Mixed aneurysm: A new proposed nomenclature for a rare condition.

BACKGROUND: Mixed intracranial aneurysms are vascular lesions appearing in the ruptured saccular aneurysms whose blood is contained by perivascular tissues forming another cavity called pseudoaneurysm. All cases until now have been reported in the literature with subarachnoid hemorrhage. CASE DESCRIPTION: A 65-year-old woman presented with multiple brain aneurysms with no history of subarachnoid hemorrhage. Endovascular treatment was chosen for left-sided aneurysms [lateral carotid wall (LCW) and posterior communicating (PCom)]. After the embolization of the LCW aneurysm, the patient developed a left third nerve palsy. A head computed tomography scan was immediately performed which did not show any SAH. The control angiography demonstrated PCom aneurysm with intraaneurysmal contrast retention even in the venous phase, along with modification of the aneurismal sac format, leading to diagnoses of mixed aneurysm. The PCom aneurysm was successfully coiled and an operation was performed to clip the right side aneurysms. The patient was discharged after 10 postoperative days. CONCLUSION: Mixed intracranial aneurysm has special radiological characteristics that should be promptly recognized to offer the best treatment.

Metastatic prolactinoma: case report with immunohistochemical assessment for p53 and Ki-67 antigens.

Pituitary carcinomas are rare neoplasms characterized by craniospinal and/or systemic metastases originated from the pituitary. Their histopathology is frequently indistinguishable from that of benign adenomas. The development of markers that better reflect their behavior is desirable. We present the case of a 47 year-old man with a prolactin-secreting macroadenoma who was submitted to surgeries, cranial radiation therapy, and bromocriptine treatment, but evolved to a fatal outcome after the disclosure of intracranial metastases. Tumor samples underwent p53 and Ki-67 immunohistochemical assessment. p53 was absent in all samples, a rare finding among pituitary carcinomas. Ki-67 proliferative index was 2.80% in the original tumor, 4.40% in the relapse, and 4.45% in the metastasis. The figure in the relapse is higher than the expected for a noninvasive adenoma. In conclusion, p53 staining is not positive in all pituitary carcinomas. A high Ki-67 proliferative index in a pituitary adenoma might indicate a more aggressive behavior.