Meningiomas malignos: análisis etiopatológico, alternativas terapéuticas y asociación con otras patologías / Malignant meningiomas: etiological analysis, therapeutic alternatives and association with different pathologies

Objetivo: analizar en la casuística de los últimos 5 años las distintas variantes que serían determinantes de su desarrollo, agresividad, invasión. Recidivas, la coexistencia con otras patologías, del tratamiento realizado, y efectuar una revisión bibliográfica de la literatura. Material y método: en el período 2005-2009, fueron intervenidos, quirúrgicamente 76 pacientes con diagnóstico de Meningioma, se hallaron 5 con grado II-III. En ellos se consideraron las siguientes variables: sexo, edad, localización, diagnóstico histopatológico, Ki 67, genética y biología molecular, tratamiento quirúrgico, recidiva, radioterapia, terapéutica hormonal y asociación a otras patologías. Resultados: los 5 pacientes (7%) con diagnóstico histológico de Meningiomas agresivos fueron de sexo femenino (100% de los casos), con una edad media de 51 años. En cuanto a la localización: 3 casos se originaron en la hoz cerebral, 1 caso a nivel de la convexidad y 1 caso a nivel columna dorsal. En el 100% de las muestras se realizó Ki 67, EMA, VIM, y receptores a progesterona. La anatomía patológica reveló 4 atípicos y 1 anaplásico. El 90% de los casos presentó recidiva. El tratamiento fue resección quirúrgica seguido de radioterapia postrecidiva, excepto a nivel espinal. En una paciente se asoció a cáncer de mama y otra a cirugía de absceso cerebral. Conclusión: factores genéticos, hormonales y de reparación celular se asocian a la formación de estos tumores. Los actuales avances en biología molecular permitirán tratamientos seleccionados para cada paciente según las características tumorales, hasta la llegada de ese futuro, la cirugía seguida de radioterapia, continúa siendo el tratamiento de elección...

Adenoma acidófilo de células madre: reporte de un caso atípico / Stem cells acidopylic adenoma: report of an atypical case

Objective. We developed a bibliographic research of this rarely and highly aggressive entity, showing our experience and taking into account the special case of one patient, who developed an extremely aggressive disease. Description. Patient of 71 years that consults our department for left cavernous syndrome associated with moderate headache and bilateral visual accuracy diminish. Pituitary IRM was performed showing a homogeneous selar tumor that causes slight mass effect towards optic quiasm. Both cavernous sinuses were compromised. Intervention.Trasfenoidal surgery was performed, reaching the diagnosis of acidophil stem cell adenoma. The patient is dismissed. One week later and because of the development of sudden visual loss she was admitted once again. Pituitary IRM was performed showing a massive growth of the known lesion, requiring transcranial approach. Important mass reduction was achieved but our patient evolution was erratic. Three weeks after surgery we decided to repeat the IRM where we discovered the great mass reduction achieved in the second surgery did not reflect the voluminous lesion shown. One week later the patient died. Conclusion. Acidophil stem cell adenomas of the pituitary gland are mixed PRL/GH lesions, but because its immaturity non functional secreting hormones are produced; this is why these patients do not express physiognomic changes. We should think of this pathology in any pituitary tumor with low PRL-GH expression and few physiognomic changes, and aggressive natural evolution.(AU)

Adenoma acidófilo de células madre: reporte de un caso atípico / Stem cells acidopylic adenoma: report of an atypical case

Objective. We developed a bibliographic research of this rarely and highly aggressive entity, showing our experience and taking into account the special case of one patient, who developed an extremely aggressive disease. Description. Patient of 71 years that consults our department for left cavernous syndrome associated with moderate headache and bilateral visual accuracy diminish. Pituitary IRM was performed showing a homogeneous selar tumor that causes slight mass effect towards optic quiasm. Both cavernous sinuses were compromised. Intervention.Trasfenoidal surgery was performed, reaching the diagnosis of acidophil stem cell adenoma. The patient is dismissed. One week later and because of the development of sudden visual loss she was admitted once again. Pituitary IRM was performed showing a massive growth of the known lesion, requiring transcranial approach. Important mass reduction was achieved but our patient evolution was erratic. Three weeks after surgery we decided to repeat the IRM where we discovered the great mass reduction achieved in the second surgery did not reflect the voluminous lesion shown. One week later the patient died. Conclusion. Acidophil stem cell adenomas of the pituitary gland are mixed PRL/GH lesions, but because its immaturity non functional secreting hormones are produced; this is why these patients do not express physiognomic changes. We should think of this pathology in any pituitary tumor with low PRL-GH expression and few physiognomic changes, and aggressive natural evolution.

Tumor de células gigantes de base de cráneo: reporte de 2 casos y revisión de la bibliografía / Giant cell tumors of the skull base

Objectives: Presentation of two cases of a pathology of the skull base of very low frequency in world-wide literature. Material and methods: First case: male patient, 25 years old. The RMN of brain showed a lesion in selar, supra and paraselar location. Second case: female patient, 40 years old. The RMN of brain showed right temporal lesion with adjacent bone commitment. Results: Both patients were treated surgically, anatomopathologyic diagnosis was giant cells tumor (GCT). Conclusion: The GCT are generally benign, locally aggressive, the surgical excision has proved to be the most effective treatment. The presentation of this work is due to the scant bibliography reported until the moment on GCT of the skull base.