Atypical meningioma: clinicopathological analysis of a new WHO classification

The World Health Organization [WHO] reclassified atypical meningiomas in 2000, creating a more clear and broadly accepted definition. We evaluated the pathological and clinical management for atypical meningioma patients according to the new WHO grading system at Cairo University Hospital. A total of 30 atypical meningiomas occurring in 30 patients between 2005 and 2007 were prospectively reviewed to determine diagnosis, postoperative treatment trends and early outcomes. In the 3-year period, 371 meningiomas were operated on at Cairo University Hospital; of these, 320 [86.5%] were benign, 30 [8%] atypical and 21 [5.6%] malignant. The histological parameters permit an accurate identification of atypical and malignant meningiomas with high growth potential and recurrence rates that far exceed that of benign meningiomas. We hope that the use of these relatively simple histological criteria will help to further the understanding of the biology of this important group of tumours

Correlation of angiogenesis with grade and recurrence in superficial and invasive urinary bladder transitional cell carcinoma

The aim of this study was to correlate the level of MVD with the grade, recurrence and prognosis of the tumor in an attempt to understand the events controlling angiogenesis so as to evaluate the use of anti-angiogenic therapy in the treatment of urinary bladder tumours. The material of this study consisted of 52 selected PT1 and PT2 cases of transitional cell carcinoma [TCC] obtained by transurethral resection biopsy. Cases were collected from El-Sahel teaching hospital during the period from Januray 2006 to January 2009. Age, sex and other clinical data of the patients were taken from the clinical sheets. Each paraffin block was re-cut by microtome at five Um thickness,stained with haemtoxylin and eosin for routine histopathological examination and grading of the tumour and assessment of muscle invasion. Immunohistochemical staining of the endothelial cells was done by monoclonal antibody against CD31 antigen. 32 cases were superficial TCC while 20 were invasiveTCC. Superficial TCC cases were treated starting 2 weeks after TURBT by intravesical Bacillus Calmete and Guerin [BCG] in 28 out of the 32 cases of superficial TCC. All cases went under follow up for a period of 24 months,however,only 30 cases showed regular follow up. Six cases showed recurrence of the tumour after a follow-up period ranging from 20 - 24 months.Invasive TCC cases were treated by radical cystectomy and urinary diversion with follow up every 6 months, however, pelvic nodules were seen in 4 cases after 2 years. Histopathological evaluation was done for grade of tumour and the extent of invasion,counting the neovascular density after immunostaining by monoclonal antibody against CD31 antigen to determine the MVD. The age of Jhe patients in all studied cases ranged from 30 to 79 years with 41 males and 11 females.Of the 52 studied cases,32 [61.5%] were stage pTl, while 20 cases [38.5%] were stage pT2. Grades 1,2,3 were respectively found in 18,30 and 4cases. All grade 1 cases were stage pTl [100%], while grade 2 cases showed 14 cases [46.6%] stage pTl and 16 cases [53.4%] stage pT2. All grade 3 cases were stage pT2 [100%]. Six cases showed recurrence after treatment; 2 were grade 1 and 4 were grade 2. All recurrent cases were stage pTl,2of them showed bilharzial infestation and were grade 2.MVD was counted per high power field [HPF] at magnification x400The median MVD in grade 1 cases was 37 vessels/HPF In grade 2 cases it was 53.5 vessels/HPF ,some of which were superficial tumours ,while others were invasive .In grade 3 cases it was 116.5 vessels/HPF .According to the stages of the studied cases of TCC, MVD ranges in stage pTl,pT2 and pT3 cases were 19-88,39-148 and 116.5vessels/HPF.The median MVD of stage pTl grade 1 cases was 37 vessels/HPF, median MVD in stage pTl grade 2 cases was 53.5 vessels/ HPF, while stage pT2 grade 2 cases was 68.5 vessels/HPF. As for grade 3, all cases were stage pT2, the median MVD was 116.5 vessels/HPF. The median MVD is increasing as the grade increases [P <0 .001]. The median MVD for grade 1 cases showing recurrence was 46, and grade 2 cases showing recurrence was 53.5, while grade 1 cases without recurrence was 36 and grade 2 was 57. Out of the 52 cases,there were 6 cases of recurrence;3 cases were within a MVD range 0-50,another 3 cases were in the MVD range 51-100 while there were no cases of recurrence found in the MVD range over l00.The remaining 46 cases without recurrence were 22 cases in a MVD range 0-50, 21 cases in the MVD range 51-100 and 3 cases in the MVD range above 100. Tumor grade and MVD are valuable to predict prognosis in superficial TCC while quantification of angiogenesis does not help in the prediction of the recurrence in superficial TCC. Moreover,a significant correlation was found between MVD and tumour grade for stages PTl and PT2.Thus,MVD correlation with tumour grade can help in planning for anti-angiogenesis strategies. We recommend to further study the effect of anti-angiogenic treatment as a curative modality together with the routine therapeutic regimen for grades 2 and 3

Evaluation of different pathological and molecular methods in diagnosis and monitoring of polyoma BK virus nephropathy in renal transplant patients

Human Polyoma BK virus is a DNA virus that has many transmission methods including feco-oral, respiratory, transplacental and from donor tissue with a usual unnoticed primary infection. Reactivation of Polyoma BK virus occurs in immunsuppressed patients such as pregnant females, cancer patients, patients with human immunodeficiency virus type 1 infection and recipients of renal or other allografts. Reactivation in renal transplant patients manifest as renal dysfunction resembling acute graft rejections and my be complicated with graft loss. In this study we aimed to evaluate different pathological and molecular methods in diagnosis and monitoring BK virus nephropathy [BKVN]. Twenty renal transplant patients represented with renal dysfunction manifested clinically and by elevation in serum creatinine level were investigated by means of histopathological examination of renal biopsy specimen, detection of decoy cells in urine cytology specimen and detection of Ployoma BK DNA in urine and plasma by PCR. Three patients out of 20 [15%] were diagnosed as BKVN positive by urine cytology, histpathological examination of renal biopsy and by detection of BK virus DNA in urine and plasma. Not all these methods were approved to be useful in monitoring our positive cases after reduction modification of the immunosuppressive therapy. Detection of decoy cells in urine cytology specimen and detection of Polyoma BK virus DNA in urine were the most efficient and reliable methods for monitoring BKVN

comparison of ondansetrom and cyclizine as prophylaxis against postoperative nausea and vomiting in children

Nausea and vomiting is a relevant and common problem with unfavourable sequelae in children undergoing some plastic surgery procedures. There is a lack of anti-emetic trials performed in children, with only a few investigating the roles of the older anti-emetic agents such as cyclizine compared with newer ones such as ondansetron. This randomised, controlled, double-blind study examined the effectiveness of a single dose of ondansetron [0.1 mg.kg1] and cyclizine [20 mg] in the prevention of postoperative nausea and vomiting in 150 children [mean age 3.6 years] undergoing plastic genitourinary procedures. Rates of previous postoperative nausea and vomiting and motion sickness were comparable across the groups. Postoperative vomiting was significantly reduced with ondansetron prophylaxis [P= 0.006] but there was no detectable antiemetic effect with cyclizine. Furthermore, cyclizine caused pain on injection [P<0.001]