Huge cystic craniopharyngioma with unusual extensions: a case report

The findings on computed tomography (CT) of a huge cystic craniopharyngioma in a 3-year-old girl are described. The cyst occupied both anterior cranial fossae and a part of it extended to the region of the third ventricle which was displaced posteriorly. The tumor showed no contrast enhancement after the intravenous administration of contrast medium.

Neuroradiological manifestations of suprasellar pituitary adenomas, meningiomas and craniopharyngiomas

The radiological manifestations of 16 pituitary adenomas, six meningiomas and 14 craniopharyngiomas were reviewed. The differential diagnosis of these tumors is possible with a few exceptions when skull radiography, CT, angiography and metrizamide cisternography are carefully evaluated. Prolonged injection angiography (PIA) is particularly important for demonstrating the contours of pituitary adenomas and meningiomas. Metrizamide cisternography is indicated when the tumor contours are obscure using PIA, or when the differential diagnosis is uncertain.

Primary intracranial sarcomas: radiological diagnosis with emphasis on arteriography

The radiological manifestations of primary intracranial sarcomas may be non-specific and they vary widely according to their histological variations. Reticulum cell sarcomas, however, can be included in the differential diagnosis with a high degree of reliability when one observes a hypovascular mass with arterial encasement and deep medullary veins. Tumor vessels and tumor stains supplied by dilated feeding arteries suggest the possibility of a sarcoma of the brain or of the meninges in infants. Nine reticulum cell sarcomas, four undifferentiated sarcomas, and one fibrosarcoma are presented here with their radiological manifestations, especially on angiography.

Glial fibrillary acidic protein in medulloblastoma

Twenty-four cases of classical medulloblastoma and one case of desmoplastic medulloblastoma were examined for glial fibrillary acidic protein (GFAP) using the immunoperoxidase method to assess astrocytic differentiation. In 16 cases of classical medulloblastoma GFAP-positive cells were present in variable numbers. These cells were classified as three different types according to size and shape. The type 1 cell was morphologically identical to the ordinary tumor cell, with a hyperchromatic nucleus and a scanty cytoplasm. The type 2 cell had a fairly rich cytoplasm with short cytoplasmic processes. The type 3 cell was characterized by a relatively large nucleus with sparse chromatin and well-developed cytoplasmic processes, and was considered a reactive astrocyte. The type 1 and some of the type 2 cells seemed to be neoplastic, displaying astrocytic differentiation. The remaining type 2 cells may have been reactive astrocytes. In one case of desmoplastic medulloblastoma, the majority of GFAP-positive cells were arranged in "islands", and had delicate fibrillated processes. GFAP-positive cells were also observed outside these "islands", though they were less numerous. Most of them were regarded as type 3 cells, but some were type 2. This may be interpreted as meaning that the glial character of the tumor was expressed more within than outside these "islands".

Intraspinal meningioma in childhood

This is a report of a surgically proven meningioma en plaque of the cervical region in a 10-year-old girl.

Antitumor activities of newly synthesized 5-carbamoyl-1 H-imidazol-4yl 1-adamantanecarboxylate and 5-carbamoyl-1H-imidazol-4yl piperonylate

In synthetic studies on the chemical modification of the nucleoside antibiotic bredinin, two new derivatives, 5-carbamoyl-1H-imidazol-4-yl 1-adamantanecarboxylate and 5-carbamoyl-1H-imidazol-4-yl piperonylate, were found to possess a potent antitumor activity in several experimental tumor systems, even though bredinin itself shows only in vitro cytotoxicity and thus lacks therapeutic effectiveness. These two derivatives of bredinin exhibited antitumor activity against a wide variety of tumors, including leukemias L1210 and P388, Lewis lung carcinoma, B16 melanoma, Colon 26 and 38 adenocarcinomas. Ehrlich carcinoma, and Sarcoma 180. It is noteworthy that these agents showed good therapeutic effects not only against ascitic types of tumors but also against a number of slow-growing solid tumor lines, particularly the ascitic and solid forms of Ehrlich carcinoma. At their optimal doses, both compounds effected a complete cure of all or most of the mice treated. Although the mechanisms of action of these compounds remain unknown, they are able to suppress in vivo tumor growth, presumably by being slowly anabolized in vivo to an active form and inhibiting purine de novo synthesis as bredinin does.

Prolonged injection angiography for diagnosing intracranial neoplasms

Prolonged injection angiography (PIA), in which large amounts of contrast material are administered for three or four seconds, was used to visualize the vasculature of 70 intracranial neoplasms. Tumor stains were demonstrated better with or solely by PIA in all pituitary adenomas with suprasellar extension and in most meningiomas. PIA was less effective in tumors with marked arteriovenous shunts or in low-grade gliomas. PIA is especially indicated when avascular or hypovascular masses are encountered on conventional angiography or when contrast enhancement is encountered on computed tomography (CT). PIA is also indicated to demonstrate neoplasms which are not enhanced with contrast media on CT since PIA demonstrates the venous anatomy surrounding the tumors especially well.

Radiosensitive meningioma

A hugh intracranial angioblastic meningioma responded well to preoperative irradiation. The indication for preoperative irradiation of hypervascular and inaccessible meningiomas is discussed.

Angiographic diagnosis of acoustic neurinomas and meningiomas in the cerebellopontine angle--a reappraisal

Forty-two acoustic neurinomas and seven meningiomas in the cerebellopontine angle were reviewed, and the radiological differential diagnosis of these tumors is discussed. Though enlarged internal auditory meati and characteristic CT findings were reasonably reliable indicators for the diagnosis of acoustic neurinomas, it was angiography which substantiated their correct diagnosis. An arcuate vein was frequently demonstrated with acoustic neurinomas, but never with meningiomas. Visualization of tangled veins seems to favor a diagnosis of acoustic neurinomas. Contrary to earlier reports, tumor stains were most frequently visualized using selective external carotid arteriography. The degree of tumor stains did not aid in differentiating acoustic neurinomas from meningiomas. The importance of using angiotomography, especially in the anteroposterior projection, and external carotid angiography during prolonged injections of large amounts of contrast media, is emphasized.

Irradiated meningiomas: a clinical evaluation

Eighteen cases of intracranial meningioma that received preoperative or postoperative irradiation with 60Cobalt or Linac have been reviewed. Eight patients received preoperative irradiation because their tumours were very large, hypervascular, and surgically not readily accessible. Two angioblastic meningiomas of the haemangiopericytoma type responded well to irradiation and were easily extirpated. One of these developed a local recurrence and metastases to the lungs and liver nine years after surgery. The recurrent intracranial tumour and nodules in the lungs responded well to irradiation. The other six cases of meningiomas of meningothelial, transitional, or haemangioblastoma types, did not improve clinically or radiologically after irradiation. Ten cases received postoperative irradiation because their tumours were only partially removed or were histologically malignant. In all cases irradiation was most effective for recurrent tumours of the haemangiopericytoma type. This study indicates that irradiation is useful in tumours of the haemangiopericytoma type as an adjunct to surgery or for palliation in advanced stages. Irradiation may been effective in supressing recurrences in two cases of other types of meningioma, although the number of cases is too small to allow any definite conclusion.

Ciliated and goblet cells in craniopharyngioma. Light and electron microscopic studies at surgery and autopsy

A case of a suprasellar epithelial cyst in a 48-year-old man is reported. The cyst was lined with two different types of stratified epithelium: one was two to three or more layers of squamous cells with overlying ciliated columnar cells and goblet cells at the surface and the other was tyical stratified squamous epithelial cells. The tumor was neither a pure Rathke's cleft cyst nor a typical craniopharyngioma but was considered essentially to be a craniopharyngioma with ciliated columnar cells and goblet cells. Thus it might be considered a mixed form of these two tumors. This case indicates the close relationship between craniopharyngiomas and Rathke's cleft cysts.

Prolonged injection angiography for diagnosing intracranial cavernous hemangiomas

A case of intracranial cavernous hemangioma displaying feeding arteries, tumor stains, and venous pools is presented. Tumors of this type may simulate avascular masses on angiography; however, when surgically excised, they bleed profusely. A correct preoperative diagnosis can help avoid unnecessary incisions. Prolonged injection angiography clearly depicts the tumors and their venous pools, which may be pathognomonic of cavernous hemangiomas.

Angiographic diagnosis of fourth ventricle tumors

Twelve primary fourth ventricle tumors and 22 medulloblastomas occupying mainly the fourth ventricle were analyzed, with emphasis on the differential diagnosis, vascularity, and some unusual findings. Though both types of tumor often have identical manifestations, the correct diagnosis can be made in most cases by careful evaluation of the posterior inferior cerebellar artery, particularly the choroidal and nodular branches. Unusual findings in primary fourth ventricle tumors mimicking tumors of the pons and medulla oblongata are described, and possible explanations for these findings are discussed. The results of this study underscore the importance of angiotomography in the diagnosis of tumors of the fourth ventricle.

[The smear method for histological diagnosis of the tumors of the central nervous system (author's transl)]

The smear method for rapid diagnosis of tumors of the central nervous system at operation is not popular in this country, although this has been widely used in North America and Europe since 1930s. During the period from 1958 to 1976 we experienced 1447 histologically verified tumors of the central nervous system. This smear preparation stained by eosin and methylene blue was made for rapid diagnosis in 718 cases of them. We reviewed these cases and described microscopical findings of various kinds of tumors. In over 90% of cases the correct diagnosis will be obtained from the smears. It can be said that the smear method is appropriate for intraoperative rapid diagnosis of neurosurgical cases.

Intracerebral meningioma with disseminated arachnoidal ossification

A case of intracerebral meningioma associated with disseminated plaques of arachnoidal ossification is presented. The osseous plaques were situated on the same side and predominant in the neighborhood of the tumor. Histologically the ossification was thought to have originated from the wall of the pial vessels.

Extracerebral cavernous hemangioma of the middle fossa

Two cases of extracerebral cavernous hemangioma in the middle fossa are reported. Cerebral angiography showed a large avascular mass lesion in each case, but the tumors were very vascular at operation. Recovery of vision occurred in one case postoperatively. Diagnosis and treatment of these tumors are discussed.

Angiographic manifestations of intracerebral cavernous hemangioma

A case of intraventricular cavernous hemangioma is reported, with a review of the literature, especially that dealing with angiography of intracerebral lesions. Dense venous poolings and a localized area of venous stain were observed in this case.

Lipoma of the cerebellopontine angle. Case report

The authors present a surgical case of a lipoma of the cerebellopontine angle in a 28-year-old woman.

Radiosensitivity of meningioma--analysis of five cases of highly vascular meningioma treated by preoperative irradiation

Preoperative 60Co-irradiation was given in five cases of highly vascular meningioma. Radiation doses ranged from 3,000 to 6,000 rads and were delivered over periods from 17 to 45 days. In one case of tentorial meningioma preoperative irradiation produced a marked reduction in the size and the vascularity of the tumour, as seen on the angiograms, and of the hot area in the brain scan. Papilloedema and abducens palsy also improved. After irradiation the tumour was totally removed. Histopathologically the tumour was a meningioma resembling a haemangiopericytoma. Coagulation necrosis of the parenchyma of the tumour was prominent. In the other four cases (three of meningothelioma type and one of haemangioblastoma type) the preoperative irradiation caused little or no change in the angiograms or in the brain scans. A mild clinical improvement occurred in one case, but deterioration took place in other cases. It may be concluded that preoperative irradiation gives little or no beneficial effect on meningiomas other than those of certain types, such as those resembling haemangiopericytomas, or malignant meningiomas. The clinical and radiological differential diagnosis between the usual types of meningioma and those which are either malignant or resemble haemangiopericytomas is discussed.

3H-thymidine autoradiography of the CSF cells in cases of non-neoplastic disease

Human CSF cells in cases of non-neoplastic disease of the central nervous system (CNS) were examined in vitro by 3H-thymidine autoradiography. Immediately after withdrawl by lumbar or ventricular puncture, the CSF was incubated in a sedimentation chamber at 37 degrees C for 1 hr with an admixture of 3H-thymidine at a concentration of 1-2 muCi/ml CSF. In a few cases the CSF withdrawn was incubated in a glass tube in the same condition as in a sedimentation chamber, and the CSF cells were collected by centrifugation. The CSF cells collected were fixed in methanol and the microautoradiographic procedure was performed. Labeled CSF cells were found in 21 cases out of 22. The average labeling index of the total nucleated cells was 0.22% with the highest labeling of 0.74%. Almost all the labeled cells were thought to be medium to large sized lymphocytes and monocytoids. Peripheral blood was examined by a similar method and the results were compared with those of the CSF. It may be noteworthy that thre exist DNA synthesizing cells in the CSF even in a non-neoplastic state of the CNS, although the number is not large.

The application of immunofluorescence to the study of renal disease. I. Influences of various conditions of specimens and conjugates on the fluorescent patterns of kidney

Some basic problems in immunofluorescence were reexamined, limiting the object to kidneys. As to thickness of sections, 4 mum was demonstrated to be the most reasonable also to kidney specimens. Treatment of PBS for a short time before staining was recommended not only for cleanup effect but also for the possibility to disclose covered antigenic determinants. It was also established that fluorescent antibody with adequate F/P molar ratio, as well as with strict specificity, should be used, in order to prevent "false positives".

Liver alcohol dehydrogenase in Japanese: high population frequency of atypical form and its possible role in alcohol sensitivity

Electrophoretic and quantitative studies reveal that 85% of Japanese carry an atypical liver alcohol dehydrogenase (ADH). The frequency of ADH polymorphism is identical with the reported frequency of alcohol sensitivity in the Japanese population. This identity in population frequencies points to a causative relationship between the two phenomena and suggests that alcohol sensitivity might be due to the increased acetaldehyde formation in individuals carrying the atypical ADH gene.

[Neuroradiologic diagnosis of trigeminal neurinoma originating from the gasserian ganglion (author's transl)]

Three cases of trigeminal neurinoma originating from the Gasserian ganglion were reported. The findings observed on plain roentgenograms, cerebral angiograms and pneumoencephalograms were described in detail. Neuroradiologic examinations used routinely our department for the diagnosis of the skull base tumors were as follows; (1) plain skull examinations, including lateral, straight posterior-anterior, anterior-posterior half axial (Towne), axial, Stenvers, optic canal as well as tomograms in frontal, sagittal and axial projections; (2) angiographies by transfemoral catheter technique including selective internal carotid, external carotid and vertebral angiograms, and orbital-cavernous sinus venography via frontal and femoral veins; (3) pneumoencephalography with tomography. Bone destruction of the middle fossa including foramen ovale, foraman spinosum and lateral aspect of the sella was seen in all cases. Superior orbital fissure, optic canal and anterior surface of the petrous bone were also eroded depending upon the extent of tumors. Sharply circumscribed erosion of the petrous apex was seen in one of 3 cases, indicating the tumor extention into the posterior fossa. A soft tissue mass in the sphenoid sinus and ethmoidal air cells was recognized in all cases. Selective internal and external carotid angiograms demonstrated tumor vessels in 2 of 3 cases. Orbital-cavernous sinus venography was helpful for the interpretation of the lesion extending to the cavernous sinus and its neighboring structures. Conventional gas encephalography showed elevation of the temporal horn, and the concave arch formed by the supracornual cleft and lateral cleft was directed basally and medially in all of the cases. Tomography was also useful in the more detailed analysis of temporal horn. It should be stressed that the plain skull features are most important for deciding which contrast examination should be performed further.

3H-thymidine autoradiography of CSF cells in primary reticulum cell sarcoma of the brain

CSF cells in a case of primary reticulum cell sarcoma of the brain with diffuse subarachnoid spreading were examined by 3H-thymidine autoradiography. Immediately after lumbar puncture, the CSF withdrawn was incubated at 37 degrees C for 1 hr with an admixture of 3H-thymidine at a rate of 1 muCi/ml CSF. The cells were collected by centrifugation and the microautoradiographic procedure was performed. The labeling index (L.I.) of the total CSF cells was 10.5%, and when non-neoplastic cells, i.e. polymorphonuclear leukocytes, small lymphocytes, monocytes etc., were excluded, the real L.I. of the tumor cells in the CSF was supposed to be more than 14.4%. Referring to the results of various brain tumors reported in the literature, this belongs to the highest labeling group. The high L.I. of the tumor cells in this case was well consistent with the extremely rapid clinical course. It should be stressed that the examination of CSF cells by 3H-thymidine autoradiography in cases of brain tumors could be one of the valuable methods indicating the DNA synthesis of the tumor cells, which is an important parameter of malignancy.

Application of double staining technique and incident light fluorescence microscopy to immunofluorescence studies on renal diseases

A method, by which the more precise localization of immunofluorescent deposits in the glomerulus is easily demonstrated with the fluorescence microscopy, was described. By means of this method, the deposits even in the Bowman's space could be identified, as well as the deposits in the subepithelial, subendothlial and mesangial regions. From this result, it was suggested that this method should be widely used for the immunofluorescence studies on human renal biopsied sections, in order to elucidate the relationship between the localization of deposits and renal diseases.