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Central nervous system atypical teratoid/rhabdoid tumors of infancy and childhood: definition of an entity.

Clinical and pathological features of 52 infants and children with atypical teratoid/rhabdoid tumor (ATT/RhT) of the central nervous system are defined. This tumor is typically misdiagnosed as a primitive neuroectodermal tumor (PNET) primarily because 70% of ATT/RhTs contain fields indistinguishable from classic PNETs. Separation of these two tumor types is crucial because the prognosis for ATT/RhT is given even when treatment includes surgery with or without radio and/or chemotherapy. These tumors are most common in infants less than 2 years of age. The cases described in this study arose in intracranially in all but one instance, although one-third had already spread throughout the subarachnoid space at presentation. Clinical signs and symptoms and radiological features do not distinguish ATT/RhTs from PNETs. The tumors are composed entirely (13%) or partly (77%) or rhabdoid cells. Seventy percent contains fields of typical PNET alone or in combinations with mesenchymal and/r epithelial elements. The immunohistochemical profile is unique: epithelial membrane antigen, vimentin, and smooth-muscle actin are positive in the majority of tumors and markers for germ-cell tumors are consistently negative. Abnormalities of chromosome 22 distinguish ATT/RhTs from PNETs, which typically display an i(17q) abnormality.

Antibodies↗

Ectopic expression of Par-4 leads to induction of apoptosis in CNS tumor cell lines.

Prostate apoptosis response-4 (Par-4) is a pro-apoptotic protein originally identified as a gene product upregulated in prostate tumor cells undergoing apoptosis. Down-regulation of Par-4 has been linked to several cancers. Since Par-4 also plays a crucial role in neuronal apoptosis, we investigated the expression of Par-4 in tumor cell lines derived from representative tumor types of the CNS, including primitive neuroectodermal tumor (PNET), medulloblastoma, neuroblastoma and glioma of human, rat and murine origin. We show that Par-4 is frequently down-regulated, either transcriptionally or post-transcriptionally in the CNS tumor cell lines. Moreover, we demonstrate that ectopic expression of Par-4 is sufficient to directly induce apoptosis in these CNS tumor cells, in contrast to other cancer cells where replenishment of Par-4 levels only sensitizes the cells to apoptotic stimuli. Induction of apoptosis by Par-4 in the neural tumor cell lines is independent of endogenous Bcl-2 levels and PKCzeta activity, although it has been proposed that Par-4 can exert its pro-apoptotic function by down-modulation of Bcl2 expression and inhibition of PKCzeta. Co-expression of Par-4 and a dominant-negative mutant of FADD resulted in a slight reduction of apoptosis in some tumor cell lines, indicating that Par-4 may partially induce apoptosis via the Fas death pathway. Furthermore, these data suggested that the pro-apoptotic function of Par-4 involves (an)other yet unidentified apoptotic pathway(s) in the CNS tumor cell lines. Since Par-4 by itself is not sufficient to induce apoptosis in non-tumor cells, reintroduction of Par-4 into primary CNS tumors or reactivation of the pathways of Par-4-mediated apoptosis represent promising targets in anti-tumor therapy.

Animals↗

Experimental evidence for a neural origin of Ewing's sarcoma of bone.

The histogenesis of Ewing's sarcoma remains unknown. Recent studies have suggested a relationship to an unusual form of childhood neural tumor, often termed peripheral neuroepithelioma or primitive neuroectodermal tumor. Five Ewing's sarcoma tumor cell lines were studied for evidence of a neural phenotype. Under normal culture conditions, no morphologic evidence of neural differentiation was detected. Treatment with retinoic acid, an agent known to induce marked neural differentiation in neuroblastoma, had no demonstrable effect. Treatment with either cyclic AMP or TPA, in contrast, induced pronounced morphologic evidence of neural differentiation. Cells developed elongate processes with varicosities by phase-contrast microscopy; filaments, microtubules, and uraniffin-positive dense core granules were present by electron microscopy. Three neural markers (NSE, NFTP, and cholinesterase) were absent or barely detectable in untreated cells, but became abundant after treatment. These results provide convincing evidence for a neural histogenesis of Ewing's sarcoma. They also suggest a close relationship between Ewing's sarcoma and peripheral neural tumors, including the chest wall tumor described by Askin, but only a distant relationship to neuroblastoma.

Adolescent↗

Predominant expression of human zic in cerebellar granule cell lineage and medulloblastoma.

Zic is a novel zinc finger protein which displays a highly restricted expression pattern in the adult and developing mouse cerebellum and is highly homologous to the recently cloned Drosophila pair-rule gene Opa. To clarify the mechanism for the development of the human cerebellum and its involvement in human nervous system diseases, we have isolated human Zic cDNA and examined its expression by using monoclonal antibody against recombinant Zic protein. The nucleotide sequence of human Zic cDNA is 85% homologous to that of mouse Zic cDNA. Its putative amino acid sequence is highly conserved (> 99%) except for substitution of only two amino acid residues. In situ chromosome hybridization localized the human Zic gene to chromosome band 3q24. Human Zic protein was immunohistochemically detected in the nuclei of the cerebellar granule cell lineage from the progenitor cells of the external germinal layer to the postmigrated cells of the internal granular layer. Furthermore, Zic protein was detected in medulloblastoma (26/29 cases), whereas no other tumors examined (over 70 cases including primitive neuroectodermal tumors) expressed this protein. These findings suggest that Zic is a potential biomarker for medulloblastoma as well as the human cerebellar granule cell lineage.

Adolescent↗

Small round-cell type of malignant peripheral nerve sheath tumor.

Five cases of primitive, small, round-cell tumor that are a type of hitherto unclassified neurogenic sarcoma are described. The tumors were located deep within the soft tissue of the trunks and limbs without association with major nerves. The histologic features consisted mainly of uniform, small, round, tumor cells with scanty cytoplasm. Foci of uniform, short, spindle-shaped tumor cells arranged in whorl-like patterns were observed in some areas. Although the immunoreactivity for the neural markers, Leu-7 and MIC-2, was not marked, cell processes and fragmentous basal laminae, which are ultrastructural neural features, were found in both spindle-shaped and round tumor cells. In four cases, EWS chimeric transcripts were analyzed by reverse-transcription polymerase chain reaction. EWS chimeric mRNA (EWS-FLI-1, EWS-ERG, EWS-E1AF, EWS-ETV1, EWS-FEV) was not detected in any cases. The tumors were not consistent with peripheral primitive neuroectodermal tumor. We propose them as a small round-cell type of MPNST that might differentiate toward the immature neural cells.

Adolescent↗

Intracranial hypertension as an initial manifestation of spinal neuroectodermal tumor.

A 19-year-old girl had headaches, blurred vision and vomiting for 2 weeks. Neurological examination revealed only bilateral papilloedema and left abducens palsy. Neuroimaging of the brain was normal. Cerebrospinal fluid study showed intracranial hypertension (IH), hypoglycorrhachia, hyperproteinorrhachia, and a negative cytology study. Eight months after the onset, paraparesis occurred. Spinal magnetic resonance imaging showed intramedullary masses at the cervical and thoracic cords with extensive seeding. Biopsy of the mass showed primitive neuroectodermal tumor (PNET). IH rarely occurs in patients with spinal cord neoplasms. Its incidence is low and the condition is always associated with signs of myelopathy. We report a patient whose initial manifestation of spinal PNET was IH only. Spinal tumor should be considered in IH patients whose intracranial examinations are negative.

Adult↗

Primary cutaneous pre-B lymphoblastic lymphoma immunohistologically mimics Ewing's sarcoma/primitive neuroectodermal tumor.

Precursor B-cell lymphoblastic lymphomas (B-LBLs) are rare and most often involve the skin in the head and neck region. Histologically, cutaneous B-LBLs may be confused with other small round-cell neoplasms. Moreover, half of B-LBL patients are negative for CD45 (leucocyte common antigen, LCA), a widely used marker for the diagnosis of lymphoma, and a significant portion express CD99, a marker for Ewing's sarcoma (ES) or primitive neuroectodermal tumor (PNET). Therefore, an extranodal B-LBL may be misinterpreted as PNET or ES. Here, we report on 2 boys, aged 10 and 5 years, with primary cutaneous B-LBL of the scalp. PNET was initially misdiagnosed because the tumor cells were negative for CD45 but strongly positive for CD99. Advanced stage of acute lymphoblastic leukemia (ALL) developed later and both patients died during the course of treatment for ALL. In retrospective analyses, tumor cells in the initial biopsy specimens of both patients were found to be reactive to terminal deoxynucleotidyl transferase (TdT), CD43 and CD10. Thus, the diagnosis of B-LBL was confirmed. These cases illustrate the possibility that primary cutaneous B-LBL may mimic ES or PNET immunophenotypically, and that correct diagnosis in doubtful cases may be facilitated by analysis using a complete panel of antibodies, particularly including TdT and CD43.

Antigens, CD↗

Expression of carcinoembryonic or related cross-reacting antigens in primary pediatric neuroectodermal brain tumors.

Various amounts of carcinoembryonic antigen (CEA) or cross-reacting antigen (CRA) were expressed in eight childhood primitive neuroectodermal tumors (PNETs) and in three of 12 astrocytomas (ASTR) using frozen section immunocytology. The antigen detection was performed using two recently developed anti-CEA monoclonal antibodies (MoABs), B.18.7.7 and D.14, reacting with a CEA specific antigenic epitope. Unfortunately, the two new MoABs also demonstrated cross-reactivity with nonspecific cross-reacting antigens (i.e., NCA-55) specific for the intratumoral granulocytes and cytotoxic mononuclear effector cell population. Three of eight PNETs contained 1 to 10% of CEA- or CRA-positive brain tumor cells. In two of eight, the antigenic epitopes were found in 10 to 50% of tumor cells, and in three of eight a large population (50 to 90%) of such cells was detected. Three pilocytic ASTRs contained CEA or CRA in 1 to 10% of cells. CEA or CRA positivity was located both on the cell surface and intracellularly in both tumor types. CEA or CRA expression in both tumor types was detectable only in fresh frozen sections and D.14 was preferable to B.18.7.7. The three pilocytic ASTRs lost CEA or CRA reactivity after formalin fixation and paraffin embedding. CEA-related cross-reacting antigen (NCA-55) was detected on the cell surfaces of tumor-infiltrating mononuclear cells, macrophages, neutrophilic granulocytes, and probably in some brain tumor cells also.

Adolescent↗

[Immunohistochemical and ultrastructural studies of intracranial immature teratoma--a comparative observation on neuroblastoma, PNET and ependymal tumor, with a special reference to rosette structures].

Immature teratoma occurs occasionally in the brain of children and contains a large amount of immature neuronal tissue. These primitive neuronal components are a good target for studying the morphology of primitive neuroectodermal tumors, including neuroblastoma, ependymoblastoma, medulloepithelioma and so on. Primitive neural tubes are immunohistochemically and ultrastructurally studied in two cases of primary immature teratoma of the child brains, compared to true rosettes in a case of neuroblastoma, primitive neural tube in the fetal rat brain (9 to 13 days of gestational age). The study also extends to the pathology of PNET. Ultrastructurally the primitive neural tube like structures in two teratomas were virtually identical those of developing fetal rat brains and true rosettes in a neuroblastoma. However, these tubular structures are different from each other in immunohistochemistry. These differences are considered to reflect the different developmental lineage of the tumor cells, that is, neuroblastoma produces only neuroblastic cells, and primitive neural tubes in teratoma both neuroblastic and glioblastic cells. Rejuvenation of neuroblastoma cells seems to render a VIM-positivity of the tumor cells.

Animals↗

Immunohistochemical analysis of neural cell adhesion molecules. Differential expression in small round cell tumors of childhood and adolescence.

The neural cell adhesion molecule (NCAM) was discovered in a search for cell surface antigens of chicken neurons that contribute to cell adhesion and pattern formation during development. Homologous adhesion molecules have been identified in several species, including humans. In this immunohistochemical study, the authors examine the role of human NCAM in tumor diagnosis. The authors used a monoclonal antibody (MAb), 5.1H11, to examine NCAM immunoreactivity in frozen sections of more than 450 tumors, including more than 80 small round cell tumors (SRCT) of childhood and adolescence (neuroblastomas, Ewing's sarcomas [ES], peripheral neuroepitheliomas [PN], primitive neuroectodermal tumors [PNET], esthesioneuroblastomas, malignant ectomesenchymoma, medulloblastomas, small cell osteosarcomas, mesenchymal chondrosarcomas, embryonal rhabdomyosarcomas, and lymphomas). The authors show that 1) neuroblastomas and primary brain tumors are NCAM+; 2) ES, most PN/PNETs, and melanomas are NCAM-; 3) embryonal rhabdomyosarcomas and various other sarcomas are NCAM+; 4) neuroendocrine tumors are NCAM+; 5) subsets of carcinomas of kidney, ovary, lung and other organs are NCAM+; and 6) lymphoid tumors are NCAM-. Tests with normal fetal and adult tissues indicate that these findings reflect only in part the NCAM phenotypes of corresponding normal tissues. Notably the NCAM- phenotype of ES and PN/PNET is not explained by current histogenetic models for these tumors, which suggest a primitive neuroectodermal origin. Finally the authors show that NCAM expression among SRCT has an inverse relationship with the expression of p30/32MIC2, a cell surface antigen of ES and PN/PNET detected with MAb HBA71. These results suggest that immunohistochemical assays for NCAM and p30/32MIC2 expression may aid in the further characterization of SRCT of childhood and adolescence.

Antibodies, Monoclonal↗

Efficacy of postoperative chemotherapy using cisplatin plus etoposide in young children with brain tumors.

Neuraxis radiation therapy (RT) for primary intracranial tumors is associated with major late effects if administered to very young children. To control residual tumor and to delay RT, we treated eight young children (median age 6.5 months) with primary central nervous system (CNS) tumors using combination chemotherapy: cisplatin, 20 mg/M2/day plus VP-16, 75 mg/M2/day i.v. for 5 days, given q. 3-6 weeks for 8 cycles. The tumors were medulloblastoma (one), malignant ependymoma (two), primitive neuroectodermal tumor PNET (two), malignant glioma (two), astrocytoma (one). Six had measurable disease; three had positive cerebrospinal fluid (CSF) cytopathology. All patients with measurable tumor had initial objective responses (three) complete response [CR], one partial response [PR], two minor response [MR], including cytopathology (three CR of three) and metastatic deposits (two CR of two). One patient relapsed during chemotherapy. Median time to disease progression was 17.5 months; median survival was 34 months. Three patients, none of whom received RT, have prolonged progression-free intervals of 47-67 months to date. Neurodevelopmental progress continued during and after chemotherapy. Chemotherapy toxicity was mild. Median neutrophil nadir was 312/mm3, platelets 72,000. Fever during neutropenia occurred in six of 61 courses. Moderate high-frequency auditory losses were detected in three patients, and mild renal injury (GFR less than 70 ml/min) was detected in two of seven evaluable children. This pilot study demonstrates the apparent efficacy and mild toxicity of 5 day courses of cisplatin plus VP-16, with delayed RT, in young children with CNS neoplasms. A POG treatment protocol that incorporates cisplatin plus VP-16 is evaluating primary chemotherapy with delayed radiotherapy in larger numbers of pediatric brain tumor patients.

Antineoplastic Combined Chemotherapy Protocols↗

Can the standardized uptake value characterize primary brain tumors on FDG-PET?

The aim of this study was to evaluate the usefulness of measuring the standardized uptake value (SUV) in primary brain tumors on fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) scans. Two groups of patients were studied. Whole-brain glucose cerebral metabolic rates (wCMRs) and SUVs were obtained in 20 normal subjects. Twenty-seven patients with histology-proven malignant primary CNS tumors (high-grade gliomas n=22, primitive neuroectodermal tumors n=3, ependymomas n=2) were also studied. The degree of FDG uptake was assessed by visual inspection and thereafter regions of interest were placed over the lesion, the contralateral cortex and white matter and the whole brain. Average (avg) and maximum (max) pixel values were determined in each site. Based on these measurements, SUV, tumor to cortex (T/C) and tumor to white matter (T/WM) activity ratios were calculated. There was no correlation between wCMRs (4.55+/-0.36 mg min(-1) 100 g(-1)) and wSUVs (5.41+/-0.43) in the normal subjects (r=0.18, P=0.45). In the second group, 17 lesions were described as definitely and seven as probably malignant. However, SUVs in these tumors and in the contralateral cortex were not significantly different. Although the SUVs were generally higher in the tumor than in the contralateral white matter, there was a significant overlap between the values. The range of the SUVs was wide: 2.54-11.8 for the tumors, 2.98-9.96 for the cortex and 1.87-6.76 for the white matter. SUVs in the normal cortex were negatively correlated with blood glucose level at the time of the injection. SUVs in the whole brain and in the cortex were lower in patients previously treated by irradiation, even months after completion of the treatment. No correlation was detectable between any of the SUVs and the age of the patients, tumor type, time post injection, use of dexamethasone, patient weight, dose injected and visual score. With cutoff levels of 1.5 for T max/WM and 0.6 for T max/C, the sensitivity of the activity ratios was 74% and 96% respectively. In conclusion, SUVs do not correlate with CMRs across subjects and appear to be of limited value in characterizing brain tumors. Visual assessment and measurement of the activity ratios currently remain the most reliable methods of analysis.

Adult↗

Neurotrophins and neuronal versus glial differentiation in medulloblastomas and other pediatric brain tumors.

Medulloblastomas are highly malignant and poorly understood childhood neoplasms. To determine if neurotrophins might influence the phenotypic properties of medulloblastoma in a paracrine or autocrine manner, 51 pediatric brain tumors including 20 biopsy specimens of these primitive neuroectodermal tumors (PNETs) and 31 other pediatric brain tumors were studied. Immunohistochemistry was used with antibodies to nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and NT-3, their cognate high affinity receptors as well as to neuronal and glial markers. TrkA, TrkB, and TrkC were observed in 5 (25%), 8 (40%), and 17 (85%), respectively, of these medulloblastomas while NGF, BDNF, and NT-3 were observed in 6 (30%), 8 (40%), and 3 (15%), respectively, and antibodies to neurofilament (NF) and glial fibrillary acidic proteins (GFAP) stained 16 (80%) and 11 (55%), respectively. TrkA and NGF were not observed in the same biopsy samples, while TrkB and BDNF were co-distributed in 6 of the cases, all of which expressed NF proteins. TrkC and NT-3 were co-distributed in 3 of the medulloblastomas, and these areas overlapped with NF protein-positive tumor cells in all 3 cases. In contrast to medulloblastomas, TrkA and NGF co-distributed in other pediatric brain tumors, and both Trk receptors and their neurotrophins co-distributed with GFAP-positive tumor cells in 13 (42%) of the non-PNET pediatric brain tumors. The absence of medulloblastomas that contain NGF and TrkA is consistent with in vitro data demonstrating that NGF-mediated TrkA signaling induces apoptosis. Finally, this study also suggests that BDNF and NT-3 may act in a paracrine or autocrine manner through TrkB and TrkC receptors, respectively, to induce neuronal differentiation in medulloblastomas.

Adolescent↗

Expression of anaplastic lymphoma kinase in soft tissue tumors: an immunohistochemical and molecular study of 249 cases.

Although anaplastic lymphoma kinase (ALK) has been considered a diagnostic marker specifying a subset of anaplastic large cell lymphomas and inflammatory myofibroblastic tumors (IMTs), the existence of this receptor in some other mesenchymal malignancies has been recently reported. We examined a wider variety of soft tissue tumors to further advance the survey of ALK status in mesenchymal lesions. ALK protein expression was evaluated immunohistochemically with 2 specific antibodies (ALK1 and 5A4) in 249 benign and malignant soft tissue tumors, and the expression of ALK transcripts and 8 types of ALK fusion transcripts was assessed using reverse transcription-polymerase chain reaction (RT-PCR) in 165 and 100 tumors, respectively. Moreover, ALK gene status was analyzed by interphase fluorescence in situ hybridization (FISH) in 17 tumors with ALK expression. Immunohistochemically, ALK protein was detected in 69 cases (28%), including IMTs (4 of 4), rhabdomyosarcomas (4 of 7), various lipogenic tumors (35 of 65), Ewing's sarcoma/peripheral primitive neuroectodermal tumors (6 of 10), malignant fibrous histiocytomas (8 of 37), leiomyosarcomas (3 of 18), and other non-IMT tumors (9 of 108); however, most of these, except the IMTs, displayed merely low-level expression. Although ALK transcripts were identified in 85 (52%) of the 165 cases examined by RT-PCR, the full-length (wild-type) ALK, rather than the truncated or chimeric forms detected in IMTs, predominated in most non-IMT tumors. Except for 2 IMTs, all cases with the expression of ALK messages displayed no detectable ALK fusion transcripts. More than 67% of the cases analyzed by both RT-PCR and immunohistochemical assays demonstrated concordant results. ALK gene amplification was found in 4 non-IMT tumors (2 leiomyosarcomas and 1 case each of rhadomyosarcoma and malignant fibrous histiocytoma) analyzed by FISH, and the rearrangement of this gene was identified in 2 IMTs. The current data expands the variety of non-IMT soft tissue tumors with ALK expression, and warrants further investigation of its underlying molecular mechanisms.

Anaplastic Lymphoma Kinase↗

Secretion of gastrin-releasing peptide by retroperitoneal tumors.

PURPOSE: Gastrin-releasing peptide (GRP) is a neuropeptide with growth factor activity in vitro for a variety of tumors including neuroblastoma. If GRP is secreted by neuroblastomas, its detection in serum might be an excellent way to both diagnose and monitor this tumor in patients. METHODS: Small portions of resected tumor specimens were maintained in tissue culture as tumor explants for 24 hours. The tumors included: 3 ganglioneuromas, 1 neuroblastoma, 1 primitive neuroectodermal tumor, 1 Wilms' tumor, 1 rhabdoid tumor, and 1 benign brachial plexus tumor. Control flasks were maintained simultaneously under identical conditions. After 24 hours of incubation, the tumor-conditioned media and the control media were assayed in duplicate for [GRP] using a radioimmunoassay. RESULTS: All the conditioned media from the benign tumors contained < 25 pg/mL net GRP, whereas all the malignant tumor-conditioned media contained > or = 45 pg/mL (P = 0.003). CONCLUSIONS: These data suggest that GRP is secreted by pediatric retroperitoneal tumors and that the amount secreted varies directly with the degree of malignancy of the tumor. This study suggests that GRP may be a candidate tumor marker for pediatric retroperitoneal tumors.

Biomarkers, Tumor↗

Gains and losses of DNA sequences in childhood brain tumors analyzed by comparative genomic hybridization.

Primary central nervous system neoplasms are the most common solid tumors in children. Genetic changes underlying childhood brain-tumor development and progression are incompletely characterized. To get an overview of the genetic events leading to the development of brain tumors and to identify chromosomal regions that may contain genes important in brain-tumor progression, we employed a comparative genomic hybridization technique. Twenty-four pediatric primary brain tumors were analyzed in this study. DNA copy number changes were observed in most of the samples (79%), and almost all chromosomes were involved. The total number of genetic aberrations (copy-number gains and losses per tumor) was significantly higher in the cerebellar primitive neuroectodermal tumor subgroup than in the gliomas. The high-grade tumors had more DNA changes than did the low-grade tumors. The most often gained chromosomes were: 6q (45%), 4q (34.5%), and chromosome 1 (24% of the cases). The minimal common regions involved in DNA gains were narrowed down to 6q14-16 and 4q26-28. Losses of a specific chromosome (partly or as a whole) occurred on average in 7% of the cases. Chromosomal regions that were most often lost included chromosome 1 (17%), chromosome 16 (17%), and chromosome 2 (14%). These findings suggest that genes localized to these minimal common chromosomal regions play a role in the tumorogenesis of childhood brain tumors. Our results indicate: (1) a great degree of genomic imbalance in these tumors; (2) that a high number of aberrations correlate with aggressive tumor biology; (3) and that nonrandom genetic changes may be associated with particular tumor types.

Adolescent↗

Apparent diffusion coefficient of human brain tumors at MR imaging.

PURPOSE: To determine if apparent diffusion coefficient (ADC) can be used to differentiate brain tumors at magnetic resonance (MR) imaging. MATERIALS AND METHODS: Institutional review board approval or informed patient consent was not required. MR images were reviewed retrospectively in 275 patients with brain tumors: 147 males and 128 females 1-81 years old, treated between September 1997 and July 2003. Regions of interest were placed manually in tumor regions on MR images, and ADC was calculated with a five-point regression method at b values of 0, 250, 500, 750, and 1000 sec/mm2. ADC values were average values in tumor. All brain tumor subgroups were analyzed. Logistic discriminant analysis was performed by using ADC, age, and patient sex as independent variables to discriminate among tumor groups. RESULTS: A significant negative correlation existed between ADC and astrocytic tumors of World Health Organization grades 2-4 (grade 2 vs grades 3 and 4, accuracy of 91.3% [P < .01]; grade 3 vs 4, accuracy of 82.4% [P < .01]). ADC of dysembryoplastic neuroepithelial tumors (DNTs) was higher than that of astrocytic grade 2 tumors (accuracy, 100%) and other glioneuronal tumors. ADC of malignant lymphomas was lower than that of glioblastomas and metastatic tumors (accuracy, 83.6%; P < .01). ADC of primitive neuroectodermal tumors (PNETs) was lower than that of ependymomas (accuracy, 100%). ADC of meningiomas was lower than that of schwannomas (accuracy, 92.4%; P < .01). ADC of craniopharyngiomas was higher than that of pituitary adenomas (accuracy, 85.2%; P < .05). ADC of epidermoid tumors was lower than that of chordomas (accuracy, 100%). In meningiomas, ADC was not indicative of malignancy grade or histologic subtype. CONCLUSION: ADC is useful for differentiation of some human brain tumors, particularly DNT, malignant lymphomas versus glioblastomas and metastatic tumors, and ependymomas versus PNETs.

Adolescent↗

Brain tumors in the first two years of life: a review of forty cases.

From 1962 to 1989, 40 infants with brain tumors and less than 2 years old were treated at the Department of Neurology of the Clinical Hospital of the University of São Paulo Medical School. The clinical and neuropathological findings were reviewed as to histological diagnosis, age, sex, signs and symptoms, therapy and outcome. Medulloblastoma was the most common histological type (n = 11), followed by ependymoma (n = 9), choroid plexus tumor (n = 6), astrocytoma (n = 3) and primitive neuroectodermal tumor (n = 2). The tumor was infratentorial in 21 infants, supratentorial in 18 and disseminated in 1.

Adolescent↗