Infected intracranial meningiomas.

OBJECTIVE: Infection associated with an intracranial meningioma is an extremely rare condition. Only six cases have been described in the literature. Because of its dual pathologies, initial radiologic diagnosis can be difficult. We present the first reported case of multiple infected intracranial meningiomas and correlate the radiologic and histologic findings. METHODS: A 70-year-old woman presented with sepsis and a left hemiparesis following ureteroscopy and lithotripsy. A large right parietal lesion and a smaller left frontal lesion were diagnosed on magnetic resonance imaging. Diffusion-weighted imaging and an apparent diffusion coefficient map demonstrated features of cerebral metastases. RESULTS: A 2-stage excision confirmed atypical meningiomas containing an intratumoral abscess secondary to Escherichia coli. The patient made a full neurologic recovery. Despite the additional techniques, the radiologic diagnosis was initially challenging because of the dual pathologies. Nonetheless, the radiologic appearance was consistent with the complex histologic findings. CONCLUSIONS: In the appropriate clinical context, diffusion-weighted imaging and apparent diffusion coefficient map aid the diagnosis of infected intracranial meningiomas.

Curvularia fungi presenting as a large cranial base meningioma: case report.

OBJECTIVE: Fungal infections are emerging as a growing threat to human health, especially in immunocompromised patients. Candida, Cryptococcus, and Aspergillus are a few of the commonly encountered organisms leading to brain abscesses. In this report, we describe Curvularia geniculata as the causative agent in central nervous system infection. CLINICAL PRESENTATION: Our review of the literature did not reveal a similar published case of central nervous system infection with this organism. A 35-year-old African-American man presented with obstructive hydrocephalus from a large cranial base lesion. Imaging characteristics on computed tomographic and magnetic resonance imaging scans were consistent with those of a cranial base meningioma. INTERVENTION: The patient underwent an endoscopic transnasal/transclival approach to the anterior middle cranial base for biopsy and decompression of this lesion. A spindle cell proliferation was observed on frozen section, which favored a diagnosis of meningioma. However, on permanent sections, we identified fungal hyphae with budding. Subsequent biopsies grew Curvularia in fungal cultures. Deoxyribonucleic acid sequencing was used to confirm the identification of the isolate as Curvularia geniculata. CONCLUSION: Limited data are available for in vitro susceptibility testing of Curvularia, and treatment modalities have not yet been standardized. The prognosis is usually poor. Despite being treated with voriconazole and intravenous amphotericin, this patient progressed to multiorgan failure and ultimately died. This is the first reported case of central nervous system infection by Curvularia geniculata.

Comparison of the inflammatory responses of human meningeal cells following challenge with Neisseria lactamica and with Neisseria meningitidis.

The rationale for the present study was to determine how different species of bacteria interact with cells of the human meninges in order to gain information that would have broad relevance to understanding aspects of the innate immune response in the brain. Neisseria lactamica is an occasional cause of meningitis in humans, and in this study we investigated the in vitro interactions between N. lactamica and cells derived from the leptomeninges in comparison with the closely related organism Neisseria meningitidis, a major cause of meningitis worldwide. N. lactamica adhered specifically to meningioma cells, but the levels of adherence were generally lower than those with N. meningitidis. Meningioma cells challenged with N. lactamica and N. meningitidis secreted significant amounts of the proinflammatory cytokine interleukin-6 (IL-6), the C-X-C chemokine IL-8, and the C-C chemokines monocyte chemoattractant protein 1 (MCP-1) and RANTES, but it secreted very low levels of the cytokine growth factor granulocyte-macrophage colony-stimulating factor (GM-CSF). Thus, meningeal cells are involved in the innate host response to Neisseria species that are capable of entering the cerebrospinal fluid. The levels of IL-8 and MCP-1 secretion induced by both bacteria were essentially similar. By contrast, N. lactamica induced significantly lower levels of IL-6 than N. meningitidis. Challenge with the highest concentration of N. lactamica (10(8) CFU) induced a small but significant down-regulation of RANTES secretion, which was not observed with lower concentrations of bacteria. N. meningitidis (10(6) to 10(8) CFU) also down-regulated RANTES secretion, but this effect was significantly greater than that observed with N. lactamica. Although both bacteria were unable to invade meningeal cells directly, host cells remained viable on prolonged challenge with N. lactamica, whereas N. meningitidis induced death; the mechanism was overwhelming necrosis with no significant apoptosis. It is likely that differential expression of modulins between N. lactamica and N. meningitidis contributes to these observed differences in pathogenic potential.

Meningioma associated with abscess formation--a case report.

A rare case of meningioma associated with both intratumoral and peritumoral abscess formation occurred in a 38-year-old man presenting with signs and symptoms of elevated intracranial pressure, intracranial infection, and right temporal pole mass lesion. The mass lesion was totally removed, revealing a meningioma. Group B streptococcus and peptostreptococcus were cultured from both the tumor and peritumoral white matter. Hematogenous spread of the organisms related to recent dental work was the likely mechanism.

Peritumoral Citrobacter koseri abscess associated with parasagittal meningioma.

OBJECTIVE AND IMPORTANCE: This is the second report of a Citrobacter-associated brain abscess in an adult and the first report of its association with an intradural tumor. Excluding those associated with trauma, neurosurgical procedures, and proximity to the skull base, only seven other cases of abscesses associated with intracranial tumors have been published. Five of seven tumor-associated abscesses with a microbiological diagnosis involved gram-negative bacteria, a finding that may indicate a predilection of these microorganisms for intracranial tumors. CLINICAL PRESENTATION: A 78-year-old female patient presented with a 6-month history of confusion and personality changes. Her medical history included paroxysmal atrial fibrillation and a 10-day course of high-dose dexamethasone but no other predisposing conditions for sepsis. She was afebrile, had no focal neurological deficits, and had no systemic abnormalities on examination. Computed tomographic imaging revealed a noncalcified, homogeneously enhancing, 3-cm-diameter, extra-axial tumor associated with the right anterior falx cerebri. The tumor did not extend to the skull base. INTERVENTION: At craniotomy, 10 to 20 ml of thick pus was found around the posteroinferior surface of the tumor. On extended culture, this material demonstrated Citrobacter koseri growth, which was effectively treated with ceftriaxone followed by meropenem and one repeated abscess aspiration. No systemic source of the infection was found. CONCLUSION: The characteristic endothelial invasiveness of Citrobacter and related gram-negative bacteria may predispose to the formation of abscesses in association with intracranial tumors.

A case of 'circling seizures' and an intratumoral abscess.

We describe a case of a 38-year-old woman who presented with 'circling' seizures and was found to have an intracranial mass with features consistent with a meningioma. Three weeks prior to her presentation she underwent an uncomplicated vaginal hysterectomy. However, after discharge to home she developed a 4-day history of fever, chills and night sweats that eventually resolved. She underwent surgical removal of her intracranial mass without difficulty but intra-operative pathology showed features of acute cerebritis at the margins of the tumor. Further sectioning of the mass revealed evidence of an intratumoral abscess. Culture of the meningioma revealed heavy growth of Bacteroides fragilis. The patient was treated with intravenous antibiotics, discharged home in excellent health and has had no recurrence of seizures. In our case report we will review the historical literature on the incidence and features of intratumoral abscess. Although it is considered a rare event, our case demonstrates both common and unique features about this occurrence and highlights an unusual chain of events in the natural history of the patient's meningioma and the way in which it became clinically apparent.

Abscess formation within a parasagittal meningioma. Case report.

The authors present the case of a 78-year-old woman who developed right lower-extremity paralysis after a focal seizure. Neuroradiological studies revealed a small parasagittal meningioma, which at the time of resection was found to contain a bacterial intratumoral abscess secondary to Proteus mirabilis. This is only the second reported case of intratumoral abscess formation in a meningioma and the first such occurrence to be reported in an otherwise healthy, immunocompetent individual.

Isolation of Inoue-Melnick virus from human meningioma-derived cell cultures and detection of antibody in patients with meningioma.

Inoue-Melnick virus (IMV) was isolated from six of seven human meningioma-derived cell cultures, while the virus was not isolated from six other brain tumor cell cultures. Sera of 145 consecutive neurosurgical inpatients were tested for IMV-neutralizing antibody. Of 26 patients with meningioma, 22 were positive for IMV antibody (84.6%). Of the remaining 119 patients, 16 were positive.

Cloning of SV40 genomes from human brain tumors.

From two human brain tumors SV40 genomes were isolated by recombinant DNA techniques. The SV40 genome cloned from a human meningioma DNA was shown to be indistinguishable from wild-type SV40. In contrast, the SV40 genome cloned from a human astrocytoma proved to be a nonviable deletion mutant with a truncated early region removing most of the large T-coding region. In addition, this mutant also carries a tandem duplication of an intact origin of replication.

An in vitro study of the susceptibility of cells from a meningioma of human origin for measles virus.

A cell culture from a meningioma of human origin was found permissive for the Edmonston strain of measles virus. Virus was isolated from the supernatant of infected cell sheet as soon as 48 hr post-inoculation. Cytopathic effect, observed by light microscopy, exhibited syncitia plus intracytoplasmic and intranuclear inclusions. Electron microscopy enabled viral nucleocapsids to be observed first in the cytoplasm and secondly within the nucleus of infected cells.

Particles resembling oncornaviruses. Spontaneous release from cultured meningioma cells.

A cell culture from thoracic cord meningioma tissue obtained at surgery was maintained for several passages in cell culture. These cells spontaneously released particles with an RNA of high-molecular weight (90S to 95S) and a density similar to that of type C oncornaviruses. The implications of these results and similar findings by others are discussed.

Simian virus 40-related antigens in three human meningiomas with defined chromosome loss.

Two out of seven meningiomas tested in early cell cultures by indirect immunofluorescence staining showed simian virus 40 (SV40)-related tumor (T) antigen. In one tumor 90% of the cells were positive. An additional SV40-related antigen (U) was found in 10% of cells of a third tumor. These findings indicate that the meningioma cells showing a positive reaction are transformed by a papova virus that has at least partly the same antigenic properties as SV40 virus. SV40-related viral capsid (V) antigen was absent in all the meningiomas tested. No virus infectious for African green monkey kidney (AGMK) cells could be isolated. The tumors positive for T and U antigens showed the chromosome aberration typical for human meningiomas, i.e., the loss of one chromosome, G-22. The T-antigen-positive tumors showed further hypodiploidization. Experiments to rescue virus from the T-antigen-positive tumors showed further hypodiploidization. Experiments to rescue virus from the T-antigen-positive meningioma cells were performed: fusion of cells pretreated with 8-azaguanine with cells premissive for SV40 led to a low percentage (0.01-0.05%) of V-antigen-positive nuclei in heterokaryon cultures. On the basis of these results, the possibility of a correlation between the meningioma, a relatively common intracranial tumor in man, and an SV40-related papova virus must be considered. It remains to be shown whether this virus is a causative agent for human meningiomas.

Particles with RNA of high molecular weight and RNA-directed DNA polymerase in human brain tumors.

We have previously shown that neoplastic cells of human breast cancers, leukemias, lymphomas, and sarcomas contain particles similar to the viruses that have been established as etiologic agents of these diseases in mice. The present paper concerns tumors of the central nervous system for which no suitable animal model or corresponding virus exists. Nevertheless, using the simultaneous detection test, we showed that human brain tumors contain 70S RNA and RNA-directed DNA polymerase encapsulated in a particulate component possessing a density of 1.17 g/ml. These particles satisfy the three diagnostic criteria that characterize RNA tumor viruses of animals. 24 Out of 26 (92%) of the most malignant (glioblastoma and medulloblastoma) brain tumors examined contained these virus-like entities.