Markers of cell division cycle in glioblastoma: significance in prediction of treatment response and patient prognosis.

OBJECTIVE: To investigate whether expression of regulatory components of the cell division cycle can be used independently to predict survival and response to adjuvant therapy in glioblastomas. METHOD: A tissue micro-array, constructed using glioblastomas (n = 66), was stained using antibodies against minichromosome maintenance protein-2 (Mcm-2), expressed throughout the cell-division cycle; geminin, a protein that prevents re-initiation of DNA replication; and cyclin A, an S-phase cyclin. A semi-quantitative labelling index (LI) was calculated using an average of 18 high-power fields (hpf) in three replicate cores. The patients were divided into two groups: Group 1 (n = 50) underwent surgery and radiotherapy with 24 patients receiving temozolomide, and Group 2 (n = 16) received surgical treatment only. RESULTS: The LIs (median +/- IQR) for Group 1 were as follows: Mcm-2, 36.7% (22.9%-51.8%); geminin, 7.8% (5.8%-10.5%); and cyclin A, 4.2% (2.4%-6.9%). Elevated LIs, higher than the median, for geminin and cyclin A correlated with prolonged survival when the tumours received adjuvant therapy (Kaplan-Meier curves, p = 0.0046 and p = 0.0063 for geminin and cyclin A, respectively). Linear regression analysis revealed positive correlations with survival for Mcm-2 (p = 0.0376), geminin (p = 0.0006) and cyclin A (p = 0.004). In Group 2, there was no relationship between the patient survival and the LI for any marker. CONCLUSIONS: Geminin and cyclin A, each show potential as independent prognostic markers in glioblastomas receiving adjuvant therapy. This may reflect the fact that both geminin and cyclin A estimate proliferating tumour cell subpopulations sensitive to radio/chemotherapy. These markers could provide valuable prognostic information, even in small biopsies, especially if combined with O(6)MGMT expression and 1p;19q deletion status.

Pituitary macro adenoma and vestibular schwannoma: a case report of dual intracranial pathologies.

The concurrent presence of multiple primary brain tumours with different histological characteristics is very rare. A case of dual intracranial benign tumours comprising pituitary adenoma and vestibular schwannoma is described. The aetiology and genetic association of these pathologies is explored and the literature of multiple intracranial tumours of different cell types is reviewed.

Retropharyngeal pseudomeningocele.

A 38-year-old male was found to have a retropharyngeal pseudomeningocele along with C1 - C2 dislocation. Absence of any possible history, misleading circumstantial evidence and rarity of the entity made it impossible to diagnose the condition preoperatively. Concurrent medical problems dominated and the patient died. As a result, outcome of the pseudomeningocele could not be evaluated.

The surgical treatment of Chiari malformation association with atlantoaxial dislocation.

Five cases of Chiari malformation associated with atlantoaxial dislocation are presented. A lateral plate and screw fixation was performed in all cases. Reversal foramen magnotomy was performed in three cases and two patients underwent the conventional posterior bony decompression for Chiari malformation. In an average postoperative follow-up period of 8 months (range 3 months to 2 years) neurological symptoms and signs improved in all patients, with radiological and clinical evidence of bony union and stability of the craniovertebral region. The surgical problems encountered in such cases where a posterior decompression was required in addition to a fixation procedure are enumerated in this report. The advantages of the proposed operations are described.