitherto unsuspected alterations in connective tissue/vasculature and associated ECM in the adult BTBR T+ tf/J mouse. The drastic changes of the connective tissue and ECM in the neurogenic zone of the lateral ventricle may contribute to incorrect neurogenesis during developmental and adult stages.     

Gadolinium-enhanced magnetization transfer contrast imaging of intracranial tumors.

The magnetization transfer contrast (MTC) technique was used in low-field-strength (0.1 T) magnetic resonance (MR) imaging of 28 patients with intracranial tumors. MTC images were generated with an off-resonance, low-power radio-frequency pulse applied during the interpulse delay period of a gradient-echo partial-saturation sequence (TR msec/TE msec = 200/20). Images in the presence and absence of the MTC pulse were concurrently acquired before and after injection of gadopentetate dimeglumine at a dose of 0.1 mmol/kg. The contrast agent enhanced 27 of 28 tumors. Application of the MTC pulse improved the contrast-to-noise ratio (C/N) between tumor and normal white matter in 26 of 28 cases on the preinjection images and in 25 of 28 cases on the postinjection images. On the gadolinium-enhanced images, the mean C/N was 2.6 +/- 1.7 without the MTC pulse and 3.2 +/- 1.9 with the MTC pulse. The greatest contrast improvement with the MTC technique was obtained in tumors showing the strongest paramagnetic enhancement. The results indicate that MTC can improve contrast between normal brain and some intracranial neoplasms. The use of gadopentetate dimeglumine generally intensified this effect.     

脑胶质肉瘤和胶质母细胞瘤的常规MRI比较研究

目的比较脑胶质肉瘤和胶质母细胞瘤在常规MRI上的影像表现。方法回顾性分析22例脑胶质肉瘤和92例脑胶质母细胞瘤在平扫和增强MRI上的表现,比较两者在发病年龄、性别、瘤体大小、瘤周水肿程度、强化形态、病变分布及脑膜侵袭等方面的差异。结果脑胶质肉瘤和胶质母细胞瘤在发病年龄、性别方面无差别(P=0.152,P=0.278)。胶质肉瘤的脑膜侵袭率为63.6%(14/22),胶质母细胞瘤的侵袭率为33.7%(31/92),两者有显著差别(2=6.662,P=0.01),两种病变在大小、水肿程度,强化形态、病变分布方面无差别(P=0.343,P=0.464,P=0.795,P=0.399)。结论脑胶质肉瘤比胶质母细胞更易侵及局部脑膜。     

Primary leptomeningeal lymphoma of the lumbar spine

This report describes primary leptomeningeal lymphoma (PLML) of the spine in a 58-year-old female. LML is rare, especially in the immunocompetent, and it is almost always secondary in origin. To our knowledge, there have been very few cases of PLML of the lumbar spine reported in the literature and even fewer reports using recent MR imaging (MRI) technology to aid with diagnosis. MRI is useful in differentiating CNS lesions and may be helpful in the diagnosis of this extremely rare primary lymphoma. PLML is briefly reviewed.     

The embryologic basis for the anatomy of the cerebral vasculature related to arteriovenous malformations

A detailed understanding of vascular anatomy is essential to facilitate appropriate decision-making by clinicians responsible for treating arteriovenous malformations (AVM) of the brain and dura. This work reviews the embryologic development of the cerebral vasculature, including the dural venous sinuses, with a focus on the relevant angioarchitecture. There is little doubt that dural AVM are acquired lesions; however, conflicting evidence exists regarding the pathophysiology of brain AVM. Patients described in this review provide support for both of the proposed mechanisms for the development of brain AVM (post-natal development compared to embryologic origin). Further work is required to improve our understanding of the pathophysiology of these lesions.     

脑脊膜血管外皮细胞瘤的诊断和治疗

目的探讨脑脊膜血管外皮细胞瘤诊断和治疗。方法回顾分析1984-2005年收治的32例脑脊膜血管外皮瘤,探讨其临床病理特征、临床治疗方法及预后。结果本组男女之比1.4:1;术前仅3例影像学诊断血管外皮瘤,其余均诊断为脑膜瘤。术前影像学误诊率为92%。所有病例均行手术治疗 放射治疗,27例影像学全切,4例次全切除,1例部分切除。获得随访的29例患者1年肿瘤复发率57%,所有病例免疫组化病理结果显示vimentin 。结论脑脊膜的血管外皮瘤为起源于脑脊膜问叶组织、低度恶性的肿瘤,男性多见,术前易与脑膜瘤相混淆,免疫组化病理有特征性表现;该肿瘤易复发,手术力争全切是改善预后的最重要因素;不管术中是否全切肿瘤,术后都应辅助放射治疗以改善预后。     

脑膜癌病的脑脊液细胞学诊断相关因素研究

目的 探讨影响脑膜癌病脑脊液细胞学诊断的相关因素。方法 回顾性分析46例脑膜癌病患者的临床资料。结果 46例脑膜癌病的脑脊液中，38例发现瘤细胞(约82．6％)；40例腰穿脑脊液中，35例检到瘤细胞；6例脑室穿刺脑脊液中，3例检到瘤细胞；35例腰穿脑脊液检到瘤细胞中，26例为第一次检到瘤细胞，5例第2次检到瘤细胞，3例第3次检到瘤细胞，l例3次以上检到瘤细胞；6例硬脑膜-蛛网膜强化者仅l例脑脊液细胞学检到瘤细胞；4例软脑膜-蛛网膜强化者脑脊液细胞学均检到瘤细胞；38例原发肿瘤中，19例血液系统肿瘤(白血病、淋巴瘤)均检到瘤细胞，7例肺癌检出4例，5例胃癌检出3例，4例乳腺癌检出2例，1例室管膜瘤全部检出，1例脑淋巴瘤全部检出。结论常规脑脊液细胞学检查具有较高的特异性，脑脊液的来源、腰穿检查的次数、脑膜癌病病变的位置、原发肿瘤及组织类型均为影响其敏感性的重要因素。