[Affection of the nervous system in leucoses and malignant lymphomas (author's transl)].
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Biomedical subjects
Publications and source records attributed to F Slowik.
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According to the examination of the ultrastructure of the human gliomas and the ultrastructural localization of their free cholesterol, it can be established that the main part of the free cholesterol is present in the cells in a structural fixed form and that multiplication of the free cholesterol, occurring due to cell degeneration in the vacuoles and cysts, can be brought in connection with the disintegration of these structures.
Sixty-eight primary malignant lymphomas of the CNS exclusively confined to the brain and its leptomeninges from a series of about 8000 intracranial neoplasms (incidence 0.85%) were examined and classified according to current histopathologic criteria. Average age at onset of symptoms was 55 years, mean duration of illness to time of diagnosis was 3 months. Survival averaged 1,8 months with supportive care, but 17,2 months with surgery, radiation and/or chemotherapy. CSF cytology was useful and reliable tool for clinical diagnosis. The cerebral hemispheres were affected in about 50%, the basal ganglia in 18%, posterior fossa in 10%, while multifocal lesions amounted to 22%. All CNS tumors were of the diffuse type of non-Hodgkin's lymphomas; no follicular (germinal center) lymphomas were observed. Three histological patterns comparable to extraneural lymphomas were distinguished: Immunoblastoma (reticulosarcoma) occurred most frequently (58.8%), lympho-plasmacytoid immunocytoma constituted 28 percent, while lymphoblastic lymphoma occurred least frequently (13.2%). There were no significant differences with regard to onset, location, growth pattern or clinical course except for a much poorer prognosis of lymphoblastic lymphoma. Although there are no definite cytological differences between malignant lymphomas arising in extraneural sites or as primary lesions in the CNS, the latter showed a much greater proportion of phagocyting histiocytes (and microglia) and a frequent occurrence of plasmacytes and their precursors which apparently exceded pure host reaction. The prognostic value of modern classification schemes for CNS lymphomas needs further critical evaluation.
Out of 960 human brain neoplasms seven primary lymphomas were cultured and grown up to twenty eight days. The monolayers had common cytological characteristics; /i/ immediately after plantation a high density of uniform cells was observed; /ii/ many cells were lost during subsequent medium changes; /iii/ the monolayers contained lymphocyte-like cells in different numbers. According to their individual characteristics the cultures could be classified into three categories: 1./ In the cultures of three tumours lymphocyte-like cells predominated. These tumours had low proliferative capacity in vitro. 2./ Cultures of three other tumours consisting mainly of tissue macrophages had a high proliferative capacity in vitro. 3./ Cultures of a single tumour showed the combined features of the former two categories: both lymphocyte-like cells, and tissue macrophages were present. These cultures showed the highest proliferative activity. On the basis of these findings it is quite possible that beside other methods, tissue culture technique may be useful in the classification of brain lymphomas.
The incidence of the various histological subtypes of meningiomas was examined in 1238 patients with surgically treated meningiomas, about 80% arising within the cranial cavity. The histological classification used was that of Courville (1950) and Rubinstein (1972), but "angioblastic" meningiomas were segregated into 3 groups: highly vascularized meningiomas, hemangioblastomas, and hemangiopericytomas. Endotheliomatous and transitional forms constituted 85% of the total (71.5% of intracranial tumors), fibroblastic forms 6.6 and 7.5%, respectively, and highly vascularized (endotheliomatous or transitional) meningiomas 5.2% of the intracranial tumors, while true "angioblastic" meningiomas (hemangioblastomas and hemangiopericytomas) amounted to 2.8% of the total (3.1% of the intracranial tumors). 1.2% were "atypical" (so-called malignant) meningiomas; true meningeal sarcomas were excluded. The incidence of recurrence in patients surviving at least 5 years after apparently complete removal of the tumor was 13% for all sites, and 14.2% for intracranial tumors, but almost twice as high after partial removal. There were no significant differences in the recurrence rate and intervals between first and second operation according to the various histological subtypes of meningiomas, except for hemangiopericytomas which recurred with significantly higher frequency and, together with atypical meningiomas, at much shorter intervals than the others. The prognostic significance of some histological criteria in "non-angiomatous" meningiomas was examined in 211 patients surviving at least 5 years after apparently complete removal of the tumor. Among the recurrences, there was a significantly higher degree of cellularity and increased mitotic rate and, probably, of cortical invasion, while nuclear pleomorphism, increased vascularity, and focal necroses showed no definite differences. The presence of mitotic figures alone appeared to be of no prognostic value. While most recurrent meningiomas did not change their basic morphological type significantly, about 12.5% of the recurrences appeared to have a different rate of growth as suggested by increased cellularity and mitotic rates. In 2 cases an isomorphic (benign) meningioma became a true spindle cell sarcoma.
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Two cases of association of primary malignant cerebral non-Hodgkin's lymphoma with clinically silent meningiomas are reported. In one case, the malignant lymphoma of the left frontal lobe was diagnosed radiographically and the small parasagittal meningioma was detected at autopsy. In the other case, both CNS neoplasms, a parasagittal meningioma and a multifocal periventricular and brainstem lymphoma, were only detected at autopsy. In both cases, the small meningiomas were located at the cerebral convexity. The concurrence of the slowly growing meningiomas and the highly malignant cerebral lymphomas, seen in two among about 140 confirmed cases of primary CNS lymphomas, is probably coincidental. No other neoplasms were found outside of the CNS.