Multiple, primary multifocal brain astrocytoma. Case report.
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In the present study, the "8 drugs in 1 day" regimen was tested in 54 children: 27 relapses (brain and/or spinal and/or meningeal sites), 10 refractory progressive diseases, 13 macroscopic residual tumors after partial excision and/or radiotherapy; in 4 cases, this regimen was prescribed as first line treatment. The response rate (complete and partial remission) was 46%. Results were very encouraging in medalloblastomas with a response rate of 76.5% whereas in brain stem gliomas it was only 23% and 33% in other astrocytomas. Immediate toxicity, mainly hematological, was very moderate. These results justify to propose this regimen as adjuvant chemotherapy, mostly in medulloblastomas and to plan other similar trials, using the most active drugs which seem presently to be alkylating and platinum-derived agents.
Thirty-six cases of primary itracranial neoplasm in children (over 1 year but under 13 years of age) seen at the university medical center between 1951 and 1982 were reviewed because of concern as to the results and after-effects of applied therapy. The overall 5-year actuarial survival rate was 17%. Several factors of possible prognostic relevance, such as patient's age, intracranial location of the tumor, application or non-application of therapy, single or multiple modes of therapy, and extent of surgery, were analyzed. Completeness of surgical removal of the tumor proved to be the only statistically significant factor that correlated with survival. There was only one recorded case of severe learning disability and abnormal neuropsychologic development among the 12 living patients. The influence of patient's age (and technical factors) at the time of irradiation in correlation with the child's subsequent posttreatment functional performance, as reported in the literature, is reviewed.
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The normal range of glucose-phosphate-isomerase (GPI) in the plasma of children during the first month of life is up to 80 U/l; until the end of the second year of life between 11 and 50 U/l; thereafter the upper limit is 46 U/l. In osteogenic sarcoma or medulloblastoma there is a good correlation between activity of GPI in plasma and clinical tumor stage. In a lot of other tumors sensitivity of this enzyme is either very low as in Ewing-sarcoma or myeloic leukemia or there is no consistent relation to the extent of the tumor. High activities of GPI are equally obtained in children suffering from cystic fibrosis, diabetes mellitus or muscular dystrophy. GPI is not valid as a tumor marker even being raised in sarcoma and medulloblastoma as mentioned. So it is not necessary to check GPI activity as a part of routine enzyme chemistry.
The authors used a new noninvasive method, decimeter radiothermometry, to measure cerebrocranial temperature in 68 patients with brain tumors. It made it possible to study the mean temperature of a tissue layer situated at a depth of 3-5 cm from the surface to an accuracy of up to +/- 0.1 degrees C. Temperature anomaly at the site of the tumor projection was revealed in three fourths of cases, mainly when it was localized laterally. Cerebrocranial temperature was compared with the morphological structure of the tumor. The diagnostic value of the method in tumors of the brain is demonstrated.
A case of a primary intracerebral lymphoma, presenting with posterior uveitis, is reported together with its stepwise diagnostic approach. Various aspects of the diagnostic and therapeutic problems with these malignant tumours are discussed. The importance of indirect techniques for achievement of the diagnosis is emphasized.
Immunostaining patterns of two glia-associated proteins, glial fibrillary acidic protein (GFAP) and S-100 protein (S100P), were compared using the peroxidase-antiperoxidase (PAP) method on adjacent paraffin sections in 100 brain tumors including 52 astroglial tumors, 13 oligodendrogliomas, 14 ependymomas, 13 choroid plexus papillomas and 8 medulloblastomas. Most astroglial tumors showed similar immunoreactivity for both proteins. Fibrillary processes, however, showed a stronger and more crisp staining with anti-GFAP than with anti-S100P, whereas cell nuclei were labeled only for S100P. Focal dissociation of immunoreactivities for the two proteins was prominent in several malignant astroglial tumors including giant cell glioblastoma, and in subependymal giant cell astrocytoma. In oligodendrogliomas, GFAP-positive neoplastic oligodendrocytes also showed immunoreactivity for S100P; a smaller number of tumor cells were immunoreactive only for S100P, comparable to normal mature oligodendroglia. Most ependymomas were characterized by a similar distribution of cells immunoreactive for both proteins. In choroid plexus papilloma, absent or only focal immunoreactivity for GFAP contrasted with diffuse labeling for S100P in all cases; this seems of value for a differential diagnosis of papillary CNS tumors. In medulloblastoma, some tumor cells of a classical type were immunoreactive only for S100P; on the contrary, GFAP positive tumor cells with sparse or absent immunoreactivity for S100P were found in desmoplastic medulloblastomas. Similar immunoreactivities for both proteins in most tumors suggest a generally parallel production of both proteins by glial tumor cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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The authors report of 3 observations of the familiar incidence of the central nervous system neoplasms. In the first case it was brain astrocytoma in 2 brothers, in the second case is was man with the meningioma of falx cerebri and his sister with capillary hemangioma of the cerebellum, in the third case it was a woman with astrocytoma of the left temporal lobe and her brother with medulloblastoma. The authors are of the opinion that it was only coincidence in all three cases.
In the course of only three years we studied three children, who presented for a long time with failure to thrive as the only symptom of an intracranial tumour. Up to 24 months elapsed from the first manifestation at the age of four, ten and eleven months to the final diagnosis. A suprasellar tumour was discovered once, an infratentorial one twice. In spite of lower caloric intake a more rapid weight gain was documented after neurosurgery. The intracranial tumour is an important part of differential diagnosis in infants and young children not thriving satisfactorily.
This report presents three cases of primary intracranial germ cell tumor encountered in unusual sites, or essentially non-midline structures. The three provided the opportunity to examine surgically obtained tissues with the electron microscope. The histological diagnosis was initially made by light microscopic observations. The first case was a 10-year-old boy in whom the tumor occupied the right thalamic and basal ganglionic region and was diagnosed as a yolk sac tumor. The second an 11-year-old boy who presented with a mass lesion on the left thalamic and basal ganglionic region, diagnosed as germinoma. The third was a 39-year-old man who presented with multiple tumors in the ventricular system and posterior fossa, also diagnosed as germinoma. Among the three cases, neither diabetes insipidus nor ophthalmologic disorder was manifested. Extensive examination and autopsy findings indicated that these intracranial lesions had not metastasized from primary extracranial tumors, including those of the genital organs.
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CT and MR imaging have revolutionized diagnostic medical imaging. MR scanning in particular is the method of choice to evaluate the CP angle lesion or other posterior fossa lesion. With CT pneumocisternography, neurovascular structures of the internal auditory canal and lesions can be visualized. Experience indicates that MR scanning will replace CT.
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