[An autopsy case of pericallosal lipoma with mental retardation].

The patient was a 69-year-old male who had visited our psychological department due to mental retardation. Pericallosal lipoma was indicated by MRI taken during treatment. On December 30, 1998, the patient fell from steps and struck his forehead hard, and then limb palsy occurred. He was emergently brought to our hospital. Under the suspected diagnosis of traumatic cervical spinal cord injury, preventive therapy was performed to observe the clinical course in which paralysis gradually improved. On January 22, 1999, however, he died of cardiopulmonary arrest due to sudden suffocation. In general, the connection of choroid plexus lipoma and pericallosal lipoma is bilateral in most cases. In our patients, MRI suggested that a connection with cerebral ventricles through choroidal fissure existed with no right and left difference, however, autopsy findings revealed that the lipoma existed along the left cerebral arch with obvious connection only with the left choroid plexus. The present case seemed to be a very rare case.

Enhancement of the intracranial arterial wall at MR imaging: relationship to cerebral atherosclerosis.

PURPOSE: To investigate the relationship between intracranial arterial wall enhancement and atherosclerosis. MATERIALS AND METHODS: Intracranial vertebral arteries of 30 patients and carotid arteries of 62 patients were studied with spin-echo magnetic resonance imaging with contrast enhancement and spatial presaturation. Arterial wall enhancement was graded as follows: stage 1, no substantial enhancement; stage 2, faint or thin area of enhancement; stage 3, definite and thick area of enhancement. RESULTS: In vertebral arteries, stage 3 enhancement was seen in 11 patients (mean age, 73.7 years) and stage 1 in eight (mean age, 56.4 years). In carotid arteries, stage 3 enhancement was seen in 13 patients (mean age, 71.0 years) and stage 1 in 21 patients (mean age, 39.0 years). In both arteries, stage was well correlated with age (P < .05). CONCLUSION: Arterial wall enhancement is related to aging and is probably due to neovascularity in association with atherosclerotic plaques. This finding may permit assessment of intracranial atherosclerosis and other vascular diseases.

CT and MRI features of intracranial germ cell tumors.

The computed tomographic (CT) and magnetic resonance imaging (MRI) features of 73 histologically proven primary intracranial germ cell tumors were analysed. CT images were available for all 73 patients, and 22 of them were also examined by MRI. The tumors were classified as germinoma, mature teratoma, immature or malignant teratoma, yolk sac tumor, choriocarcinoma, embryonal carcinoma and mixed type. Germinoma was revealed as a high- or slightly high-density area on plain CT scan, and was enhanced homogeneously. MRI revealed iso- or slightly low signal intensity on T1-weighted images, and iso- or high intensity on T2-weighted images. Mature teratoma, which had a clear margin on neuroradiological images, was characterized by mixed density on CT scans, often showing large cysts and area of calcification. Immature or malignant teratoma had a similar pattern to that of mature teratoma, but the cystic components and area of calcification tended to be less and smaller respectively. The tumor margin was obscure in malignant teratoma, and perifocal edema was observed in some cases. The shape of yolk sac tumors was irregular. Plain CT scan revealed an iso- or low-density mass with good heterogeneous enhancement. Perifocal edema was observed in some cases. In mixed germ cell tumors, MRI imaging was useful for detecting teratomatous components, particularly fatty components. Although definite histological diagnosis cannot be achieved by CT and/or MRI alone, detailed analysis of neuroradiological images are useful for predicting the histological diagnosis.

Disseminated necrotizing leukoencephalopathy following irradiation and methotrexate therapy for central nervous system infiltration of leukemia and lymphoma.

The authors report four adult patients with disseminated necrotizing leukoencephalopathy (DNL) following therapy for central nervous system (CNS) involvements of leukemia and lymphoma. Five to fourteen months after starting therapy with 30.6-62.5 Gy of whole brain irradiation and 120-500 mg of intrathecal methotrexate (MTX), DNL developed. Brain CT scans demonstrated a characteristic symmetrical white matter low density area. Furthermore, the brain CT scans disclosed tumorous lesions with contrast enhancement in three cases. In two of the three cases autopsy proved the tumorous lesions to be necrotic foci but not leukemic tumors. Post-mortem neuropathological studies of three patients disclosed characteristic features of DNL: multiple coagulative necrosis in the white matter with myelin degeneration, swollen axons, prominent calcification, and enlarged reactive astrocytes. Three of the four patients obviously received greater doses of whole brain irradiation and intrathecal MTX than patients who remained free from DNL after treatment with whole brain irradiation and/or MTX. Analysis of the etiological factors in this series underscores the prevailing danger of treatment for neoplastic CNS involvement with excessive doses of whole brain irradiation combined with intrathecal MTX.

Correlation between bromodeoxyuridine-labeling indices and patient prognosis in cerebral astrocytic tumors of adults.

Bromodeoxyuridine (BUdR), a nonradioactive thymidine analogue, is taken up by cells in S-phase, and the ratio of BUdR-positive nuclei to the total number of cells counted is defined as the labeling index (LI). In this study, BUdR LI and the clinical course of 50 cerebral astrocytic tumors in adults were analyzed. The obtained LI distributed continuously in a broad range from 0% to 19%. The mean LI of 28 glioblastomas, 12 anaplastic astrocytomas, and ten astrocytomas were 8.5%, 4.2%, and 1.2%, respectively, and these differences were statistically significant (P = 0.05). In the analysis of LI and the recurrence-free period (RFP), regardless of the histologic findings, 23 patients with LI more than 5% had a median RFP of 9.0 months; the median RFP of nine patients with LI of 3% to 5% was 14.7 months. Nine of 13 patients with LI less than 3% have not yet recurred after a median follow-up of 36 months. These differences were also statistically significant by the generalized Wilcoxon test (P = 0.05). The proliferative potential reflected by the BUdR LI is a good clinical indicator for predicting the rate of tumor growth in cerebral astrocytic tumors. In combination with histologic diagnosis, BUdR LI could help in determining a patient's prognosis more precisely.

[Radiation-induced brain atrophy].

Clinico-pathologic characteristics of radiation-induced brain atrophy were reviewed. Radiation-induced brain atrophy becomes obvious 2 to 3 months after radiation therapy in more than half of the patients who have been irradiated to the brain. Mental and neurologic deterioration were well correlated with the severeness of brain atrophy. Pathologically, demyelinating process secondary to direct neurotoxicity of irradiation seemed to be responsible for the entity. A large target field or whole brain irradiation and the senility of patients were major risk factors. The most important differential diagnosis is normal pressure hydrocephalus which is basically curable. The prognosis of radiation-induced brain atrophy is poor. The only possible method to protect the brain from this pathologic entity is to minimize target field as much as possible.

Subacute brain atrophy after radiation therapy for malignant brain tumor.

Brain atrophy with mental and neurologic deterioration developing a few months after radiation therapy in patients without residual or recurrent brain tumors has been recognized. Two illustrative case reports of this pathologic entity are presented. Six autopsy cases with this entity including the two cases were reviewed neurologically, radiographically, and histopathologically. All patients presented progressive disturbances of mental status and consciousness, akinesia, and tremor-like involuntary movement. Computerized tomography (CT) demonstrated marked enlargement of the ventricles, moderate widening of the cortical sulci, and a moderately attenuated CT number for the white matter in all six patients. Four of the six patients had CSF drainage (ventriculoperitoneal shunt or continuous lumbar drainage), however, none of them improved. Histologic examination demonstrated swelling and loss of the myelin sheath in the white matter in all patients, and reactive astrocytosis in three of the six patients. Neither prominent neuronal loss in the cerebral cortex or basal ganglia, nor axonal loss in the white matter was generally identified. The blood vessels of the cerebral cortex and white matter were normal. Ependymal layer and the surrounding brain tissue were normal in all patients. These findings suggested that this pathologic condition results from demyelination secondary to direct neurotoxic effect of irradiation. The authors' previous report was reviewed and the differential diagnoses, the risk factors for this pathologic entity, and the indication for radiation therapy in aged patients with a malignant brain tumor are discussed.

Malignant growth hormone-secreting pituitary adenoma with hematogenous dural metastasis: case report.

A rare case of growth hormone-secreting pituitary adenoma with hematogenous metastasis to the dura mater of the cerebral convexity is presented. Immunohistological staining was essential to the diagnosis. The histological findings demonstrated that the metastasis was blood-borne. Extensive removal of the tumor and postoperative chemotherapy resulted in partial remission. The mechanism of metastasis, the histological findings, the treatment, and the prognosis are discussed.

[Angioblastic meningioma with metastases to the vertebra and adjacent bones: a case report].

A case of angioblastic meningioma with multiple metastases to the vertebra and the adjacent bones is presented. A 60-year-old man was admitted to our hospital complaining of pain in the left arm, right chest and abdominal wall, the left buttock, and on the posterior surface of the both legs. He had first undergone subtotal removal of tentorial meningioma eight years before admission. Histological diagnosis of angioblastic meningioma was confirmed. He subsequently received radiation therapy when the tumor recurred six years before admission and again underwent subtotal removal of the recurrent tumor, followed by radiation therapy, four years before admission. Bone scintigrams demonstrated abnormal uptake of radionuclide by the vertebral arches of Th 1, Th 10, Th 11, the vertebral bodies of L 4, L 5, the right 7th rib, and the left iliac bone. Myelography and CT examination with intrathecal infusion of metrizamide revealed marked cord-compression by the space-occupying lesions at the level of the first and the tenth thoracic vertebral bodies. Chest roentgenograms, ultrasonograms and whole body CT examinations showed no other lesions. The tumor was partially resected from the iliac lesion. The diagnosis of metastatic meningioma was confirmed by the histological findings. Postoperative radiation therapy to the first, tenth, and eleventh portions of the thoracic vertebra, and the fourth and the fifth portions of the lumbar vertebra--the causative lesions of the pain--relieved the pain.(ABSTRACT TRUNCATED AT 250 WORDS)