Temozolomide for aggressive ACTH pituitary tumors: failure of a second course of treatment.

INTRODUCTION: Temozolomide (TMZ) is an oral alkylating agent that has been used over the past 8 years to treat aggressive pituitary tumors resistant to conventional therapy. To date, only 25 patients treated with TMZ for ACTH producing pituitary tumors (14 adenomas and 11 carcinomas) have been reported. MATERIALS AND METHODS: We present a retrospective review of the medical records of three patients with aggressive ACTH producing adenomas treated with TMZ. In the three cases there was evidence of progression to conventional therapy before starting TMZ. We used the conventional scheme for the treatment of gliomas until completing 7, 12 and 6 cycles respectively. Reduction in tumor size was evident after the 3rd, 5th and 4th cycle of TMZ and progression free survival was 25, 19 and more than 12 months in the three patients respectively. Improvement of the ocular and visual symptoms was evident after the 4th cycle of treatment in all cases. Normalization of urinary free cortisol levels was achieved after the 3rd and 9th cycle in the two cases with hypercortisolism. Two of the three patients received a second course of treatment when the disease progressed but it did not stop tumor progression. The principal side effects were G3 neutropenia, G1 and G2 thrombocytopenia, G1 lymphopenia, asthenia and nausea. CONCLUSION: The treatment with TMZ is effective and safe in patients with aggressive corticotrophin tumors resistant to conventional therapy. Nevertheless once the disease progresses, a second course of treatment does not seem to be effective.

Lesiones cerebelosas en pompas de jabón y adenopatías mediastínicas / Cerebellar soap bubble lesions and mediastinal lymphnodes

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Sordera súbita. Hallazgos en la hemorragia coclear / Sudden deafness: findings in cochlear hemorrhage

La sordera súbita debida a hemorragia laberíntica es una entidad clínica relativamente poco frecuente, y puede ser el único hallazgo demostrable en el estudio de neuroimagen de la sordera súbita, bien como hecho aislado o ligado a una laberintitis, en forma de hiperintensidad laberíntica en secuencias potenciadas en T1 de la resonancia magnética (RM), sin objetivarse refuerzo laberíntico tras la administración de contraste. Presentamos un caso en el que la hemorragia coclear produjo una sordera súbita en una mujer de 22 años previamente asintomática. Revisamos la bibliografía y evaluamos el papel de la existencia de hiperintensidad en los estudios de RM craneal

Sudden deafness owing to labyrinth hemorrhage is a relatively rare clinical entity; labyrinth hemorrhage may be the only demonstrable finding in neuroimaging studies performed for sudden deafness, whether as an isolated finding or associated with labyrinthitis, manifesting as labyrinth hyperintensity in T1-weighted MRI sequences without enhancement after contrast administration. We present a case in which cochlear hemorrhage caused sudden deafness in a previously asymptomatic 22-year-old woman. We review the literature and evaluate the role of the presence of hyperintensity in cranial MRI

Malignant prolactinoma with multiple bone and pulmonary metastases. Case report.

Malignant prolactinomas, as with other pituitary carcinomas, are rare tumors. The authors describe a 14-year-old boy who presented with visual loss caused by a pituitary prolactinoma. He underwent transsphenoidal surgery, radiotherapy, and dopamine agonist therapy, but 6 years after the initial diagnosis his pituitary tumor regrew and bone and pulmonary metastases developed. The authors review the literature and discuss the clinical presentation of malignant prolactinomas, their rarity, histological characteristics, distribution of the metastases, different treatment approaches, and their poor prognosis.

Osificación aislada del ligamento amarillo torácico: una rara causa de mielopatía en nuestro medio / Isolated ossification of the thoracic yellow ligament: a rare cause of myelopathy in our general population

La mielopatía debida a osificación del ligamento amarillo vertebral es una entidad clínica relativamente frecuente en la población asiática, especialmente en Japón, pero extremadamente rara en nuestro medio, habiéndose descrito muy pocos casos en pacientes occidentales. Presentamos un caso en el que la osificación del ligamento amarillo torácico a nivel D9-D11 produjo un síndrome compresivo medular en una mujer caucasiana de 45 años previamente asintomática. Revisamos la bibliografía y evaluamos el papel de las dos técnicas de imagen fundamentales en el diagnóstico de la entidad: TC y RM (AU)