Pathological features of 78 metastatic or multicentric neoplasms involving the central nervous system in dogs / Aspectos patológicos e distribuição de 78 neoplasias metastáticas ou multicêntricas envolvendo o sistema nervoso central de caninos

Secondary neoplasms affecting the central nervous system (CNS) may occur through blood flow or direct extension. This condition occurrence has increased both due to a longer life expectancy of dogs, as well as with the employment of chemotherapeutics, which may increase the survival period and, thus, the odds of the occurrence of metastasis. The aim of this study was to analyze the epidemiological features, such as the age, breed and sex of the animals affected, as well as the gross and microscopic findings of the metastasis from neoplasms involving the CNS of 78 dogs, and, based on the data, estimate the occurrence and frequency of the metastatic or multicentric neoplasms. Females (71.79%) were most affected than males, with an average age of 9.5-years-old and a median of 10-years-old. Most of the cases had a multifocal distribution (73.07%), and epithelial neoplasms (50%) were the most common. Telencephalon was the most affected neuroanatomical region (61.1%). Mammary neoplasms were the most frequent (47.44%), followed by hemangiosarcoma (19.23%), lymphoma (10.26%) and melanoma (6.41%). Less common neoplasms included osteosarcoma, histiocytic sarcoma and lung carcinoma (2.56%). Mammary neoplasms were mainly composed of anaplastic and micropapillary carcinomas, of which only multifocal microscopic lesions were observed.(AU)

Neoplasias secundárias envolvendo o sistema nervoso central (SNC) podem ocorrer por via hematógena ou por extensão direta. A ocorrência desta condição vem aumentando devido à expectativa de vida mais longa dos cães, bem como através do uso de quimioterápicos, os quais podem ampliar a sobrevida e, portanto, as chances para a ocorrência de metástases. O objetivo deste estudo foi analisar os aspectos epidemiológicos, como idade, raça e sexo dos animais afetados, bem como caracterizar os achados macroscópicos e microscópicos de neoplasmas com metástases envolvendo o SNC de 78 caninos e, baseado nestes dados, estimar a ocorrência e a frequência de neoplasias metastáticas ou multicêntricas. Fêmeas (71,79%) foram mais afetadas do que machos, com uma idade média de 9,5 anos e mediana de 10 anos. A maior parte dos casos apresentava distribuição multifocal (73,07%), e neoplasias de origem epitelial (50%) foram as mais frequentes. A localização neuroanatômica mais afetada foi o telencéfalo (61,1%). As neoplasias mamárias foram as mais frequentes (47,44%), seguidas por hemangiossarcoma (19,23%), linfoma (10,26%) e melanoma (6,41%). Osteossarcoma, sarcoma histiocítico e carcinoma pulmonar (2,56%) foram neoplasias menos frequentes. Os tipos de neoplasmas mamários mais observados foram o carcinoma anaplásico e o carcinoma micropapilar, nesses dois tipos as lesões eram multifocais e observadas somente na microscopia.(AU)

Neoplasia de células dendríticas plasmocitoides blásticas con respuesta inicial a quimioterapia y recaída en sistema nervioso central: caso clínico / Blastic plasmacytoid dendritic cell neoplasm with complete clinical remission with chemotherapy and central nervous system relapse: report of one case

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive hematologic malignancy that most commonly manifests as cutaneous lesions with or without bone marrow involvement and leukemic dissemination. The demonstration of tumor cells with the characteristic immunophenotype with expression of CD56, generally CD4 and dendritic cell antigens (CD123, cyTCL-1, HLA-DR), in the absence of myeloid or lymphoid lineage markers is required for the diagnosis. Responses to chemotherapy are initially satisfactory, with frequent systemic and central nervous system relapses. We report a 24 year-old male with BPDCN, initially diagnosed and treated as non-Hodgkin CD4+ T-cell lymphoma, with initial complete remission who evolved with early central nervous system relapse. A second attempt of chemotherapy failed and the patient died two months later.

Cerebrospinal fluid approach on neuro-oncology / Estudo do liquido cefalorraquiano em neuro-oncologia

Central nervous system (CNS) involvement is a major complication of haematological and solid tumors with an incidence that ranges from 10% in solid malignances up to 25% in specific leukaemia or lymphoma subtypes. Cerebrospinal fluid (CSF) patterns are unspecific. Though CSF cytology has a high specificity (up to 95%), its sensitivity is generally less than 50% and no diagnostic gold standard marker is available, yet. New technologies such as flow cytometry, molecular genetics and newer biomarkers may improve diagnostic sensitivity and specificity, leading to the CNS involvement diagnosis, and consequently, to an effective prophylaxis and successful treatment.

O envolvimento do sistema nervoso central (SNC) é uma das maiores complicações das neoplasias de linhagem hematológica e dos tumores sólidos, com uma incidência que varia de 10% nestes últimos até 25% nas leucemias e subtipos de linfomas. Os padrões do líquido cefalorraquiano (LCR) nestes casos é inespecífico. Embora a citologia do LCR tenha uma alta especificidade (acima de 95%), sua sensibilidade é geralmente menor que 50%, e nenhum marcador biológico de padrão-ouro é disponível até o momento. Novas tecnologias, como a citologia de fluxo, a genética molecular e novos biomarcadores poderão aumentar a sensibilidade e especificidade no diagnóstico, levando ao diagnóstico de envolvimento do SNC, e consequentemente a profilaxia efetiva e tratamento bem sucedido.

Fatores de risco para metástases à distância no câncer de cabeça e pescoço / Risk factors for distant metastasis in head and neck cancer

OBJETIVO: Identificar os fatores de risco para o desenvolvimento de metástase à distância (MD) entre pacientes com câncer de cabeça e pescoço cirurgicamente tratados. MÉTODOS: Realizou-se estudo retrospectivo de 253 pacientes entre janeiro de 1997 e dezembro de 2002. Deles, 10 desenvolveram MD durante o seguimento. Foram avaliados: gênero, idade, sítio primário, classificação TNM, nível de doença linfonodal e presença de invasão extracapsular macro ou microscópica. RESULTADOS: A média de sobrevida para pacientes com MD, a partir da finalização do tratamento oncológico, foi de 16 meses (com desvio-padrão de 2,256 meses). A presença de invasão extracapsular macro (risco relativo = 14,429) e microscópica (RR = 17,471) e os estadiamentos patológicos avançados cervical (RR = 4,409) e do tumor primário (RR = 2,929) apresentaram significado estatístico como fatores de risco para MD. CONCLUSÃO: Os fatores de risco para o surgimento de MD foram: invasão extracapsular macro e microscópica, presença de linfonodo positivo à avaliação histopatológica e tumor primário avançado.

OBJECTIVE: To identify risk factors for the development of distant metastasis (MD) among patients with head and neck squamous cell carcinoma (SCC) surgically treated. METHODS: A retrospective study of 253 patients from January, 1997 to December, 2002 was performed. Out of them, 10 patients presented DM during the follow up. The following aspects were analyzed: gender, age, tumor primary site, TNM classification, cervical lymph node status, and the presence of extracapsular spread - gross or microscopic. RESULTS: The survival average for the patients with DM, after finishing the oncological treatment, was 16 months (standard deviation = 2.256). The presence of both gross extracapsular spread (Odd ratio = 14.429) and the microscopic one (OR = 17.471) and the both the neck advanced pathological staging (OR = 4.409) and the primary tumor staging (RR = 2.929) presented statistical significance as risk fators for the occurrence of DM. CONCLUSION: The risk factors for DM were: microscopic and gross extracapsular spread, the pathological presence of positive neck lymph node and advanced primay tumor.

Dural metastases presenting as an extradural hematoma: a rare presentation

We report a case of an elderly man who presented with hemiparesis and plain CT scan findings highly suggestive of an extradural hematoma as the underlying cause. This patient was later found to have dural metastases secondary to bronchogenic carcinoma. Dural metastases are rare, usually presenting as dural mass, but may also present as chronic subdural or extradural hematoma on non contrast CT scan, leading to an erroneous diagnosis in the unsuspecting

Neuroblastoma metastático para o sistema nervoso central / Metastatic neuroblastoma in the central nervous system

O neuroblastoma metastático para o sistema nervoso central é raro. Säo relatados dois casos de neuroblastoma de supra-renal em duas crianças brancas, do sexo feminino, com 13 meses e 24 meses de idade, respectivamente. A primeira apresentou metástases intracranianas durante o tratamento para neuroblastoma disseminado. A segunda paciente apresentou sintomatologia inicial de hipertensäo intracraniana e o tumor abdominal primário somente foi descoberto quando a criança foi avaliada de acordo com nosso protocolo clínico. Alertamos para a importância do exame neurológico na criança com neuroblastoma, principalmente quando há metástases para os ossos do crânio e deteriorizaçäo neurológica.

Central nervous system metastases from breast carcinoma: a clinical and laboratorial study in 47 patients

In this retrospective study, 47 patients with clinical diagnosis of central nervous system metastases of breast cancer were evaluated by computerized tomography (CT), magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. The patients were divided in 2 groups: 1, without leptomeningeal neoplasm and 2, with leptomeningeal neoplasm. In the group 2, the time interval between the primary disease and the central nervous system metastasis as well as the survival time were shorter than in group 1 (40 and 4.3 months in group 2 versus 57 and 10 months respectively, in group 1). In both groups the most common neurological symptons and signs were intracranial hypertension and motor deficits. The most sensitive diagnostic methods were CT and MRI in group 1, and the CSF examination in group 2. The use of the tumor markers CEA and CA-15.3 in the routine examination of CSF showed promissing results, mainly in leptomeningeal forms.

Serum adenosine deaminase and arylsulfatase A as an index of early infiltration of central nervous system in acute lymphoblastic leukemia

The level of adenosine deaminase [ADA] and arylsulphatase A [ASA] in the sera of 22 patients with acute lymphoblastic leukemia [ALL] were significantly increased when compared with the control healthy group. Also, there is a significant increase in the activity of these enzymes in patients with ALL with central nervous system [CNS] infiltration when compared with patients of ALL without CNS infiltration. We conclude that the estimation of ADA and ASA in the serum may be useful for detection of the early infiltration of the central nervous system by leukemic cells in acute lymphoblastic leukemia

Central nervous system leukemic relapse in children with acute lymphoblastic leukemia areview of 36 patients

The aims were to present the outcome of treatment of acute lymphoblastic leukemia [ALL], and to discuss the central nervous system [CNS] leukemic relapse in relation to some risk factors. Patients and Materials: 36 children with acute lymphoblastic leukemia diagnosed at King Hussein Medical Center [KHMC] during a 3- year period were included in this study. All children were given the same systemic chemotherapy with triple intrathecal [TIT] chemotherapy during induction, followed by 1800-2400 cGy cranial irradiation as a prophylactic measure to prevent CNS relapse. Ten children [28%] developed bone marrow [BM] relapse, two [5.5%] testicular relapse and 5 [14%] CNS relapse. Patients with CNS relapse were treated by reinduction of chemotherapy and TIT in the form of weekly injections for 4-6 weeks and every 4-6 weeks thereafter. The median duration of CNS remission was 21 months. CNS prophylaxis therapy during induction and maintenance therapy is important in both high and standard risk groups to reduce the CNS relapse. Treating overt CNS leukemic relapse by TIT chemotherapy on a maintenance schedule, has resulted in prolonged CNS remission in hope that other modalities of treatment will be available

Tumores do sistema nervoso central: abordagem anatomopatológica / Central nervous system tumors: anatomo-pathological approach

A patogênese dos tumores cerebrais é, em grande parte, desconhecida, embora os fatores genéticos pareçam ser imporatantes em algumas de suas formas. Sendo assim, foi revisado o resultado histopatológico de material enviado para análise, proveniente de 173 cirurgias de tumor cerebral realizadas entre 1989 e 1992. O material de estudo foi dividido em três grupos: neoplasias primitivas, infiltraçöes e tumores matastáticos. Segundo os autores, torna-se imperativo o relacionamento constante dos estudos referentes às incidências de neoplasias do sistema nervoso central com métodos e técnicas diagnósticas, bem como as técnicas cirúrgicas adequadas a cada caso

Evolución del cáncer de mama en pacientes menores de 35 años / Evolution of the breast cancer in patients under 35 years

Desde octubre de 1980 a mayo de 1992 se diagnosticaron 18 casos de cáncer de mama en pacientes menores de 35 años (rango 24-35). El estadio de presentación fue E I: 22 por ciento; E II: 67 por ciento; E III: 11 por ciento. En el 50 por ciento (9/18) hubo compromiso axilar (con más de tres ganglios en cinco). Doce pacientes efectuaron QT adyuvante; 7 sin y 5 con antraciclinas. El período libre de enfermedad de las primeras fue 74,4 meses y el de las segundas 20,8 meses. El 60 por ciento presentó metástasis hepáticas; el 40 por ciento pulmonares; el 30 por ciento en SNC y el 20 por ciento en coroides. A la fecha de cierre sobreviven 11/18 pacientes: Nueve libres de enfermedad, 1 en respuesta parcial y 1 en progresión. El promedio de SBV de las 11 pacientes es de 56,5 meses.