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PubMed1997

Pediatric leptomeningeal metastases: outcome following combined therapy.

Fifteen children ranging in age from 4 to 18 years with leptomeningeal metastases were evaluated for extent of tumor and treated with radiotherapy or chemotherapy. Histologic diagnosis included: acute lymphoblastic leukemia (4); anaplastic astrocytoma (1); ependymoma (2); nonseminomatous germ cell tumor (1); non-Hodgkin's lymphoma (1); pineoblastoma (1); and primitive neuroectodermal tumor not otherwise specified (2). Pretreatment imaging studies demonstrated recurrent intracranial parenchymal disease in nine, spinal disease in four, and abnormal radioisotope ventriculography in six. Systemic disease was seen in four children (3 leukemia; 1 non-Hodgkin's lymphoma). All children were treated with systemic chemotherapy and intraventricular chemotherapy. Nine children received radiotherapy to bulky or symptomatic leptomeningeal disease. Median survival was 6 months (range, 4-18 months). Children with hematologic malignancies had superior outcomes compared to children with solid tumors. Three children with leukemic or lymphomatous meningitis are alive and disease free whereas all children with carcinomatous meningitis died. In conclusion, leptomeningeal metastases in children portends a limited survival, and therapies at this time remain palliative except in children with hematologic malignancies.

Adolescent↗
PubMed1993

Posterior dural arteriovenous malformation and medulloblastoma in an infant: case report.

A newborn is described who presented with heart failure from a posterior dural arteriovenous malformation and had a coexisting congenital medulloblastoma. There have been sporadic reports of arteriovenous malformation and brain neoplasms in older children and adults, and these have generally been glial tumors. This is the first known case of a combined congenital primitive neuroectodermal tumor and arteriovenous malformation in an infant.

Cerebellar Neoplasms↗
PubMed1985

[Brain tumor induced in dogs by intracerebral inoculation of SR-RSV induced cultured tumor cells--electron microscopic study].

An experimental transplantable canine brain tumor model with the advantages of rapid tumor growth within 10 days and relative safety for the investigator is presently available. The tumor is produced by intracerebral inoculation of cultured cells derived from a canine brain tumor induced by the Schmidt-Ruppin strain of the Rous-Sarcoma virus (SR-RSV). It has potential use as a model in experiments designed to evaluate the effectiveness of chemotherapy and radiotherapy with serial computerized tomography scans. However, characterization of the induced tumor is essential. Ideally, it should have features attributable to glioma and/or neuroectodermal tumors. Utilizing the technique of intracerebral inoculation of cells cultured from the original dog brain tumor induced by SR-RSV, Salcman et al identified the tumor they induced in brains of mongrel puppies as a glioma by light microscopic criteria (Reference). The purpose of our study was to further characterize this experimental tumor by electron microscopic and immunohistochemical techniques. Tumor was induced in 6 mongrel puppies. Stains of the tumor for immunohistochemical reactivity to glial fibrillary acid protein, S-100 protein and 210K neurofilament protein were all negative. With the electron microscope, the intracerebral tumor cells were mostly undifferentiated. They had a few cell processes, occasional punctate adhesions and some microvilli-like structure. The tumor cell nucleus was usually oval shaped and sometimes had nuclear indentations. The cytoplasm contained abundant free ribosomes, some rough endoplasmic reticulum and mitochondria. Collagen fibers and basal lamina were not observed in the intercellular spaces. The capillaries within the tumor were characterized by proliferation of immature endothelial cells which were non-fenestrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1998

Fine-needle aspiration cytology of extraskeletal Ewing's sarcoma.

Extraskeletal Ewing's sarcoma (EES) is a round-cell malignancy that manifests most commonly in the paravertebral and intercostal regions. It occurs predominantly in adolescents and young adults, between the ages of 10 and 30 yr, and follows an aggressive course with a high recurrence rate. Distant metastasis is also common. The tumor is often confused with other round, small-cell neoplasms, including primitive neuroectodermal tumor, neuroblastoma, embryonal rhabdomyosarcoma, and lymphoma. This report pertains to a fine-needle aspiration cytologic diagnosis of EES, supported by clinicopathologic and fine structural correlations in a 56-yr-old man who presented with a rapidly growing, massive, right groin mass. The smears showed a diffuse cellular population of malignant round cells composed of two types: one group of larger cell exhibiting a thin-rim, pale cytoplasm, less hyperchromatic nuclei, nucleoli, and diffusely dispersed chromatinic nuclear details; and the second group of smaller and darker cells with highly hyperchromatic and almost smudged nuclei. These are chief cells and dark cells, respectively. Special studies revealed significant intracytoplasmic glycogen and positive vimentin and HBA-71 immunostaining. Cytogenetic findings of chromosomal 11;22 translocation is also supportive of the diagnosis of EES.

Antigens, Neoplasm↗
PubMed2001

Cloning and tissue-specific gene expression studies with Dlxin-1, a newly identified transcriptional activator.

Dlxin-1, a unique member of the necdin/melanoma associated antigen gene (MAGE) family, is a novel protein that binds Dlxin-5 and regulates its transcriptional function. We have cloned the homology region between Dlxin-1 and necdin from mouse melanoma cells. Here we report the expression cloning, characterization, and detailed tissue-specific expression studies of Dlxin-1. A unique expression pattern of Dlxin-1 emerged from the work wherein strong expression of a 3.2-Kb transcript was observed in mouse brain and embryos. Amongst the representative established cell lines of different tumor categories studied the presence of transcript was detected only in sarcomas and neuroectodermal tumors. Characteristically, lymphomas, leukaemias, adenocarcinomas, and carcinomas did not express Dlxin-1. Also, we observed a growth suppression on ectopic expression of this cDNA possibly due to the close homology shared with necdin, a neuron-specific growth suppressor. The extensive homology of our Dlxin-1 clone to necdin makes it an attractive system to understand the importance of the necdin/MAGE family of molecules in cell cycle regulation.

3T3 Cells↗
PubMed1994

Mediastinal tumors in children: experience with 196 cases.

BACKGROUND: Mediastinal masses are relatively common in infants and children. These lesions are often neoplastic in origin and have a high risk of malignancy. METHODS: This report concerns 196 infants and children with mediastinal tumors. Fifty-five cases (28%) were benign, and 141 (72%) were malignant. Diagnosis included Hodgkin's disease (47), neuroblastoma (46), non-Hodgkin's lymphoma (37), teratoma (18), ganglioneuroma (14), cystic hygroma (11), Schwannoma (five), germ-cell tumors (three), lipoma (three), thymic tumor (three), malignant histiocytosis (two), neurofibroma (two), mesenchymal sarcoma (one), rhabdomyosarcoma (one), peripheral neuroectodermal tumor (one), hamartoma (one), and hemangioma (one). Diagnoses were usually made by assessing the patient's age, radiologic evidence of tumor location, the presence of calcium in the tumor, and the presence of tumor markers (alpha-fetoprotein, vanillmandelic acid, human chorionic gonadotropin). Diagnoses were verified by histologic evaluation. Resection was the only treatment for benign tumors. Biopsy and chemotherapy (and/or radiation) were employed for lymphoid tumors, and resection and adjuvant therapy were used for other solid malignancies. RESULTS: Survival was achieved in 53 of 55 (96.3%) patients with benign tumors and 105 of 141 (74.4%) patients with malignant tumors. CONCLUSIONS: Seventy-two percent of mediastinal tumors in this study were malignant. Early diagnosis followed by biopsy and chemotherapy for lymphoid tumors or resection of nonlymphoid tumors along with aggressive adjuvant therapy result in high survival rates (74.4%). Children with benign tumors almost always survive (96.3%) after resection.

Adolescent↗
PubMed1995

The role of spiral (helical) computerized tomography with three-dimensional reconstruction in pediatric solid tumors.

The ability to accurately assess tumor size and orientation to surrounding vital structures is an important consideration during preoperative evaluation. The authors report on nine children with solid tumors (hepatoblastoma [1], neuroblastoma [2], adrenal cortical carcinoma [2], liver adenoma [1], primitive neuroectodermal tumor [PNET] [1], and stage V Wilms' tumor [2]) for whom tumor resectability was questioned because of the tumors' close proximity to major blood vessels (noted through conventional radiographic imaging). The children had scanning with spiral volumetric acquisition computerized tomography, (CT) which obtains images during continuous rotation of the x-ray source while the patient moves at a constant velocity through the gantry. This technique is rapid (18 to 30 seconds), and is similar with respect to radiation exposure; little or no sedation is required, and the contrast dose is lower than that of conventional CT. Three-dimensional reconstruction of spiral CT imaging provided useful information that allowed successful resection in all nine cases. The authors suggest that spiral CT may become an important imaging modality in the preoperative evaluation of pediatric solid tumors and that further evaluation of this new methodology is warranted.

Adolescent↗
PubMed1996

Expression of BCL-2 gene product in embryonal tumors of the central nervous system.

BACKGROUND: The expression of bcl-2 is associated with suppression of programmed cell death and prolonged cell survival. Recently, immunoreactivity to the bcl-2 gene product has been reported not only in a variety of embryonal and adult nonhematopoietic tissues, but also in neuroblastoma. However, the study of bcl-2 expression has not been performed in brain tumors. METHODS: In this study, we examined the incidence and significance of bcl-2 expression in 25 cases of embryonal tumors of the central nervous system, including medulloblastoma, neuroblastoma, ependymoblastoma, and PNET (primitive neuroectodermal tumor), which has the possibility of neuronal differentiation. RESULTS: The results demonstrated that 13 tumors (52%) positive for bcl-2 belonged to early differentiated and neuronal types, and 7 negative tumors (28.0%) mostly belonged to undifferentiated type. CONCLUSIONS: These results have led us to speculate on the possibility that tumor cells begin expressing bcl-2 along with their neuronal differentiation from primitive cells.

Adolescent↗
PubMed1998

Cryoextraction in the management of orbital tumors. An old technique revisited.

Four patients with relatively large orbital tumors are described. These patients had superomedial rhabdomyosarcoma, inferomedial cavernous hemangioma, lateral primitive neuroectodermal tumor, and superior neurofibroma, respectively. Continuing enlargement and encroachment upon vital ocular structures and suspicion of malignancy warranted surgical intervention. Following exposure of the anterior portions of these tumors, a cryoprobe was used for the complete removal of the mass. Cryoextraction greatly facilitates the excision of well-defined, solid, encapsulated, benign or malignant tumors excluding the lacrimal gland and thus minimizes trauma to adjacent tissues. More importantly, the tumor can be removed intact without capsular rupture and risk of tumor spill-over or hemorrhage. At the histopathological level, the application of a cryoprobe did not alter the microscopic structures of the lesions and did not cause any difficulty for histopathologic interpretation.

Journal Article↗
PubMed2006

Comparative analysis of germ cell transcription factors in CNS germinoma reveals diagnostic utility of NANOG.

The homeodomain transcription factor, NANOG, along with OCT3/4 (POU5F1) and SOX2, is part of the core set of transcription factors that maintain embryonic stem cell self-renewal and pluripotency. Expression of NANOG has been detected in fetal germ cells and in gonadal germ cell tumors. To assess the diagnostic utility of NANOG in central nervous system (CNS) germ cell tumors, we analyzed its expression by immunohistochemistry in a series of 12 CNS germinomas and compared its expression with other stem cell markers. Strong nuclear expression of NANOG was demonstrated in >90% of the tumor cells in all cases. In contrast, expression of OCT3/4 and placental alkaline phosphatase was inconsistent and SOX2 was expressed in only rare cells. NANOG was not detected in tumor types frequently considered in the differential diagnosis of CNS germinoma: pineoblastoma, primitive neuroectodermal tumors, medulloblastoma, lymphoma, pituitary adenoma, atypical teratoid/rhabdoid tumor, Langerhans cell histiocytosis, and gliomas. These findings demonstrate that NANOG is a sensitive and specific marker of CNS germinoma. Compared with other currently used markers, NANOG may have superior diagnostic characteristics and can facilitate identification of germinomas in minute surgical biopsies commonly obtained from these tumors. These findings also suggest a potential biologic role for NANOG in maintenance of CNS germinoma.

Adolescent↗
PubMedDate not supplied

Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation.

Intramedullary spinal cord neoplasms are rare, accounting for about 4%10% of all central nervous system tumors. Despite their rarity, these lesions are important to the radiologist because magnetic resonance (MR) imaging is the preoperative study of choice to narrow the differential diagnosis and guide surgical resection. On contrast materialenhanced MR images, intramedullary spinal tumors almost always manifest as expansion of the spinal cord and show enhancement. Syringohydromyelia and cystic lesions are frequently associated with intramedullary tumors. Nontumoral cysts tend to be located at the poles of the tumors and do not enhance on contrast-enhanced MR images, whereas cysts within the substance of the tumor are considered tumoral cysts and typically demonstrate peripheral enhancement. Spinal cord ependymomas are the most common type in adults, and cord astrocytomas are most common in children. Both entities constitute up to 70% of all intramedullary neoplasms. A central location within the spinal cord, presence of a cleavage plane, and intense homogeneous enhancement are imaging features that favor an ependymoma. Intramedullary astrocytomas are usually eccentrically located within the cord, are ill defined, and have patchy enhancement after intravenous contrast material administration. Even with these characteristics, it may not be possible to differentiate these two entities on the basis of imaging features alone. Cord hemangioblastomas are the third most common type of intramedullary spinal tumor. Gangliogliomas commonly extend over more than eight vertebral segments. Paragangliomas and primitive neuroectodermal tumors have an affinity for the filum terminale and cauda equina. Other spinal cord tumors include metastatic disease, which is characterized by prominent cord edema for the size of the enhancing portion, and primary lymphoma.

Cauda Equina↗
PubMed1997

Effective chemotherapy for advanced CNS embryonal tumors in adults.

PURPOSE: Embryonal tumors of the CNS include, among others, medulloblastoma, cerebral neuroblastoma, pineoblastoma, and primitive neuroectodermal tumors (PNETs). Almost all data on the treatment of embryonal CNS tumors are derived from the pediatric population, since these tumors are uncommon in adulthood. The purpose of this study was to examine the rate and duration of response to chemotherapy of advanced embryonal CNS tumors in adults. PATIENTS AND METHODS: We retrospectively studied all adult (> 18 years of age) patients with advanced embryonal tumors of the CNS who received chemotherapy at our institution between 1976 and 1994. Seventeen consecutive patients were treated with regimens that contained either nitrosourea or cisplatin or both sequentially, with no patients having received the combination of nitrosourea and cisplatin concurrently. RESULTS: In patients who received cisplatin-based chemotherapy, responses were observed in 84.5% (26% complete response [CR] rate), 10.5% remained stable, and 5% progressed. The median time to progression was 18 months for patients who had a CR, 6 months for those with partial response (PR), and 10 months for stable patients. Among patients who received nitrosourea-based chemotherapy, PR was observed in 27%, 36.5% remained stable, and 36.5% progress. The median time to progression was 6 months for patients who had a PR and 6.5 months for stable patients. CONCLUSION: In adults with advanced embryonal CNS tumors, conventional-dose intravenous cisplatin-based chemotherapy regimens are able to produce responses in the majority of the patients (84.5%), even as second- or third-line regimens. Nitrosourea-based regimens less frequently produce responses (27%).

Adolescent↗
PubMed2000

Type-B-IIIa hip rotationplasty: an alternative operation for the treatment of malignant tumors of the femur in early childhood.

BACKGROUND: The biological plasticity of the cartilaginous proximal part of the tibia in children makes it possible to use the tibia to reconstruct the lower extremity after excision of a sarcoma of the thigh. A type-B-IIIa rotationplasty is an alternative to prosthetic replacement in very young children who have a malignant tumor of the femur that requires extensive resection. METHODS: A type-B-IIIa rotationplasty was done in eight patients who had a femoral tumor: four had a Ewing sarcoma; three, an osteosarcoma; and one, a primitive neuroectodermal tumor. The ages ranged from two years and eight months to ten years and six months at the time of the procedure. RESULTS: All eight patients were able to bear full weight and had a good range of motion of the hip joint at a median of five years and one month (range, two years and four months to eight years) postoperatively. They also were able to participate in sports activities. Radiographs and magnetic resonance imaging studies confirmed that the lateral part of the tibial plateau had remodeled to form a structure that resembled a developing femoral head. Seven patients were operated on only once, and a second hospital stay was not necessary. The remaining patient had a prolonged hospitalization for revision of the wound. CONCLUSIONS: As an alternative to amputation or an extendable tumor prosthesis, a type-B-IIIa rotationplasty offers not only a better functional result but also biological reconstruction. Placement of the cartilaginous head of the tibia into the acetabulum permits development of a new femoral head. Thus, not only is the foot preserved as a functional knee joint but a newly formed hip joint develops as well.

Arthroplasty, Replacement, Hip↗
PubMed1990

Congenital brain tumors: a review of 45 cases.

Forty-five pathologically proved cases of neonatal brain tumors (diagnosed in neonates within 60 days after birth) were reviewed from the neuroradiology archives dating back to 1964. CT was performed in 24 cases, MR in five, sonography in six, and angiography in seven. Two-thirds of the lesions were supratentorial. The most common histology was a tumor composed of primitive or poorly differentiated tissues: 12 teratomas and 12 primitive neuroectodermal tumors, four of which were typical medulloblastomas. In addition, there were nine astrocytomas (grades I-III); four cases of glioblastoma multiforme (astrocytoma grade IV); three choroid plexus papillomas; and single cases each of ependymoma, medulloepithelioma, germinoma, angioblastic meningioma, and ganglioglioma. The dominant CT appearance, regardless of histology, was a large heterogeneous lesion with associated hydrocephalus. Coarse calcification was a constant feature in the teratomas. Prognosis was poor overall, with the longest survival seen in choroid plexus papilloma and astrocytoma. Imaging studies are most valuable in identifying and distinguishing potentially curable lesions such as choroid plexus papillomas (variably sized intraventricular lesions with homogeneous enhancement) from rapidly fatal tumors such as teratomas (large heterogeneous lesions with coarse calcifications and associated hydrocephalus).

Astrocytoma↗
PubMedDate not supplied

Congenital brain tumors: a review of 45 cases.

Forty-five pathologically proved cases of neonatal brain tumors (diagnosed in neonates within 60 days after birth) were reviewed from the neuroradiology archives dating back to 1964. CT was performed in 24 cases, MR in five, sonography in six, and angiography in seven. Two-thirds of the lesions were supratentorial. The most common histology was a tumor composed of primitive or poorly differentiated tissues: 12 teratomas and 12 primitive neuroectodermal tumors, four of which were typical medulloblastomas. In addition, there were nine astrocytomas (grades I-III); four cases of glioblastoma multiforme (astrocytoma grade IV); three choroid plexus papillomas; and single cases each of ependymoma, medulloepithelioma, germinoma, angioblastic meningioma, and ganglioglioma. The dominant CT appearance, regardless of histology, was a large heterogeneous lesion with associated hydrocephalus. Coarse calcification was a constant feature in the teratomas. Prognosis was poor overall, with the longest survival seen in choroid plexus papilloma and astrocytoma. Imaging studies are most valuable in identifying and distinguishing potentially curable lesions such as choroid plexus papillomas (variably sized intraventricular lesions with homogeneous enhancement) from rapidly fatal tumors such as teratomas (large heterogeneous lesions with coarse calcifications and associated hydrocephalus).

Brain Neoplasms↗
PubMed1986

Paucity of beta 2-microglobulin expression on small cell lung cancer, bronchial carcinoids and certain other neuroendocrine tumors.

Cell lines established from small cell lung cancer (SCLC), a neuroendocrine tumor, have low or absent expression of class I major histocompatibility complex antigens. To determine whether this phenomenon occurs also in vivo, 244 routine paraffin-embedded tumors including 32 SCLC and 79 non-SCLC (NSCLC) lung cancers were studied for expression of beta 2-microglobulin (beta 2m) by an avidin-biotin coupled immunoperoxidase technique. The majority of SCLC tumors lacked beta 2m expression, while some had weak, focal expression. In contrast, most NSCLC expressed beta 2m, often strongly. The difference between SCLC and NSCLC was highly significant statistically, suggesting that beta 2m can be used as a clinical immunodiagnostic marker for distinguishing NSCLC from SCLC. In addition, certain other neuroendocrine tumors (neuroblastoma, bronchial and midgut carcinoid tumors) lacked beta 2m expression, whereas some (pheochromocytoma, medullary thyroid carcinoma, and peripheral neuroectodermal tumors) usually stained positively. Such non-neuroendocrine tumors as colon, breast, and prostate carcinomas showed moderate to high expression of beta 2m. Selective absence of beta 2m expression by certain neuroendocrine tumors appears to be a phenomenon of biological and diagnostic importance.

Carcinoid Tumor↗
PubMed1987

[The value of neuron specific enolase (NSE) in patients with brain tumors].

gamma gamma-Enolase is considered a specific protein of neuron, which is called neuron specific enolase (NSE). Recent reports clarified that NSE exists not only in neurons but also in neuroendocrine cells, thrombocytes and lymphocytes. Besides normal neuronal tissues, high serum levels of NSE were noticed in the patients with neuroblastomas, small cell carcinomas of the lung, and malignant gliomas, etc. In order to clarify the usefulness of NSE as a marker for intracranial neoplasms or an indicator for prognosis of the patients with intra-cranial tumors, we studied serum, CSF and intratumoral fluid levels of NSE in 62 patients with intra-cranial tumors by radioimmunoassay. Serum level of NSE in healthy adults ranged from 4.1 to 8.9 ng/ml (5.6 +/- 1.38 ng/ml, n = 15) and that of CSF ranged from 4.9 to 7.3 ng/ml (means 6.1 ng/ml, n = 3). Serum samples from patients with malignant gliomas and primitive neuroectodermal tumors contained abnormally high level of NSE, of which mean value were 22.3 ng/ml and 16.1 ng/ml, respectively. However, serum samples from patients with low grade gliomas and other intracranial tumors arising from non-neuroectodermal tissues were within normal range. In 9 patients, not only serum levels but CSF levels and/or intratumoral cyst levels of NSE were examined at the same time. Except one meningioma case, CSF levels of NSE were higher (4.9-55.3 ng/ml, mean: 19.3 ng/ml) than that of serum levels (2.3-17.3 ng/ml, mean: 12.7 ng/ml). Mean NSE concentrations of intratumoral fluids in both malignant and benign tumors were 181.7 ng/ml, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Stereotactic radiosurgery for recurrent gliomas.

BACKGROUND: The treatment of recurrent gliomas is palliative; however, the local pattern of tumor recurrence permits retreatment with single fraction, high dose stereotactic radiotherapy or radiosurgery (RS). METHODS: Twenty patients (median Karnofsky performance status, 80), aged 8-62 years with recurrent gliomas, were treated with RS after failing adjuvant therapy. Tumor histologies included glioblastoma multiforme (5), anaplastic astrocytoma (10), fibrillary astrocytoma (4), and primitive neuroectodermal tumor (1). Tumor volumes ranged from 3-53.5 cc, with a median of 17 cc. RESULTS: Seven early and one late radiation complication were seen. All seven early radiation complications were due to raised intracranial pressure and resolved in all but one patient who died. Median follow-up in 19 evaluable patients was 8 months (range, 2-29 months). Fourteen patients died from progressive tumor (median survival, 7 months). Five patients, four with recurrent tumor, were alive (median follow-up, 19 months) with a median time-to-tumor progression of 9 months. CONCLUSIONS: Radiosurgery demonstrates modest efficacy with acceptable toxicity in selected patients with recurrent gliomas and warrants further investigation.

Adolescent↗