ABSTRACT
Glioblastoma multiforme (GBM) is the most common primary brain tumor and the most malignant astrocytoma in adults, with rare extra-cranial metastases, especially for subcutaneous metastases. It could be easily misdiagnosed as primary subcutaneous tumor. In this report, we describe a patient with pontine GBM who developed a subcutaneous swelling at the ipsilateral posterior cervical region 8 months after operation, and the pathological and immunocytochemical examination carry the same characteristics as the primary intracranial GBM cells, which defined it as subcutaneous metastasis. GBM with subcutaneous metastasis is extremely rare, and knowledge of a prior intracranial GBM, pathological examinations and immunocytochemical tests with markers typically expressed by GBM are of vital importance for the diagnosis of GBM metastasis. Surgical resection of subcutaneous swelling, followed by chemotherapy and radiotherapy, could be the best strategy of treatment for the patients with GBM subcutaneous metastasis.
Subject(s)
Adult , Humans , Astrocytoma , Brain Neoplasms , Glioblastoma , Neoplasm MetastasisABSTRACT
Complement system is a reaction system comprising 35 proteins with enzyme activity common in serum,tissue fluid and cell membrane. It plays an important role in anti-infection. Abnormal complement activation is involved in incidence and progression of many inflammatory diseases. The complement is activated through typical,alternative and agglutinin pathways. Following cardiovascular stent implantation,the vessel endothelium of patients with coronary atherosclerotic heart disease is damaged; serum complement C3 could enter the arterial wall to damage arterial cells to enhance the permeability release antigenic components of vessel wall,and induce antibody production. The fixing immune complex is formed and induces platelet aggregation,attachment or lipidoses. Although humoral immunity becomes accentuated following cardiovascular stent implantation,the capability to resist microorganism is reduced,which stimulates self-protection of C3,aggravates inflammation,increases circulation complex,activates complement system and aggravates endothelial injury. C3 plays an essential role in occurrence and development of ischemic cardiovascular disease,and is an important cause for restenosis and thrombosis following cardiovascular stent implantation.
ABSTRACT
Objective To evaluate the safety and efficacy of OUR Rotating Gamma System in neurosurgical clinical application. Methods Based on the results of animal experiments, 2381 patients with intracranial disease were treated using OUR Rotating Gamma System in Aohai Gamma Knife Center of Navy General Hospital of PLA betwean December 1996 and November 2002. There were 1288 males and 1093 females and their age ranged from 3 to 84 years (mean 45.8 years). 1020 patients had benign intracranial tumors, and of them 446 suffered from pituitary tumors, 254 meningioma, 148 craniopharyngioma and 103 vestibular schwannomas. Malignant tumors were diagnosed in 796 patients, among them glioma was found in 360 and metastasis in 360. 374 patients had cerebral arteriovenous malformations (AVMs) and 191 functional neurological disorders. Treatment technique of Gamma Knife Stereotactic Radiosurgery, dose prescription and precise orientation performed in intracranial tumor or foci were analyzed, and the preliminary outcome of treatment was evaluated in this study. In addition, the management of the possible complication and adverse reaction was studied. Results Gamma Knife Stereotactic Radiosurgery alone, or combined with other treatment procedures, could cure some of selected patients with benign brain lesions including pituitary neoplasms, meningioma, vestibular schwannomas, AVMs, and craniopharyngioma etc. And this treatment was also beneficial to some patients with malignant tumors. The incidence of radiation edema was 0.75%. Conclusions The clinical results suggest that Gamma Knife Stereotactic Radiosurgery is a very effective, accurate and relatively safe neurosurgical tool used either as a primary or adjuvant procedure for treatment of intracranical pathologic processes. However, it might lead to some severe or fatal complications if used inappropriately. Thus, optimal result would not be obtained unless a careful and precise Gamma treatment based on the operative rules and the effective management for postoperative complications are well planned.