Spinal spindle cell haemangioma: an atypical location.

We present a case of the 31-year-old male patient who complained of weakness in both legs and progressed slowly. Neuroimagine of the thoracic spine showed an intraspinal, extradural mass lesion, measuring 5.3 x 1.2 cm at the Th1-Th3 level. Histologically the lesion was a spindle cell haemangioma composed of dilated vascular spaces and a proliferation of bland appearing interspersed spindle cells. Immunohistochemical analysis was diffusely positive for VIM, SMA and focally for CD34. This lesion is uncommon and shows a predilection for distal extremities. Spindle cell haemangioma within the spine has not been previously reported in the literature.

Primary sellar esthesioneuroblastoma.

We describe an extremely rare case of a primary intrasellar esthesioneuroblastoma.

Spinal epidural rhabdomyosarcoma.

We report an extremely rare case of rhabdomyosarcoma in the lower cervical and upper thoracic spine. The MR imaging appearance of the lesion was nonspecific, and different from the one previously reported. The majority of the tumor was removed surgically less than a month from the onset of symptoms. Treatment was continued with spinal irradiation and chemotherapy, however diffuse leptomeningeal metastases were found six months later.

Permanent inflammatory effect of N-butylcyanoacrylate on vascular wall immunohistochemical analysis.

SUMMARY: We report a case with atypical pattern and time course of inflammatory response after partial embolization of a cerebral arteriovenous malformation with N-butylcyanoacrylate (NBCA), examined by immunohistochemical analysis. This pathomorphological finding of permanent acute inflammation has not been previously reported in humans.

Lymphocytic adenohypophysitis simulating a pituitary adenoma in a pregnant woman.

The lymphocytic hypophysitis, appearing in women during the third trimester of pregnancy or early post-partum period, is a rare cause of hypopituitarism and pituitary enlargement. A 39 year-old woman presented in the 37th week of pregnancy with bilateral heteronymous quadrantanopsia, CT indicative of tumorous mass and symptoms of hypopituitarism with decreased thyroid hormone and thyrotrophin levels, and low normal level of cortisol. After the birth of a healthy male child the patient breastfed for 10 days, sight disturbances disappeared, but amenorrhea persisted. Upon admittance the visual field showed no abnormalities. MR of the sellar region confirmed previous CT findings. Endocrinological testing confirmed secondary hypothyroidism and cortisol deficiency, normal levels of prolactin with satisfactory reaction to thyroliberin. Histology showed mononuclear infiltration, and immunohistochemistry revealed T-cells (CD3) at the borders, and B-cells (CD20) in the follicular center. Due to enlargement of the pituitary associated with hypopituitarism, an incorrect diagnosis of a tumor could be made.

Nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemistry detecting NOS in healthy and chronically inflamed pulp.

The aim of this study was to examine the expression of nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) activity in human dental pulps and determine whether there are changes of the activity in chronically inflamed pulp tissue. Nineteen pulps with clinical diagnosis of chronic pulpitis were collected during endodontic treatment. The healthy controls were obtained from teeth extracted for orthodontic therapy. The clinical diagnosis was confirmed by histological analysis. Healthy pulps showed stratified odontoblasts in peripheral parts, while in central area there was normal connective tissue. Chronically inflamed pulps showed less expressed stratification of odontoblasts and infiltration of lymphocytes, polymorphonuclear leukocytes, plasma cells and mastocytes. NADPH-d granular reactivity was assessed semi quantitatively under the light microscope by a single observer and scored on an intensity scale from negative reaction to very strong reaction. In healthy human pulps, NADPH-d activity was strong to very strong in odontoblastic layer. Endothelial cells and Schwann cells showed strong NADPH-d reactivity, while the other parts of central area were weakly positive. Similar distribution of reactivity was expressed also in chronically inflamed pulp; moderate to strong reaction was observed in stromal area as result of positive reaction in inflammatory cells and endothelial cells of abundant newly formed capillaries.

Syringoid eccrine carcinoma.

A rare case of a syringoid eccrine carcinoma in a 52-year-old male patient is described. During the first hospitalization, syringoma was diagnosed, both clinically and histologically, keeping in mind the possibility of its malignant alteration. Difficulties in making a diagnosis with histological and immunohistochemical examinations are reported. The possibility of differential diagnosis of primary breast carcinoma and methods of its exclusion are also described. Treatment of the patient was surgical with good results.

Comparative immunohistochemical analysis of estrogen receptor and chromogranin-A reactivity in plurihormonal human prolactinomas.

The aim of the study was to compare the immunoreactivity of estrogen receptors (ER) and chromogranin-A (CHR-A) in human prolactinomas with verified plurihormonality. Eleven cases of prolactinomas, nine found in women aged from 15-32 and two found in two men both aged 54 years, were analyzed for possible colocalization of other hormones produced by adenohypophysis, i.e. growth hormone (GH), thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH) and adrenocorticotropic hormone (ACTH). All evaluated cases of prolactinomas were clinically manifested by elevated values of prolactin (PRL) in patient serum, while the values of other assayed hormones were within the normal range. Although biopsy material is not routinely submitted to immunohistochemical analysis for plurihormonality, these eleven cases of operated prolactinomas were randomly examined to the presence of plurihormonality. In six cases of prolactin-producing adenomas, the coexistence of growth hormone was detected. Colocalization of follicle-stimulating hormone and weak expression of adrenocorticotropic hormone were found in two cases each. Thus, bihormonal activity (PRL + GH) was found in six, and trihormonal activity (PRL + GH + FSH and PRL/GH + ACTH) in three cases of prolactinoma. In addition, the presence of prolactin and growth hormone was demonstrated in morphologically different cells. Eight of these eleven pituitary adenomas were tested for estrogen receptors (ER), which play an important role as growth stimulating factors and secretory factors for prolactin-producing cells. We tried to determine if there was a difference in the intensity of expression of estrogen receptors and chromogranin-A between pure prolactinomas and mixed, plurihormonal prolactinomas. By use of monoclonal antibodies, chromogranin-A found to be reactive in seven of eleven prolactinomas, i.e. in plurihormonal prolactinomas. Estrogen receptors were markedly expressed in all the eight prolactinomas analyzed, which may prove significant in the treatment of these hypophyseal tumors.

Concomitant bihemispheric cerebral ganglioglioma and hemangioma in an 18-month-old child: case report.

This is a rare case of concomitant bihemispheric cerebral ganglioglioma and hemangioma in an 18-month-old child. There were two identical processes; a combination of ganglioglioma and hemangioma was located in the parieto-occipital region of both cerebral hemispheres. The child underwent diagnostic computed tomographic and magnetic resonance imaging examinations for seizures and right-sided facial palsy, which showed the bilateral presence of parieto-occipital, oval, well-demarcated, subcortically located processes. A biparieto-occipital craniotomy was carried out and two well-demarcated abnormalities were observed and both were removed in toto. Two years after the operation, the boy had normal psychomotor development and remained free from seizures with no therapy required. Repeat magnetic resonance imaging showed no tumor recurrence. Gangliogliomas are relatively uncommon tumors in childhood, located in the supratentorial compartment and usually associated with seizures. Histopathologic and immunohistochemical analysis of the two processes found in our patient showed them to be a ganglioglioma and a hemangioma, confirming the dysontogenetic origin of these alterations and the association between malformations and tumor growth. The combination of ganglioglioma and hemangioma, especially bilateral presentation of two such identical processes in a young child, is very rare and was not found in the recent literature.

Color Doppler flow imaging of ocular tumors.

AIM: To analyze the usefulness of color Doppler flow imaging in the differentiation of benign and malign ocular tumors. METHODS: Blood flow in tumor and ocular blood vessels was assessed by color Doppler flow imaging in 20 patients with malignant melanoma of the uvea and 19 patients with cavernous hemangioma. Blood velocity measurements in orbital vessels in these patients were compared with the same measurements in 20 healthy individuals. RESULTS: Blood flow inside the tumor tissue was observed in all patients, except in a single case of uveal melanoma. Internal blood flow of intraorbital hemangiomas was slower and their resistance index lower than that of melanomas. Patients with a tumor did not differ from the controls in blood flow velocities in the ophthalmic artery, central retinal artery, and posterior ciliary arteries. Only the patients with uveal melanoma had higher maximal blood flow in central retinal artery and posterior ciliary arteries compared to other patients. CONCLUSION: Color Doppler flow imaging of blood flow can be a useful method to assess the vascularization of ophthalmological tumors, and to differentiate uveal melanoma from orbital hemangioma.

Frequency of skin cancer and other ultraviolet radiation provoked skin lesions of eyelid and periocular region in the 1981-1992 period.

It is well known that the region of eyelids and periocular skin is exposed to ultraviolet radiation (UV rays), so it is the location of skin changes associated with the effects of this radiation. The analysis of basal cell carcinomas, keratoses, keratoacanthomas and cornu cutaneum of this regions covered a 12-year period. In the total of 1,398 skin biopsies from the Department of Ophthalmology, Sestre Milosrdnice University Hospital from Zagreb, the above mentioned lesions were found in 498 cases. Most frequent were basal cell carcinomas (BCC), found in 377 cases, followed by squamous cell carcinoma (SCC) in 64, keratoses in 37, cornu cutaneum in 8 and keratoacanthoma in 12 cases. As BCC was the most frequent finding in the bioptic material from this clinic, special emphasis was put on this tumor, its age and sex distribution, and localization. In the discussion and material analysis, particular reference is given to the causative relation with the effects of UV radiation. As a special contribution to the discussion on the connection of these changes with UV radiation, 3 cases with the occurrence of BCC and seborrheic keratoses in the same lesion and a patient with senile elastosis and BCC in the same segment of the skin of an eyelid are described.

Cortical distribution of gangliosides in Alzheimer's disease.

In Alzheimer's disease, all ganglio-series gangliosides (GM1, GD1a, GD1b and GT1b) were found to be decreased in temporal and frontal cortex, and nucleus basalis of Meynert. In addition, in Alzheimer's disease simple gangliosides (GM2, GM3) were elevated in frontal and parietal cortex, possibly correlating to accelerated lysosomal degradation of gangliosides and/or astrogliosis occurring during neuronal death.

Cavernous angioma in cavernous sinus: case report of a rare location.

A case of cavernous angioma situated in the left cavernous sinus is presented. Occasional difficulties in accessing correct preoperative diagnosis with computerized tomography and angiography were encountered. Intraoperative relationships of neural and vascular structures of the cavernous sinus and tumor mass are described. An "en mass" extirpation was achieved without further neurological damage. A possible origin of cavernous angioma from the 6th cranial nerve is discussed.

Anaplastic ependymoma in children--increasing incidence?

During 1988 and 1989, 16 cases of ependymomas were diagnosed at the Department of Pathology, University Hospital "Sestre milosrdnice", Zagreb. The specimens were obtained from the Department of Neurosurgery of the same hospital. Seven tumors out of these 16 were supratentorial, four of them being diagnosed as anaplastic ependymomas. At the time of the first operation, patients with anaplastic ependymoma were aged 2 to 18 years, and there were three man and one woman. The criteria for this diagnosis were cellular pleomorphism and anaplasia, vascular hyperplasia with marked endothelial proliferation, and the most important of all, the presence of numerous mitoses. Necroses, cystic degenerations and bleeding were found in all four tumors. The aim of this study is the survey of morphology, tumor localisation and patient's age at the moment of diagnosis as relevant factors for the prognosis of these tumors. It seems significant to indicate a relatively great number of these tumors in only a two-year period in one hospital, while statistical data reported in the literature have been taken from several institutions in various towns or states for much longer period of even several decades. Hence, this study could be in favour of the idea presented in the recent literature data, that this tumor type is increasing.

Brain gangliosides in Alzheimer's disease.

The results demonstrated a statistically significant decrease of ganglio-series gangliosides (GTlb, GDlb, GDla, GMl, nmol lipid-bound sialic acid/mg DNA) in frontal and temporal cortex and basal telencephalon of brains with Alzheimer's disease (AD) in comparison to control brains (P less than 0.05). In addition, frontal and parietal cortex also showed somewhat elevated concentrations of simple gangliosides (GM2, GM3, GM4). Changes in gangliosides in seven regions of human brains with AD analyzed, except of the temporal cortex, did not significantly differ in the "a"/"b" ratio (GDla + GMl/GDlb + GTlb) of ganglioside composition in comparison to control brains. In temporal cortex, an decrease of "a"/"b" ratio on the accounts of more decreased GDla and GMl than GDlb and GTlb was found. A decreased concentration of ganglio-series gangliosides in AD probably correlates with degeneration of cortical neurons. However, elevation of simple gangliosides in frontal and parietal cortex might correlate with an accelerated lysosomal degradation of gangliosides and/or astrogliosis occurring during neuronal death.