Detection of meningeal carcinomatosis by metagenomic next-generation sequencing and copy number variation analysis of cerebrospinal fluid / 中华神经科杂志

Objective:To evaluate the significance of copy number variation (CNV) and metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) in the diagnosis of meningeal carcinomatosis (MC).Methods:Ten patients with MC diagnosed in the Department of Neurology of Peking Union Medical College Hospital from March 2022 to June 2022 were consecutively enrolled in this study. The patients were diagnosed according to the criteria of the Chinese expert consensus on the diagnosis of MC by the Chinese Society of Infectious Diseases and Cerebrospinal Fluid Cytology, and the diagnosis of MC was confirmed by CSF cytology. The control group included 10 patients who were diagnosed as autoimmune encephalitis or viral encephalitis. CSF mNGS and CNV analysis were performed simultaneously in all the patients.Results:Of the 10 patients with MC, 6 had lung adenocarcinoma, 4 had breast cancer. CSF mNGS and CNV analysis detected large CNV in 8 of 10 patients with MC, including 4 patients with breast cancer and 4 patients with lung cancer. The results of pathogenic microorganism analysis of CSF mNGS in all the patients were negative. Meanwhile, large CNV was not detected in the control group.Conclusions:CSF CNV can serve as a diagnostic marker for MC. The combination of mNGS and CNV analysis has demonstrated a high positive rate in the diagnosis of MC. The dual-omics analysis of pathogenic microorganisms and CNV has been proposed as a potential strategy to further expand the clinical utility of CSF mNGS in the realm of auxiliary diagnosis.

Intracranial Inflammatory Myofibroblastic Tumor: A Review of 49 cases

Inflammatory Myofibroblastic Tumor (IMT) is a rare pathologic entity that was first described in 1973. This lesion is most commonly found in the lungs, but other organs' involvement has also been reported. Intracranial location of Inflammatory Myofibroblastic Tumor is rare, and the first case was reported in 1980. An intriguing fact about the intracranial IMT is its resemblance with meningioma on clinical presentation and neuroimaging. We came across a case of intracranial Inflammatory Myofibroblastic Tumor (IIMT) in a 27-year-old male who presented with recurrent episodes of seizures and was diagnosed as meningioma on neuroimaging. The lesion did not subside with medical management and kept on progressing in size. The patient had to undergo surgery, and diagnosis of Inflammatory Myofibroblastic Tumor was ascertained on histopathology. This 'surprise' diagnosis prompted us to review the literature on all cases of IIMTs reported to date to better understand the entity and its implications. In this review article, we present our observations regarding various studied parameters, including patient profile, clinical presentation, site of involvement, focality of the lesion, special associations, and lines of management of the 49 published cases of IIMTs.

Meningioma primario intraóseo esfenotemporal: presentación de caso / Primary spheno-temporal intra-osseous meningioma: a case report

RESUMEN Fundamento: los meningiomas ectópicos, definidos como aquellos que no tienen ninguna conexión con la duramadre, poco frecuentes. Son una variante rara y representan cerca del uno por ciento de todos los meningiomas intracraneales. Objetivo: presentar una variante poco frecuente de un meningioma ectópico como causa de proptosis y oftalmoparesia encontrado en una paciente joven. Presentación del caso: paciente de 40 años de edad, que hace seis meses comenzó con dolor en el ojo derecho de moderada intensidad, aumento de volumen de la región frontorbitaria, disminución de la agudeza visual y visión doble. Los estudios de tomografía axial computarizada y resonancia magnética de cráneo y órbita mostraron lesión extraaxial a nivel de la pared lateral de la órbita con extensión extra e intraorbitaria con compresión de estructuras adyacentes que provocó desplazamiento anterior del globo ocular. Se realizó tratamiento quirúrgico con excéresis y el estudio histológico concluyó un meningioma meningotelial ectópico del hueso grado I. Conclusiones: los meningiomas ectópicos resultan poco frecuentes, el tratamiento quirúrgico con la resección total de la lesión es la elección para evitar recurrencias y pueden tener indicación de tratamiento oncológico complementario.

ABSTRACT Background: ectopic meningioma, defined as those that have no connection with the dura mater, are rare. They are a rare variant and represent approximately 1 % of all intracranial meningioma. Objective: to present a rare variant of an ectopic meningioma as a cause of proptosis and ophthalmoparesis found in a young patient. Case report: patient of 40 years of age, who 6 months ago began with pain in the right eye of moderate intensity, increased volume of the front-orbital region, decreased visual acuity and double vision. Computed tomography and MRI of the skull and orbit showed extra-axial lesion at the level of the lateral wall of the orbit with extra and intra-orbital extension with compression of adjacent structures that caused anterior displacement of the eyeball. Surgical treatment was performed with resection and the histological study concluded an ectopic meningotial meningioma of bone grade I. Conclusions: ectopic meningioma are infrequent, surgical treatment with total resection of the lesion is the choice to avoid recurrences and may have an indication of complementary oncological treatment.

Clinicopathological observation and literature review of cystic meningioangiomatosis / 中华神经科杂志

Objective@#To summarize the clinicopathological features of cystic meningioangiomatosis.@*Methods@#The clinical manifestations, imaging characteristics and pathological features of a case of cystic meningioangiomatosis were analysed, and the relevant literature was reviewed.@*Results@#A 16-year-old male patient from Xuanwu Hospital, Capital Medical University had a history of epileptic seizures for more than three months. Magnetic resonance imaging (MRI) demonstrated a cystic mass in the left frontal lobe with long T1 and long T2 signals. Extensive resection of the upper frontal gyrus was performed. The excised lesion presented with a cystic shape after incision and contained colorless translucent liquid. Microscopic examination of the lesion showed that the number of blood vessels in the local cortex of the brain tissue was increased and the vessels appeared to be branching. The blood vessel walls were surrounded by proliferative spindle cells, which were arranged in concentric circles. Immunohistochemical study revealed that those spindle cells and the cyst wall were vimentin positive. These cells had a rich reticular fibers. Ten months after the operation, the general condition of the patient was good, no epileptic seiƶure was observed, and the follow-up MRI did not reveal any residual lesion.@*Conclusions@#MRI of cystic meningioangiomatosis shows cystic space occupying. Pathological findings show typical features of meningioangiomatosis and cystic space formation. Cystic meningioangiomatosis has good prognosis after surgical resection.

Clinicopathological observation and literature review of cystic meningioangiomatosis / 中华神经科杂志

Objective To summarize the clinicopathological features of cystic meningioangiomatosis.Methods The clinical manifestations,imaging characteristics and pathological features of a case of cystic meningioangiomatosis were analysed,and the relevant literature was reviewed.Results A 16-year-old male patient from Xuanwu Hospital,Capital Medical University had a history of epileptic seizures for more than three months.Magnetic resonance imaging (MRI) demonstrated a cystic mass in the left frontal lobe with long T1 and long T2 signals.Extensive resection of the upper frontal gyms was performed.The excised lesion presented with a cystic shape after incision and contained colorless translucent liquid.Microscopic examination of the lesion showed that the number of blood vessels in the local cortex of the brain tissue was increased and the vessels appeared to be branching.The blood vessel walls were surrounded by proliferative spindle cells,which were arranged in concentric circles.Immunohistochemical study revealed that those spindle cells and the cyst wall were vimentin positive.These cells had a rich reticular fibers.Ten months after the operation,the general condition of the patient was good,no epileptic seizure was observed,and the follow-up MRI did not reveal any residual lesion.Conclusions MRI of cystic meningioangiomatosis shows cystic space occupying.Pathological findings show typical features of meningioangiomatosis and cystic space formation.Cystic meningioangiomatosis has good prognosis after surgical resection.

Application of cerebrospinal fluid circulating cell-free DNA in the diagnosis and treatment of leptomeningeal metastases from non-small-cell lung cancer / 中华检验医学杂志

Objective@#To investigate the application value of cerebrospinal fluid circulating cell-free DNA (cfDNA) in the diagnosis and treatment of leptomeningeal metastases in non-small-cell lung cancer (NSCLC).@*Methods@#Twenty-five patients with leptomeningeal metastases of NCSLC from Fudan University Huashan Hospital North during the period from September 2017 to November 2018 were enrolled. All 25 patients were confirmed leptomeningeal metastases by cerebrospinal fluid cytology and immunocytochemical staining of cytokeratin(CK7), carcinoembryonic antigen(CEA), thyroid transcription factor-1(TTF-1) and Ki67. The cerebrospinal fluid cfDNA was extracted and genetic variation of 12 genes including epidermal growth factor receptor(EGFR), TP53 and anaplastic lymphoma kinase(ALK) was detected by next-generation sequencing [PlasAim TM gene non-invasive detection of lung cancer (12 gene) kit, Singlera Genomics].The application value of cerebrospinal fluid cfDNA in the diagnosis and treatment of leptomeningeal metastases of NSCLC was analyzed with the cfDNA mutation data and the clinical follow-ups.@*Results@#Morphologically typical lung cancer tumor cells with tumor immunochemistry markerCK, CK7 and CEA were found in the cerebrospinal fluid of all 25 patients. Next generation sequencing of cerebrospinal fluid showed that 96% (24/25) patients had at least one single nucleotide variation (SNV) or copy number variation (CNV). The EGFR and TP53 mutations were identified in 80% (20/25) and 48%(12/25) of the patients, respectively. In addition, patients with bone metastases had a higher rate of EGFR mutations than those without bone metastases (100% vs 64%, P<0.05). Changes in the mutant allele frequency of EGFR and TP53 in cerebrospinal fluid were consistent with patients′ disease progression parameters including neurological symptoms, imaging, and tumor biomarkers. The results indicate that genetic alteration of EGFR in cerebrospinal fluid cfDNA is an actionable biomarker for targeted therapy of leptomeningeal metastases of lung cancer.@*Conclusion@#Cerebrospinal fluid cfDNA accurately reveals the unique genetic background of leptomeningeal metastasis in NSCLC, showing great application value in the diagnosis and treatment of the leptomeningeal metastasis of NSCLC.

Application of cerebrospinal fluid circulating cell-free DNA in the diagnosis and treatment of leptomeningeal metastases from non-small-cell lung cancer / 中华检验医学杂志

Objective To investigate the application value of cerebrospinal fluid circulating cell-free DNA (cfDNA) in the diagnosis and treatment of leptomeningeal metastases in non-small-cell lung cancer (NSCLC). Methods Twenty-five patients with leptomeningeal metastases of NCSLC from Fudan University Huashan Hospital North during the period from September 2017 to November 2018 were enrolled. All 25 patients were confirmed leptomeningeal metastases by cerebrospinal fluid cytology and immunocytochemical staining of cytokeratin(CK7), carcinoembryonic antigen(CEA), thyroid transcription factor-1(TTF-1) and Ki67. The cerebrospinal fluid cfDNA was extracted and genetic variation of 12 genes including epidermal growth factor receptor(EGFR), TP53 and anaplastic lymphoma kinase(ALK) was detected by next-generation sequencing [PlasAim TM gene non-invasive detection of lung cancer (12 gene) kit, Singlera Genomics].The application value of cerebrospinal fluid cfDNA in the diagnosis and treatment of leptomeningeal metastases of NSCLC was analyzed with the cfDNA mutation data and the clinical follow-ups. Results Morphologically typical lung cancer tumor cells with tumor immunochemistry marker CK, CK7 and CEA were found in the cerebrospinal fluid of all 25 patients. Next generation sequencing of cerebrospinal fluid showed that 96％(24/25) patients had at least one single nucleotide variation (SNV) or copy number variation (CNV). The EGFR and TP53 mutations were identified in 80％(20/25) and 48％(12/25) of the patients, respectively. In addition, patients with bone metastases had a higher rate of EGFR mutations than those without bone metastases (100％ vs 64％, P<0.05). Changes in the mutant allele frequency of EGFR and TP53 in cerebrospinal fluid were consistent with patients' disease progression parameters including neurological symptoms, imaging, and tumor biomarkers. The results indicate that genetic alteration of EGFR in cerebrospinal fluid cfDNA is an actionable biomarker for targeted therapy of leptomeningeal metastases of lung cancer. Conclusion Cerebrospinal fluid cfDNA accurately reveals the unique genetic background of leptomeningeal metastasis in NSCLC, showing great application value in the diagnosis and treatment of the leptomeningeal metastasis of NSCLC.

Síndrome de degeneración combinada de la médula espinal y radiculopatía en dos pacientes por quimioterapia intratecal con metrotrexato y citarabina: casos clínicos / Spinal subacute combined degeneration after intrathecal chemotherapy: report of two cases

Intrathecal chemotherapy may be complicated with the development of myelopathies or toxic radiculopathies. This myeloradicular involvement, of toxic character, is unpredictable, since these patients have repeatedly received Intrathecal chemotherapy with the same drugs without apparent injury. The toxic effect should be mainly attributed to Cytarabine and not to methotrexate, since the central nervous system lacks Cytidine deaminase, the enzyme that degrades Cytarabine. We report two patients, an 18-year-old woman and a 16 years old male, who received systemic and intrathecal chemotherapy (methotrexate, cytarabine) for the treatment of an acute lymphoblastic leukemia and developed, in relation to this procedure, a spinal subacute combined degeneration. They had a proprioceptive and motor alteration of the lower extremities and neuroimaging showed selective rear and side spinal cord hyper intensity produced by central axonopathy. Two weeks later the woman developed a quadriplegia and the young man a flaccid paraplegia due to added root involvement.

Effects of minimally invasive tumor resection under microscope on symptoms improvement, Simpson classification and prognosis in patients with sagittal sinus and falx cerebri meningioma / 中国基层医药

Objective To analyze the effects of minimally invasive tumor resection under microscope on symptoms improvement,Simpson classification and prognosis in patients with sagittal sinus and falx cerebri meningioma.Methods From December 2012 to December 2016,123 patients with parasagittal and falx meningioma in the People 's Hospital of Shanxi Province were randomly divided into two groups according to the digital table.The control group (61 cases) underwent conventional craniotomy,and the study group (62 cases) performed minimally invasive tumor resection.The symptoms improvement,Simpson classification and postoperative recurrence were compared between the two groups.Results The operation time between the two groups had no statistically significant difference (t =1.13,P ＞ 0.05).The intraoperative blood loss in the study group was (119.05 ± 26.94) mL,which was lower than (172.05 ±27.43) mL in the control group (t =10.81,P ＜ 0.01).The postoperative symptoms improvement of movement of limbs (3.22％),epilepsy (4.65 ％),sensory dysfunction (1.61％) in the study group were significantly better than those in the control group (14.75％,31.15％,27.87％) (x2 =5.02,6.34,4.14,all P ＜ 0.05).The Simpson classification of tumor resection rate in the study group was better than that in the control group(x2 =12.23,P ＜0.01).The incidence rates of complications such as epilepsy(0.00％) and intracranial hemorrhage(1.61％),and recurrence rate(0.00％) in the study group were lower than those in the control group(26.23％,27.87％,27.87％)(x2 =4.05,4.14,4.65,all P ＜ 0.05).Conclusion Minimally invasive tumor resection under the microscope can effectively improve clinical symptoms of patients with sagittal sinus and falx cerebri meningioma,which can improve tumor resection rate,effectively reduce the incidence of postoperative complications and recurrence rate.

Neuroendoscopic surgery of supraorbital keyhole approach for the removal of medium and large sized tuberculum sellae meningiomas / 重庆医学

Objective To explore the effect of neuroendoscopic surgery for the removal of medium and large sized tuberculum sellae meningiomas through supraorbital keyhole approach.Methods A retrospective research was performed on 7 case of patients with tuberculum sellae meningioma who underwent endoscopic surgery through supraorbital keyhole approach.The main performance of patients as tumor diameter were 2.8-4.7 cm and the skin incision located at superciliary aich which size of intra-frontal bone window was 3.5 cm× 2.0 cm.Results Total removal was achieved in 7 cases(simpson Ⅰ grade in 2 patients,sirnpson 1Ⅱ grade in 5 patients).Postoperative,the visual outcomes of eyes were showed improvement in 9 eyes,remained steady in 3 eyes,and deterioration in 2 eyes.All patients were followed up for 6-13 months and no recurrence was found.Conclusion Neuroendoscopic surgery through supraorbital keyhole approach is an effective method for the resection of medium and large sized tuberculum sellae meningiomas.

Seeding of Meningeal Sarcoma Along a Surgical Trajectory on the Scalp

Primary sarcomas of the central nervous system are rare. These tumors is rapid growth often produces mass effect on the brain. Diagnosis is rendered pathologically after resection. Surgical resection is the mainstay treatment and need the adjuvant therapy. We report a 44-year-old female with a meningeal sarcoma of frontal meninges. She complained headache for 2 months and palpable forehead mass for 3 weeks. Brain MRI demonstrated a soft tissue mass sized as 5.3×3.7×3.1 cm with well-defined osteolysis on the midline of the frontal bone. The mass attached to anterior falx without infiltration into the brain parenchyme. The tumor had extracranial and extraaxial extension with bone destruction. The tumor was totally removed with craniectomy and she had an adjuvant radiotherapy. However, an isolated subcutaneous metastasis developed at the both preauricular area of the scalp, originating from the scar which was remained the first surgery. After complete removal of this metastasis, she had an adjuvant radiotherapy in other hospital. However, she expired after six months after first surgery. We believe that the occurrence of tumor seeding at the site of incision in the scalp is related to using the fluid for irrigation after tumor resection and the same surgical instruments for the removal of the brain tumor.

Leptomeningeal metastases in malignant solid tumors: clinical manifestations and diagnosis / 中华神经科杂志

Objective To improve the understanding of leptomeningeal metastasis (LM),we analyzed the data of clinical manifestations,imaging findings and cytological analysis of cerebrospinal fluid (CSF) in a group of patients with LM of malignant solid tumors.Methods The clinical data of 94 patients with LM of malignant solid tumors between 2009 and 2014 in our hospital were retrospectively analyzed.We compared the clinical manifestations and auxiliary examinations of patients with different pathological types of LM.The Chi-square test was used to compare the results.Results The pathological types included adenocarcinoma (61),small cell carcinoma (24),squamous carcinoma (6),melanoma (1),large-cell carcinoma (1),and hepatocellular carcinoma (1).The median age was 58 (37-75) and the median KPS score was 40 (10-80).About 98.9％ (93/94) patients had neurologic symptoms.Neuroimaging examination was performed in 84 patients,with the sensitivity of 88.1％ (74/84);cytological analysis of CSF was performed in 85 patients,with the sensitivity of 88.2％ (75/85);while CSF biochemical examination was performed in 85 patients,with the sensitivity of 90.6％ (77/85).The sensitivity of cytology in adenocarcinoma (96.6％,56/58) was higher than those in small cell carcinoma (80％,16/20;P =0.056).The sensitivity of neuroimaging in small cell carcinoma (95.8％,23/24) was higher than that in adenocarcinoma (83.3％,45/52;P =0.409).However,the sensitivity of cytology (1/5) and neuroimaging (4/6) in squamous carcinoma was low,which led to the need of comprehensive analysis for the diagnosis.The incidence of headache,spinal nerve-related symptoms,ependymal enhancement and metastatic nodules of lumbosacral intraspinal in adenocarcinoma and small cell carcinoma showed statistically significant difference,which was 88.5％ (54/61) and 29.2％ (7/24;P ＜ 0.01),18.0％ (11/61) and 45.8％ (11/24;P =0.008),2/6 and 25.0％ (6/24;P=0.017),1.9％ (1/61)and50.0％ (12/24;P ＜ 0.01),respectively.Conclusions Neuroimaging and CSF examination are still the key points for the diagnosis of LM of malignant solid tumors.The clinical manifestations are correlated with pathological types of primary tumor.

Radiocirurgia e radioterapia estereotática no tratamento de meningeomas sintomáticos do seio cavernoso / Radiosurgery and stereotactic radiotherapy in the treatment of symptomatic cavernous sinus meningiomas

Introdução: Radiocirurgia estereotática (RCE) e radioterapia estereotática fracionada (RCEF) são inovações modernas de procedimentos radioterápicos, de alta precisão que modelam o feixe de radiação para coincidir com o contorno da lesão, por meio de um sistema de imobilização exata do paciente ao aparelho, com definição do alvo através da fusão de imagens de RM, TC, Angiografia e PET/CT; em que pelas coordenadas de referência estereotática, determina-se que a dose de radiação de alta energia prescrita pelo médico seja depositada somente no volume-alvo, com preservação dos tecidos sadios, órgãos ou estruturas localizadas em suas adjacências. Meningeomas do seio cavernoso (MSCs) representam um problema especial porque podem evoluir comprimindo ou infiltrando estruturas neurovasculares presentes no seio cavernoso. Há evidências de que a RCE e a RCEF proporcionam controle satisfatório do crescimento dos meningeomas do seio cavernoso (MSCs) com efeitos adversos reduzidos. Objetivo: Avaliar resultados da avaliação clínica e da neuroimagem de doentes sintomáticos com MSCs tratados com RCEF ou RCE exclusivamente ou de modo adjuvante à neurocirurgia. Casuística e métodos: Estudo tipo coorte e retrospectivo sobre a avaliação de 89 doentes com MSC sintomático tratados com RCE (36%) ou RCEF (64%) entre janeiro de 1994 e março de 2009 e acompanhados até o final de 2012. Haviam sido submetidos à ressecação neurocirúrgica parcial (Simpson IV) ou à biopsia (Simpson V) previamente à radioterapia 29,2% dos doentes. A dose média de RCE foi de 14Gy, e a dose total de RCEF variou entre 50,4 e 54Gy, sendo fracionada em 1,8-2Gy/dose/dia. Resultados: O período de acompanhamento variou entre 36 e 180 meses (mediana de 73 meses). A percentagem de melhora dos sintomas neuroclínicos individuais e de melhora clínica e radiológica (p > 0,05) apresentou valores semelhantes nos doentes tratados com RCE ou RCEF, sendo respectivamente de 41,6% e 48,3%. Em 37% dos doentes, houve...

Introduction: Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRS) are modern innovations in radiotherapy procedures, precision shaping the radiation beam to match the contour of the lesion, through a system of accurate patient immobilization to the device, defining target through the fusion of MRI, CT, angiography and PET / CT, which is determined by reference to stereotactic coordinates. The radiation dose of high energy prescribed by the doctor to be delivery only in the target interest, with preservation of healthy tissues, organs or structures located in their vicinity. Cavernous sinus meningiomas (CSMs) pose a special problem because they can evolve compressing or infiltrating the neurovascular structures present of the cavernous sinus. There are evidences that SRS and FRS are efficient in the treatment of CSMs. Objectives: The evaluation of the long-term clinical results and neuroimaging findings in patients with symptomatic CSM treated with FSRT or SRS as single therapy or after a previous neurosurgical treatment. Patients and methods: Retrospective cohort study involving 89 patients with symptomatic CSMs treated with SRS (36%) or FSRS (64%) from January 1994 to March 2009, and followed until the end of 2012. Previous neurosurgical partial resection (Simpson IV) or biopsies (Simpson V) had been performed in 29.2% of the patients. The median dose of SRS was 14Gy and the total dose of FSRT ranged from 50.4 to 54Gy, fractionated in 1.8 to 2Gy/dose/day. Results: The follow-up period ranged from 36 to 180 months (median= 73months). There was improvement in the individual symptoms and in the clinical and radiological findings regardless the radiotherapeutic method in 41.6% and 48.3% of the patients treated with SRS or FSRT, respectively (p > 0,05). In 37% of the patients, at least one neurological complaint present before the treatment did not change and in 43.8% patients, the image of the tumor remained stable....

Prolonged Regression of Metastatic Leptomeningeal Breast Cancer That Has Failed Conventional Therapy: A Case Report and Review of the Literature / 한국유방암학회지

Approximately 5% of breast cancer patients develop leptomeningeal metastases over the course of their disease. Though several treatments options are available for these patients, their prognosis is typically considered to be poor. We report a case of leptomeningeal failure after a patient underwent prior radiotherapy, radiosurgery, surgery, chemotherapy, and biologic therapy. This patient experienced a prolonged response after receiving bevacizumab and capecitabine. The literature currently contains several reports regarding the use of systemic therapy to manage leptomeningeal metastases from breast cancer, which we summarize. Finally, we review the relevant effects of the patient's treatment modalities and provide a rationale for the mechanism that led to her prolonged response.

Clinical observation of intrathecal chemotherapy combined with concurrent radiotherapy for leptomeningeal metastases from malignant solid tumors / 中华神经科杂志

Objective To investigate the efficacy and safety of intrathecal chemotherapy combined with concurrent radiotherapy in patients with leptomeningeal metastases from solid tumors.Methods The clinical and follow-up data of 29 patients with leptomeningeal metastases from malignant solid tumor who had intrathecal chemotherapy combined with concurrent radiotherapy were retrospectively analyzed.The treatment regimen was that 12.5-15.0 mg of methotrexate intrathecal injection once a week for 8 successive weeks combined with whole brain irradiation to a total dose of 40 Gy,20 fractions or with lumbosacral spinal canal irradiation to a total dose of 50 Gy,20-25 fractions.Results Nineteen patients completed the concurrent therapy and 19 patients were dead.There were 9 patients with complete remission of symptoms,11 with obvious improved symptoms,6 with alleviated symptoms,and 3 with no relief.All of the 29 patients,were followed up for 0.4-15.0 months.The median survival was 5 months.The 6-month survival rate was 48％ (11/23),excluding 4 patients with follow-up time less than 6 months and 2 patients noncancer deaths.The main toxicities were myelosuppression,methotrexate-related mucositis,chemical nerve root injuries,chemical meningitis,chronic neurotoxicity,seizures,and radiation-related mucositis.The incidence of severe toxicity was 17％ (5/29).Conclusions Combination of intrathecal methotrexate with concurrent radiotherapy can effectively alleviate the symptoms and improve the life quality of patients.The therapy with low incidence of severe toxicity and good tolerance has the trendency to prolong the median survival.

Clinical analysis of carcinomatous meningitis in 63 cases / 中华放射肿瘤学杂志

Objective To analyze the clinical characteristics and the prognostic factors of carcinomatous meningitis(CM). Methods 63 patients with CM treated in Tianjin Medical University Cancer Institute and Hospital from 1998 to 2008 were reviewed retrospectively. The correlations between clinical characteristics, treatment modalities and the prognosis of CM were analyzed. The common primary site was lung cancer(65%)and breast cancer(13%). All the patients were underwent MRI scan and 29 of the patients received lumbar puncture. Fifty-one patients received whole brain radiotherapy, systemic and/or intrathecal chemotherapy. The other 12 patients only received supportive care. Kaplan-Meier method and Log-rank test were used for survival analysis. Results All patients died by the end of follow-up. The follow-up rate was 95%. The number of patients who undergone 1-,2 years follow-up were 59 and 56. The median survival time was 2. 2 months(range :0. 1 -24. 4 months)for the entire group. The clinical stage and the control status of the primary disease were strongly correlated with survival(x2 = 6. 68, P = 0. 036)and(x2 = 7.04, P = 0. 008). The median survival time was 3.0 months(range: 1.0 - 24. 4 months)in patients who received ≥30 Gy whole brain irradiation, while only 1.8 months(range:0. 1-14. 2 months)in those who did not receive radiotherapy(x2 =5.54,P =0. 019). The median survival time of radiotherapy ± chemotherapy group, chemotherapy only group and supportive treatment only group were 3.0 months (range :0. 5 - 24. 4 months), 2. 2 months(range :0. 3 - 14. 2 months)and 1. 2 months(range :0. 1 - 4.5 months), respectively(x2 = 9. 32, P = 0. 009). Conclusions The prognosis of CM is very poor. The clinical stage before the diagnosis of CM and the control status of primary disease and were significantly correlated with survival. Sufficient whole brain irradiation dose may prolong survival and worth further study in a large sample study.

Clinical study of a rare case of primary central nervous system natural killer/T cell meningeal lymphoma / 中华神经科杂志

Objective To explore the clinical features and diagnostic method of primary natural killer( NK)/T cell meningeal lymphoma. Methods An unusual case of a 19-year-old male with primary NK/T cell meningeal lymphoma was reported. His clinical presentation and laboratory findings were discussed. The related literatures have been reviewed. Results The patient presented with diplopia,headache, vomiting and facial drooping at the onset, followed by progressive pain and weakness of the four limbs. Cerebrospinal fluid showed significant increase in pressure, leukocytes number, levels of protein,normal glucose and adenosine deaminase, negative tuberculosis antibody and sterile staining. In cerebrospinal fluid cytological analysis, May-Grunwald-Gimsa staining showed large number of atypical lymphocytes with irregular nucleus and nuclear fission, Ki-67 immunostaining showed extensive proliferative activity of the lymphoid cells. Flow cytometric immunophenotypic analysis of cerebrospinal fluid indicated 97. 98 percent of cells expressed surface CD3, CD7, CD56, CD2, CD5, and partially expressed CD8. This was a rare immunophenotype for NK/T-cell. Cranial MRI with gadolinium showed thickening of the trigeminal nerve with slight enhancement and diffuse leptomeningeal enhancement. CT of the chest and abdomen and bone marrow biopsies were negative. He was diagnosed as primary NK/T cell meningeal lymphoma based on the clinical features and related examination. Conclusions Primary NK/T cell meningeal lymphoma is a rare type of primary central nervous lymphomas which has special immunophenotype. The clinical features include progressive raised intra-cranial pressure, multiple cranial and spinal nerve involvements. Cerebrospinal fluid cytological analysis and flow cytometric immunophenotypic analysis are key work-up for diagnosis. It has poor response to chemotherapy and radiotherapy.

Meningiomas recurrentes: factores asociados / Recurrent meningiomas: associated factors

Objetivo: Identificar los factores relacionados con la recurrencia de los meningiomas intracraneales operados en el INEN. Material y método: Estudio retrospectivo, comparativo, analítico, de caso control. Pacientes con diagnóstico anatomopatológico de meningioma operados con control postoperatorio a cinco años. Resultados: Se realizó la remoción quirúrgica total en 36 pacientes y subtotal en 19 pacientes. Tuvieron recurrencia el 57,8% de los pacientes con resección quirúrgica subtotal y el 33,3% de pacientes con remoción total; esto nos da un OR de 2,7 con una p < 0,05. Se observó mayor recurrencia en pacientes de sexo masculino, con un OR de 1,7. La edad de recurrencia fue de 43,9 +/- 16,3 años versus 40,85 +/- 17,7 del grupo control. El tiempo de recurrencia fue en promedio de 30,7 +/- 16,3 meses. La localización del meningioma que más recurre fue la zona temporal. No existe preponderancia de ningún tipo de meningioma con respecto a la recurrencia. Conclusiones: El factor de la recurrencia fue el grado de resección quirúrgica, encontrándose que un paciente sometido a una remoción quirúrgica subtotal tiene 2,7 veces más posibilidades de presentar recurrencia del meningioma en comparación con la resección quirúrgica total. El sexo masculino presentó mayor recurrencia. La edad promedio fue de 43,9 años. El tiempo de recurrencia en promediofue de 30,7 meses. La localización más frecuente fue la zona temporal. El abordaje que presentó mayor recurrencia fue el frontoparietal. No existió preponderancia de ningún tipo histológico en el meningioma recurrente.

Objective: To identify factors related with recurrence of intracranial meningiomas operated at the Instituto Nacional de Enfermedades Neoplásicas (Peruvian National Cancer Institute). Material and method: Retrospective, comparative, analytical, case control study. Patients operated who had an anatomopathological diagnosis of meningioma and who underwent a post-operative control after five years were included. Results: Total surgical resections were performed in 36 patients, and subtotal resections were performed in 19 patients. Nearly sixty per cent (57.8%) of patients undergoing subtotal resections developed recurrences, as well as 33.3% of those who underwent total resections, giving a 2.7 odds ratio (OR) and p < 0.05. Recurrences were most frequently observed in male patients, with a 1.7 OR. Age of recurrence was 43.9 +/- 16.3 years compared to 40.85 +/- 17.7 in the control group. Time for recurrence was on average 30.7 +/- 16.3 months. The location of most frequently recurring meningiomas was the temporal area. There is no predominance of any type of meningioma with respect to recurrence. Conclusions: The factor for recurrence was surgical resection, and it was found that a patient undergoing a subtotal surgical resection had 2.7 times more likelihood for developing meningioma recurrence compared to total surgical resection. Male patients recurred more frequently. Average age of patients was 43.9 years. Average time for recurrence was 30.7 months.

Recent progress in diagnosis and treatment of carcinomatous meningitis / 国际肿瘤学杂志

Carcinomatous meningitis (CM) represents a devastating metastatic complication of malignant tumour, and the incident of CM is increasing in recent years. The diagnosis is made by both cerebrospinal fluid by lumbar puncture and radiological investigation, mainly magnetic resonance imaging. The therapeutic management of CM includes intrathecal administration of chemotherapy, radiotherapy, surgery and palliative care, but the treatment of CM remains controversial Individualized treatment and combined modality therapy are recommended at present, and the utilization of targeted drug may increase therapeutic effect of CM.

Early diagnosis of patients with meningeal carcinomatosis with carcino-embryonic antigen immunocytochemical stain examination and laser scanning confocal microscope / 中华神经科杂志

Objective To explore the early diagnostic value of carcino-embryonic antigen (CEA) immunocytochemistry examination combined with laser scanning confocal microscope (LSCM) in the patients with meningeal carcinomatosis (MC).Methods The patients were divided into experimental group (patients with MC) and control group (patients without MC).Thermo electron corporation shandon cytospin 4 centrifuge was used in the cytologic examination of cerebrospinal fluid (CSF),whose function was to produce a monolayer of cells onto a glass slide from CSF.Giemsa staining was used in 42 cases.The CEA immunocytochemistry staining was used in 29 cases and 20 controls.The double immunofluorescence staining was used in 17 cases and 20 controls.SP staining method was used in the CEA and the results were observed under the light microscope.Nuclear DNA and CEA were stained with fluorescent probe DAPI and Cy5 respectively and the results of double immunofluorescenee staining were observed by the laser scanning confocal microscope.Results There was a high positive rate in cytologic examination of CSF,and malignant cells were found in all of 42 cases for repeated CSF testing.The positive rate of routine CSF cytologic examination and CEA immunecytochemistry examination was 85.7% (36/42) and 79.3% (23/29) respectively in the first CSF specimens.There were 17 cases using double immunofluorescence staining and observed by LSCM,and the positive rate was 13/17.Compared with experimental group and control group,fluorescent value both nuclear DNA (CEA(+) 1694.04±478.06,CEA(-)1543.04±364.71,control group 603.72±178.04,t=21.386,23.144,both P<0.01) and CEA (CEA(+)1407.04±275.30,control group 202.51±54.05,t=42.934,P<0.01) were significantly different.Conclusion Immunocytochemistry examination of CSF is an important early qualitative diagnosis method for MC.LSCM improved the level of locating,qualitative and quantitative diagnosis of MC.