Multiple meningiomas in a woman irradiated in utero.

Meningiomas are a common central nervous system tumour and radiation is a known risk factor for their development. In utero radiation exposure correlates to developmental abnormalities and carcinogenesis in a dose- and gestational age-related manner. Radiation induced meningioma has been reported in detail in the literature in patients who had been irradiated earlier in life. At the time of publication, there was no data on radiation exposure whilst in utero and meningioma. We report on a 42-year-old woman with multiple intracranial meningiomas and no other risk factors except a history of in utero exposure to low dose X-ray radiation at 12weeks gestational age.

Growth rate of vestibular schwannoma.

Vestibular schwannoma (VS) is the most common tumor in the extra-axial posterior fossa compartment in adults. Growth rate is paramount to decision making regarding treatment and follow up of these tumors. We conducted a comprehensive review of the literature to answer four questions: What percentage of newly diagnosed VS will grow on follow-up? What factors correlate to tumor growth? What is the "normal" growth rate for sporadic VS? What factors characterize VS with rapid growth? Thirty-seven reports, with more than 4000 patients, fit our review criteria. One third of newly diagnosed VS will grow on follow-up of 1-3years. However, after 5years, up to one half will grow. Patient age and sex do not influence growth of VS. Hearing loss and vertigo at presentation do not predict tumor growth. It is unclear whether balance disturbance or tinnitus predict tumor growth. Tumor size and location do not predict tumor growth. Growth in the first year of observation is a strong predictor of tumor growth. The average growth rate of a VS is 0.99-1.11mm/year. However, the expected growth rate for VS that have been shown to grow at first follow-up is 3mm/year. Factors that may predict tumor growth of above 4mm/year are cystic and hemorrhagic features in the tumor, and hormonal treatment. VS grow at an average 1mm/year. VS that have been shown to grow at first follow-up should be considered for treatment, unless contraindicated. Long term follow-up is recommended for VS.

Pilomyxoid astrocytoma in the adult cerebellum.

Pilomyxoid astrocytoma (PMA) is a recently recognised World Health Organization (WHO) Grade II tumour that was previously characterised as a subtype of the WHO Grade I pilocytic astrocytoma (PA). PMA has a histological appearance distinct from PA and a poorer prognosis due to its greater propensity for local recurrence and cerebrospinal dissemination. Although originally considered a paediatric tumour involving mainly the hypothalamic and chiasmatic region, reports of the lesion occurring in the adult population and other areas of the neuroaxis are emerging. We review the literature on PMA within the adult population and present the first case of PMA in the cerebellum of an adult female.