Biomedical subjects
Publications and source records attributed to P Celli.
Although a dural tail has been described in association with meningiomas and, rarely, with other tumors in MR imaging with Gd-DPTA. Recently, a pituitary lesion was evaluated by MRI and presented a tail. For this reason the lesion was thought to be a meningioma of the tuberculum sellae, but at surgery proved to be an adenoma.
A retrospective review of 603 cases of intradural benign tumors of the cauda equina are presented (283 schwannomas and 320 ependymomas). For each tumor, the clinical course and long-term postoperative results were analyzed: it emerged that differential diagnosis between neurinomas and non tumoral lesions is not possible if based on clinical findings alone and that neuroradiological diagnosis is more accurate when MRI is employed. Long-term prognosis of neurinomas was always favourable, while in the ependymomas, early diagnosis gives excellent results because prognosis is apparently directly correlated to the length of preoperative clinical history.
A series of 72 severely head injured patients are reported, 24 (33%) with surgical intracranial hematomas. All patients were intensively cared for under the same therapeutic regime; intracranial pressure (ICP) was monitored and treated if increased. The series mortality was 39%. Uncontrollable increase of ICP (UI-ICP), always fatal, was observed in 18% of patients and in 13 of 28 deaths (46%); the incidence of UI-ICP among deaths was higher in patients less than in those more than 40 years old (55% vs 25%). Patients with UI-ICP were frequently deeply comatose and with arterial hypotension on admission; almost all died in the first days. Patients directly admitted from the scene with well staffed Life Flight Helicopter Emergency Care compared with those directly admitted from the scene with different type of ambulance service (paramedics, police, firemen and private) had a mortality rate significantly less (20% vs 54%) and an incidence of UI-ICP strongly lower both among patients (5% vs 29%) and among deaths (25% vs 54%). Thus in this small series intensive care after admission was not effective to obtain good results if patients had received poor preadmission emergency care. Review of the literature on main clinical predictors of outcome in severe head injury, have made possible some observations. Ischemic and intracranial hypertension brain lesions were generally present in patients killed by head trauma; while diffuse axonal injury, frequently responsible for vegetative, severe disability survival and late deaths, was observed only in 20-30% of postmortem examinations. Old age, poor neurological status and cardiocirculatory and respiratory disturbances prior to and upon admission positively worsened the outcome, while intracranial hematomas had a more variable predictive value. Intracranial hypertension was a definitively ominous predictor only if very high when the risk to be or become uncontrollable seems to be much elevated. UI-ICP, often fatal despite any aggressive therapy, was the single most frequent killer after severe head injury, responsible for about half of all deaths after admission. The different outcome among severe head injury series could be conceivably related to a different frequency of UI-ICP. Besides the severity of head injury and delay and mode of admission, we suggest that preadmission respiratory and cardiocirculatory and the quality of emergency medical system could strongly affect the incidence of uncontrollable increase of ICP in admitted patients and thus the mortality rate and favorable recovery of the series. The advanced preadmission emergency care service with intensive care after admission could significantly explain the better results often observed in severe head injury series.
BACKGROUND AND PURPOSE: We present a rare case of desmoplastic fibroma of the skull. Desmoplastic fibroma is a distinctive and rare neoplasm of bone that histologically and biologically mimics desmoid soft tissue tumor. Only 6 cases have been reported in the skull and none of these was diagnosed by MRI. CLINICAL PRESENTATION: A 64 year-old woman, operated on in June 1991 for left mastectomy due to a ductal adenocarcinoma and again in October 1994 for a left frontal metastatic adenocarcinoma, was admitted in our Department of Neurosurgery because a control cerebral MRI had detected a diploic lesion, isointense on T1-weighted images and hyperintense on T2, with moderate enhancement, localized in a right parietal site. Neurological examination was negative. The lesion was surgically removed and a cranioplasty was performed. Histological diagnosis was desmoplastic fibroma. Twelve months after treatment she has no neurological symptoms or signs of cerebral lesions (MRI) or systemic metastasis (total body CT). CONCLUSION: In the literature the number of desmoplastic fibroma is too small and the follow-up period too short to permit any conclusions regarding the aggressiveness of the tumor.
A cytogenetic analysis was performed on short-term cultures of 43 previously untreated childhood central nervous system neoplasms of various histology. The cells were obtained from pediatric patients, none of whom had received therapy before karyotypic evaluation. Successful chromosome studies were performed on 24 tumors. The most commonly detected structural abnormalities involved chromosomes 1 and 17. Other structural chromosome abnormalities involved chromosomes 3, 6, 8, 9, 11, 12, and 20.
The authors describe 3 cases of cerebral pleomorphic xanthoastrocytoma, one of which has an unusual neuroradiological appearance, and review the clinical and prognostic features of the 96 cases reported in the literature. Pleomorphic xanthoastrocytoma is a neuroectodermal tumor that affects young patients, in a superficial or supratentorial site, most frequently at the temporal level. It is difficult to formulate a differential diagnosis with other neuroectodermal tumors or with meningioma on the basis et neuroradiological appearance, as demonstrated by one of the cases reported here. The prognosis of this tumor is very good, regardless of the type of treatment performed, although both relapse and, more rarely, malignant tumor evolution are possible.
The authors report their results in a retrospective study of 6 cases of gliosarcoma. In 3 cases gliosarcoma presented features similar to those of glioblastoma, both at CT scan and macroscopically; in the other 3 cases they resembled meningioma. Average survival varied considerably and was correlatable to the CT features of the lesion (14 months for glioblastoma, 7 for meningioma). It seems likely that patients who have gliosarcoma with CT features suggestive of meningioma may have prolonged survival.
The authors present a case of post-traumatic intracranial meningioma, selected according to the criteria specified in the relevant literature. Assessment of the clinical characteristics of our patient and those reported in the literature seems to confirm that, in some cases, head trauma may be a factor contributing to the development of meningioma.
The authors describe 2 cases of purely epithelioid schwannomas, one spinal the other peripheral. At surgery, the spinal schwannoma appeared as an orange-sized, solid, brown mass. Total removal of the tumor was performed. The peripheral schwannoma appeared as a fusiform, brown, movable mass in the sensitive branch of the left tibial nerve and was removed by a wide en bloc excision. Intraoperative nerve action potentials were performed both prior to and following excision of the lesion. Histologically, the tumors were composed of round or polygonal cells arranged in necrotic clusters and anastomosing cords. There were areas of spindle cells. The epithelioid cells were round to oval with abundant cytoplasm. Mitoses were frequent (3 out of 10 in high-power field). S100 protein immunoreactivity was present diffusely in tumor cells (both nuclear and cytoplasmic), whereas cytokeratin, NSE, and anti-melanoma reactions gave negative results. After a long follow-up, the neurological condition of the patients is excellent and there are no signs of either recurrence or metastasis. The therapeutic management of epithelioid schwannoma is discussed.
We describe the case of a young man who, despite the presence of a tumour in the left sensorimotor cortex, exhibited no motor deficit. Integrated MRI/SPECT-CBF study during motor activation was aimed at determining which cerebral areas were involved in movement execution in this patient and their relationship with the tumour. CBF changes during motor activation were located in two motor areas: anteriorly and medially to the tumour in the left frontal lobe (+29%) and in the right medial frontal cortex (+43%). Integrated MRI/SPECT images provided both an anatomical and functional definition of the motor areas in a patient with a rolandic tumour and could prove useful in determining preoperatively an appropriate surgical strategy.
The authors report 5 cases of spinal tumor associated with subarachnoid hemorrhage. Histologically, the tumor was an ependymoma in 2 cases, a neurinoma in 2 cases and a hemangioblastoma in 1 case. The pathogenetic and diagnostic characteristics of these 5 cases are analyzed in the light of other published reports.
Ependymoblastoma is a malignant rarely reported neuroectodermal tumor. The authors describe a further case of cerebral ependymoblastoma and examine the clinical-prognostic aspects of this tumor in the light of the published data.
Two cases of intradural cavernous angioma of the cauda equina are reported, one of which presented with symptoms of subarachnoid hemorrhage. The clinical and therapeutic aspects of intradural angiomas, in particular those of the cauda equina, are discussed.
We report a case of association of a brain tumor with multiple colorectal polyposis and offer an analysis of the relevant literature with a view to revising the classification of the syndrome in relation to familial multiple polyposis and Gardner's syndrome. Differences emerged, depending on the brain tumor type, which suggests that this association may be classified as two distinct syndromes.
Reporting two cases of cavernous angioma closely associated with oligo-astrocytoma we were stimulated to revise the proper use of the term "angioglioma", introduced by Councilman 80 years ago7. In the past this term was often used in a merely descriptive sense i.e. either to give a name to an exceptional coincidence of AVM and glioma or simply to describe a hypervascularized glioma. Today, according to the majority of authors, such a use of this term has to be rejected as inappropriate. Occasionally however the term angioglioma has been used to designate a true mixed composite neoplasm developed after the transformation of both glial and angiogenic elements determined by simultaneously or consecutively acting (even possibly intermingled) oncogenic factors. Among reported cases claimed to be examples of "true" angioglioma, the association cavernomaoligodendroglioma/astrocytoma seems the most intriguing besides being also the most frequent one. Opinions about this topic however did continue to be unequivocal. While some authors regarded the oligodendroglial proliferation associated with AVM as merely reactive or malformative, others considered it as truly neoplastic putting forward the hypothesis of a common viral or genetic aetiology for both AVM and glioma.
The authors report a retrospective study of 15 patients with solitary vertebral plasmacytoma. 15 patients were considered in this study on the basis of the following characteristics: 1) histologically confirmed plasmacytoma following surgical removal; 2) existence of a single vertebral lesion, documented by skeletal and MRI scan; 3) no signs, at diagnosis of disseminated disease by blood laboratory test, urine analysis, sternal puncture, iliac bone marrow biopsy, a total-body CT scan. The clinical course of the patients has been analysed on the basis of the following factors: age, sex, length of clinical history before diagnosis, site, presence/absence of the M component. The M component is an electrophoretically homogeneous immunoglobin. The most significant factors for predicting development of multiple myeloma proved to be the presence /absence of the M component at diagnosis and, to a lesser degree, the age of the patient. In the light of other reports too, it would seem that the presence of the M component at diagnosis is a reflection of aggressive biological and clinical tumour behaviour.
Malignant peripheral nerve sheath spinal tumours are relatively rare. A primary spinal location at onset from the nerve roots is rarely reported in the literature, thus the clinical features and therapeutic results of these spinal malignant tumours are not defined. Six cases of malignant primary spinal schwannomas, 2% of 293 spinal schwannomas operated on in a 38 year period, are reported. Based on an analysis of a limited number of cases, ours and those collected from the literature (21 patients), some suggestions are possible: a) pre-operative clinical presentation and imaging studies are not predictive of malignancy; b) postoperative outcome is poor, especially in patients with von Recklinghausen's disease and after partial removal of the tumour; c) local recurrence and metastases are possible, even after radical surgery and radiotherapy.
A retrospective review of 106 cases of intradural tumors of the cauda equina are presented, subdivided into 5 groups according to their histological characteristics. For each group the clinical course and long-term postoperative results were analyzed: it emerged that differential diagnosis between neurinomas, meningiomas or non-tumoral lesions is not possible based on clinical findings alone and that neuroradiological diagnosis is more accurate when MRI is employed. Long-term prognosis was always favorable with the exception of the group of ependymomas. Nevertheless, early diagnosis in the latter group of tumors gives excellent results because prognosis is apparently directly correlated to the length of preoperative clinical history.