Immunohistochemical Localization of Tenascin-C in Glial Cell Tumors

OBJECTIVE: Growth of cerebral gliomas depends on their neovascularization and invasion into the adjacent neural tissue. There are several extracellular and intracellular factors affecting its growth. Tenascin(TN) is a type of extracellular matrix(ECM) protein which may be responsible for the migration of neoplastic cells and tumor angiogenesis, but its exact role has not been established. We studied the relation between the expression of TN and the histological grade of the glial cell tumors as well as to determine the expression of TN-C in tumor vessel. PATIENTS AND METHODS:In the fifty-six patients with glial cell tumors, we characterized the expression of tenascin-C(TN-C) in the neoplastic vessel, intercellular network, and tumor cell by immunohistochemistry using monoclonal antibody. The relationship between the histological malignancy and TN-C expression was evaluated. In addition, TN-C expression of the tumor vessels was also examined. RESULTS: The tumors included 32 glioblastomas, 13 astrocytomas, 4 pilocytic astrocytoma, 3 anaplastic astrocytoma, 1 pleomorphic xanthoastrocytoma, 1 oligodendroglioma, 1 anaplastic oligodendroglioma, and 1 mixed oligoastrocytoma. TN-C expression in intercellular network of glioblastoma, anaplastic astrocytoma, and astrocytoma was 87. 5%, 66.7%, and 61.5%, respectively. There was a close relationship between the TN-C expression and histological grade of the glial cell tumors. In 28(87.5%) of 32 glioblastomas, TN-C was significantly expressed in the tumor vessels(p<0.05). CONCLUSION: Present results demonstrate that TN-C in the glial cell tumors may be identified as a one of the related factors contributing to malignant progression. And also, enhanced expression of TN-C in the tumor vessels of glioblastoma indicate the possibility that TN-C could be involved in neoplastic angiogenesis.

Extradural Granulocytic Sarcoma in the Cervical Spine

Granulocytic sarcoma is an uncommon tumor composed of immature cells of the granulocytic series, occurring in patients with acute myelogenous leukemia and blast crisis of chronic myelogenous leukemia. It may be rarely preceded by an acute myelogenous leukemia and follows an unformly fatal course. We report a case of granulocytic sarcoma of extradural space presenting as the spinal cord compression without any evidence of leukemia in the peripheral blood. The tumor was located extraduraly in the C6-C7 area compressing the dural sac and spinal cord. After left hemilaminectomy of C6 and C7, this mass was removed completely. Postoperatively, symptoms and signs were improved. At the postoperative 10th day, the patient lost consciousness and peripheral blood study showed the findings of acute myelogenous leukemia. Thereafter, the patient received chemotherapy with Ara-C and Daunorubicin, but hematologic remission was not obtained completely. After 4 months, he revisited our hospital owing to fever, and the septic shock was encountered. The patient died of sepsis.

Prolonged Temporary Arterial Occlusion during Surgery for an Aneurysm of the Dorsal Internal Carotid Artery

The authors describe a case with an uneventful outcome following prolonged temporary arterial occlusion during surgery for an aneurysm of the dorsal internal carotid artery(ICA). It has been shown that in various situations arising during aneurysm surgery, temporary arterial occlusion effectively prevents a premature rupture. It is not possible, however, to predict beforehand what the permissible occlusion time for any individual patient might be. During dissection of a blister aneurysm of the ICA, premature rupture developed, and intermittent temporary occlusion of the ICA, which lasted for about 150 minutes, was then undertaken. In addition, intraoperative neuroprotection was effected in several ways, including intermittent reperfusion and the administration of mannitol, thiopental sodium and steroid. There were no significant postoperative neurological deficits. To the authors' knowledge, this report is unusual in that it documents prolonged temporary occlusion without major neurological sequelae in intracranial aneurysm surgery. Permissible temporary occlusion time and neuroprotective methods are also discussed.

Rostral Midbrain Dysfunction Associated with Hydrocephalus Secondary to Periaqueductal Tumor

The authors report a case of rostral mesencephalic dysfunction due to obstructive hydrocephalus secondary to periaqueductal tumor who suffered multiple shunt failures and shunt revision. This patient presented with clinical syndromes, including akinetic mutism and diencephalic autonomic epilepsy. He had computed tomography(CT) and magnetic resonance(MR) findings of dilatation of ventricular system with periaqueductal tumor. The anatomical substrates of clinical findings are reviewed. A discussion of the probable mechanism proposes that dilatation of 3rd ventricle and rostral aqueduct sufficiently explains the entire syndrome.

Cerebellar Hemangioblastoma: Clinical Presentations and Surgical Outcome

In order to analyze clinical presentations and surgical outcome, we studied eleven cases of cerebellar hemangioblastomas from among a series of 421 intracranial tumors treated over a period of seven years. The proportion of male patients was 2.7 times that of females and the age peak appeared between 30 and 50 years(mean age: 37.7 years old). The common clinical presentations were headache(73%), dizziness(55%), unilateral cerebellar dysfunction(45%), and nausea or vomiting(36%). In our series there were two cases of cranial nerve palsy associated with von Hippel-Lindau(VHL) disease. Polycythemia that normalized postoperatively appeared in two of eleven cases. Radiologic studies showed nine cystic tumors, six in the cerebellar hemisphere and three in the cerebellar vermis, and three solid tumors extended into the brain stem. After aspiration of the cyst, careful removal of the mural nodule gave good results in more than 70% of patients. Because the tumor extended into the brain stem, however, three solid lesions were resected subtotally. Postoperative complications developed in four patients, and in three of these, the lesion extended into the brain stem. In conclusion, major clinical features were due to increased intracranial pressure, and varying expression of cerebellar and cranial nerve deficits was characteristic. To determine the resectability of lesions and to minimize surgical morbidity, extremely careful clinical and neuroradiological observation is essential.