[Diagnosis of brain tumor with proton MR spectroscopy--the quantification of gliomas compared with normal brain]

We conducted quantification of proton MR spectroscopy (MRS) using water signal as an internal standard, in order to quantify the concentrations of metabolites in normal adult brains and in gliomas in vivo. Single-voxel spectra were acquired using a point-resolved spectroscopic (PRESS) pulse sequence as part of the Probe. P spectroscopy package on a GE Signa Horizon Hispeed LX1.5T scanner (TR/TE/Ave = 3000 msec/30 msec/64). The volume of interest (VOI) varied from 15.0 x 15.0 x 15.0 mm3 to 20.0 x 20.0 x 20.0 mm3 for the brain. The present study included 26 healthy volunteers and 12 patients with gliomas, whose diagnoses were verified by histologic examination. The calculated concentrations of N-acetyl-aspartate (NAA), creatine (Cre) and choline (Cho) in normal hemispheric white matter were 23.66 +/- 1.94 mM (mean +/- SD), 12.97 +/- 1.44 mM, and 4.38 +/- 0.60 mM, respectively. We found they were not necessarily uniform in different parts of the brain, for example, in the pons and basal ganglia. The concentrations of NAA and Cre decreased in all gliomas (p < 0.001). Cho concentration also decreased in the glioma (p < 0.005). The NAA/Cre, NAA/Cho, and Cre/Cho ratios can distinguish normal brain from gliomas, and NAA/Cho ratio can distinguish low-grade astrocytoma from the high-grade group. The results indicate that this noninvasive method offers reasonable estimation of metabolite concentrations in the brain in vivo and therefore is useful in diagnoses of gliomas.

Quantitative assessment of superficial venous insufficiency using duplex ultrasound and air plethysmography

OBJECTIVE

The purpose of this study was to quantitatively evaluate venous reflux in limbs with isolated superficial venous insufficiency using color duplex ultrasound. In addition, air plethysmography (APG) was used to investigate possible correlations of duplex-derived peak velocity, duration of reflux, and CEAP classification.

METHODS

One hundred and forty-six legs in 109 patients with isolated superficial venous insufficiency refluxing throughout the length of the limb were selected for prospective study by duplex scan. Reflux was defined as duration of reflux >/=0. 5 seconds. This study was conducted in a university hospital. Venous reflux was evaluated with the patients standing, by the duration of reflux, retrograde peak velocity, reflux volume at the saphenofemoral and saphenopopliteal junction as well as the greater saphenous vein in the thigh. Values obtained by APG were the venous volume (VV), venous filling index (VFI), ejection fraction (EF), and residual venous fraction (RVF). A significant difference was defined as P <.05. Three groups of limbs were analyzed: group A limbs with a retrograde peak velocity greater than 30 cm/second and a duration of reflux of less than 3 seconds; group B with a retrograde peak velocity >/=30 cm/second and a duration of more than 3 seconds; and group C with a retrograde peak velocity of less than 30 cm/second and a duration of reflux of more than 3 seconds.

RESULTS

Groups A and B contained 103 limbs, and 24 of these were in CEAP class 5 and 6. Group C contained 43 limbs, none of which were in class 5 or 6. APG demonstrated significant reflux in group A, and VFI was significantly higher compared to group B and group C (P =.0007 and P =.0064, respectively). A significant correlation was demonstrated between peak retrograde reflux velocity and VFI.

CONCLUSIONS

Severe chronic venous insufficiency is found in limbs with high reflux velocity (greater than 30 cm/second) and the duration of reflux does not correlate with severe chronic insufficiency.

Clear cell sarcoma arising in the transverse colon

A case of clear cell sarcoma (CCS) arising in the transverse colon is presented. The tumor consisted of sheets or small nests of epithelioid malignant cells possessing pleomorphic nuclei with one or more prominent nucleoli and ample clear or slightly eosinophilic cytoplasm. Some of the tumor cells contained various amounts of melanin pigments that were confirmed by histochemical and ultrastructural examinations. Immunohistochemical examination showed a positive immunoreactivity for HMB45 and S-100 protein. A metastatic nodule, which was found 9 months after surgery, showed similar histological findings to those of the primary one but lacked melanin pigments. Reverse transcriptase- polymerase chain reaction using total ribonucleic acid obtained from metastatic nodule demonstrated the presence of EWS-ATF-1 fusion gene. Based on these findings, the present case tumor is a CCS of the colon.

False localization of rupture site in patients with multiple cerebral aneurysms and subarachnoid hemorrhage

OBJECTIVE

Patients with subarachnoid hemorrhage and multiple intracranial aneurysms present a unique challenge to the neurosurgeon. Unless all aneurysms can be clipped through a single craniotomy, the surgeon must accurately determine which aneurysm has ruptured. Misjudgment may result in disastrous postoperative rebleeding from the untreated but true ruptured lesion. We assessed the risk of false localization of the rupture site and subsequent rebleeding and documented the problems in predicting the true rupture site when patients have multiple intracranial aneurysms.

METHOD

We reviewed the records of a consecutive series of 93 patients treated over a period of 12 years who presented with their first subarachnoid hemorrhage and who had multiple intracranial aneurysms. The rupture site was determined on the basis of computed tomographic and angiographic findings, and the supposed ruptured aneurysm was clipped within 2 days of hemorrhage in each patient. Additional aneurysms that could not be accessed in the same surgical session were operated on at a later stage. All patients' records were reviewed, and all computed tomographic scans and angiograms, including repeat studies performed in some patients, were retrospectively reevaluated by the authors, who had no knowledge of the patients' clinical information.

RESULTS

The location of the aneurysm that ruptured was verified at the time of surgery or during the autopsy in 76 patients (82%). The aneurysm that ruptured was the one predicted as ruptured by the surgeon before surgery in 69 patients (91%) and in retrospect in 72 patients (95%). Five of the 6 patients in whom the ruptured aneurysm was not correctly identified were thought to have only a single aneurysm. Four patients rebled after surgery, and 2 patients died as a result of the rebleeding.

CONCLUSION

In the reported series, the most common cause of rebleeding soon after aneurysm surgery was failure to obliterate the ruptured aneurysm, usually because it was missed on the initial angiogram. The results support not only meticulous radiological investigation of all intracranial arteries before surgery but also thorough surgical inspection of the target aneurysm in all cases of subarachnoid hemorrhage even after one candidate lesion has been discovered.

Color duplex-guided sclerotherapy for the treatment of venous malformations

BACKGROUND

Although surgical extirpation is the standard method for the treatment of vascular malformations, this procedure often leads to loss of motor function, nerve damage, and massive bleeding if the excision is extensive. Sclerotherapy is an alternative method of treatment for venous malformations.

OBJECTIVE

This study was conducted to assess the effect of color duplex ultrasound-guided sclerotherapy on venous malformations and the coagulability induced by sclerosing solution.

METHODS

Twenty-eight patients with venous malformations underwent percutaneous sclerotherapy by direct puncture under duplex ultrasound guidance. Intravenous catheters were inserted into duplex ultrasound-confirmed venous spaces and fine plastic tubing filled with normal saline was attached to the needle. When the needle tip was observed to pierce the vein wall, aspiration of the blood confirmed its intraluminal position. The mean volume of 3.6 ml of 3% polidocanol was injected. Subfascial ligation of the lateral marginal venous collector was performed in patients with Klippel-Trenaunay syndrome. D-dimer (DD) and thrombin-antithrombin III (TAT) were measured preoperatively and on the first and fifth postoperative days.

RESULTS

The head and neck, which was the most common site of venous malformations were involved in 57% of the patients. Venous malformations disappeared in 44% of the patients and decreased in 28%. Localized pain was the most common complication, occuring in 82% of the patients. Sclerotherapy for venous malformations produced significant swelling in 75% of the patients, which required 5-7 days to subside. Significant differences were detected in both DD and TAT concentrations on the first and fifth postoperative days.

CONCLUSIONS

Color duplex-guided sclerotherapy was effective in 82% of the patients. This procedure prevents intra-arterial injection accidents. Although patients with venous malformations showed greater coagulability, no serious thrombotic sequelae were found.

Development of a new inhibitor of glucosylceramide synthase

Analogs of the potent inhibitor of glucosylceramide (GlcCer) synthase, D-threo-1-phenyl-2-palmitoylamino-3-pyrrolidino-1-propanol (P4), based on substitutions in the palmitoyl group were made by means of a stereo-selective synthetic method in order to elucidate the role of the hydrophobic portion in both the inhibitory action toward the enzyme and the biological effects. While P4 strongly inhibited GlcCer synthase with an IC(50) of 0.5 microM in vitro, it also inhibited cell growth by 50% at the concentration of 7 microM. The shorter N-acyl chain analogs including decanoyl, octanoyl, and hexanoyl groups showed similar IC(50) values for GlcCer synthase (around 2 microM) but the hexanoyl analog exhibited only a slight inhibitory effect on cell growth, showing the dissociation between GlcCer depletion and cell growth. Several compounds which exhibit similar hydrophobicity to the hexanoyl analog of P4 were subsequently designed. We found that D-threo-1-phenyl-2-benzyloxycarbonylamino-3-pyrrolidino-1-pr opanol (PBPP) was a most potent inhibitor, showing an IC50 of 0.3 microM. In cultured cells, PBPP was able to deplete glycosphingolipids without affecting cell growth or the ceramide level.

Abnormal pigmentation of schwannoma attributed to excess production of neuromelanin-like pigment

Five cases of non-melanotic pigmented schwannoma with excess accumulation of neuromelanin are presented. The tumors were composed basically of spindle or fusiform tumor cells, compatible with those of classical schwannoma, together with varying numbers of tumor cells containing various amounts of light brown or grayish pigment. Fontana-Masson stain demonstrated argentaffin granules in some tumor cells of each tumor and bleaching with potassium permanganate abolished argentaffin reaction. Ultrastructural examination demonstrated the granules contained fine particles with heterogeneous density, occasionally together with coarse granular materials or amorphous high-density areas, indicating lysosome or autophagosome. Neither typical melanosomes nor neurosecretory granules were detected. In immunohistochemistry, neurogenic markers as well as CD68 were expressed in most tumor cells in each case and various numbers of tumor cells were positive for Leu7 and CD34. Lysozyme was also frequently positive in tumor cells, especially in granular cells. HMB45 was not expressed in any of the cases. These findings indicate that these cases are schwannomas with abnormal accumulation of neuromelanin-like pigment.

[Five cases of cerebral and/or cerebellar embolism after insertion of a heparin-coated catheter from the left thoracoacromial artery]

We reported five cases of cerebral and/or cerebellar embolism after insertion of a heparin-coated catheter from the left thoracoacromial artery for multiple liver metastases. They were one patient with multiple liver metastases from the angiosarcoma of the scalp, and 4 others with gastrointestinal cancer liver metastases. The first case suffered a cerebeller embolism just after removal of a catheter that had been obstructed. In this case, it is possible that the thrombus quickly migrated into a cranial vessel from around the catheter. In the others with patent catheters, the cerebral embolisms occurred more than a month after insertion of the catheters. In the latter cases, it is thought that embolisms did not occur because of catheter insertion maneuver. However, a thrombus that grew around the catheter migrated into the left common carotid artery or the left vertebral artery. The anti-coagulation therapy should be considered for prophylactic treatment.

Reconstruction of perianal skin defect using a V-Y advancement of bilateral gluteus maximus musculocutaneous flaps: reconstruction considering anal cleft and anal function

In order to preserve the anal function after ano-perianal skin excision for malignancy, we have reconstructed a deep, symmetrical natal cleft using a V-Y advancement of bilateral gluteus maximus musculocutaneous flaps thinned medially and sutured to the ooccyx, anococcygeal ligament and the central tendon of the perineum. This technique was applied in three cases of Bowen's disease and two cases of Paget's disease. In all five cases, postoperative anal functions such as comfortable defecation and sensation, were well preserved, the perianal skin and underwear stayed clean, and there was no disturbance of walking or exercise.

Yolk sac tumor of the stomach with an adenocarcinomatous component: a case report with immunohistochemical analysis

A 56-year-old male treated for a gastric yolk sac tumor with an adenocarcinomatous component is described. A mixed area of reticular and glandular neoplastic components was morphologically identified in this tumor. Immunohistochemically, the yolk sac tumor expressed alpha-fetoprotein (AFP), placental alkaline phosphatase (PLAP), and cytokeratin, but was negative for carcinoembryonic antigen (CEA). The adenocarcinoma was positive for CEA and cytokeratin, partially positive for PLAP, and negative for AFP. In the mixed area, the tumor cells were positive for cytokeratin, weakly expressed AFP and PLAP, and sporadically stained for CEA both in the reticular and glandular components. This area was identified as a transitional area of the yolk sac tumor and adenocarcinoma. These findings demonstrate that the yolk sac and adenocarcinomatous components are closely related. It also suggests that the tumor arose from multipotential neoplastic mucosal epithelial cells with both yolk sac and gastric mucosal phenotypes.

Acute massive pulmonary embolism following high ligation combined with compression sclerotherapy for varicose veins report of a case

A case of acute pulmonary embolism following high ligation and compression sclerotherapy for varicose veins is reported. A 54-year-old women developed superficial varicosities and stasis pigmentation on her left leg 1 year prior to her first visit to hospital. No deep vein thrombosis was detected by ascending phlebography performed 3 months prior to operation. High ligation combined with compression sclerotherapy was performed for the varicose veins. One day after treatment, the patient complained of chest pain and discomfort, and then collapsed. Perfusion scintigraphy revealed multiple embolisms in the bilateral lungs. The patient recovered after aggressive anticoagulant and thrombolytic therapy. Although pulmonary embolism is a rare complication of sclerotherapy, it is potentially one of the most serious.

Covalent structures of BmK AS and BmK AS-1, two novel bioactive polypeptides purified from Chinese scorpion Buthus martensi Karsch

Complete amino acid sequences of two novel bioactive polypeptides, each containing 66 amino acid residues, BmK AS and BmK AS-1 purified from the venom of Chinese scorpion Buthus martensi Karsch, have been determined by Edman sequencing and mass spectrometry on native proteins, reduced and S-carboxymethylated proteins and their peptides obtained after cleavage with proteolytic enzymes. Sequence analysis showed 86.4% structural identity between BmK AS and BmK AS-1 and also a high sequence similarity between BmK ASs and AaH IT4, a unique anti-insect toxin and a ligand of Na+ channels obtained from Sahara scorpion A. australis Hector, but poor sequence homology between BmK ASs and those of the known alpha-, beta-type and long-chain insect-selective type scorpion neurotoxins. The positions of four disulfide bridges in BmK AS-1 were established as Cys-12 and Cys-62, Cys-16 and Cys-37, Cys-23 and Cys-44, and Cys-27 and Cys-46, which are the same as those in alpha- and beta-scorpion neurotoxins. These results suggest that BmK ASs and AaH IT4 may form a new group sharing similar structural and functional properties in the family of scorpion neurotoxic polypeptides.

Value of repeat angiography in patients with spontaneous subcortical hemorrhage

BACKGROUND AND PURPOSE

Neuroradiological investigations do not disclose a source of bleeding in some patients with spontaneous subcortical hemorrhage. These patients may harbor undetected vascular malformations and may be at risk of rebleeding in the future. We investigated patients with subcortical hemorrhage with use of repeat angiography and MRI to determine the incidence of occult vascular malformations and the risk of bleeding during follow-up.

METHODS

We reviewed a consecutive series of 137 patients with subcortical hemorrhage during a 10-year period (June 1987 through June 1997). If the patient was <65 years old and the first angiogram and/or MRI did not show a source of bleeding, repeat angiography was recommended. All angiographic and MRI studies were reviewed. The relationship between the identified bleeding source and clinical variables such as patient age, sex, and history of hypertension and the size and location of the hematoma were examined.

RESULTS

One hundred seven patients (78%) underwent angiography on admission, 10 (7%) had immediate surgery for hematoma without angiography, and 20 (15%) had neither angiography nor surgery. Overall, an etiology for the hemorrhage was found in 55 cases (40%). Vascular malformations were common in young patients without preexisting hypertension. A second angiogram was obtained in 22 patients, and 4 arteriovenous malformations were demonstrated. Rebleeding at the site of the initial hemorrhage was not observed after a mean follow-up of 68 months.

CONCLUSIONS

Angiography performed acutely after hemorrhage may not demonstrate vascular malformations. Consideration should be given to repeat angiography in patients who do not have a specific cause for hemorrhage.

Chemical, metabolic and immunological characterization of gangliosides of human glioma cells

The patterns of ganglioside profiles were studied in 10 human glioma and one melanoma cell lines. Ganglio-series gangliosides, GM3 (NeuAc alpha2-3Gal beta1-4Glc beta1-Cer) and GM2 (GalNAc beta 1-4 (NeuAc alpha2-3)Gal beta1-4Glc beta 1-1Cer), and a neolacto-series ganglioside, sialylparagloboside (SPG) (NeuAc alpha 2-3Gal beta1-4GlcNAc beta1-3Gal beta1-4Glc beta1-1Cer), were the predominant constituents. The activities of the two key enzymes, GM3 synthetase and lactotriaosyl ceramide (Lc3Cer) synthetase, alone did not account for the ganglioside profile. Metabolic labeling with the use of [3H]glucosamine-HCl showed more pronounced difference in the synthetic rate of each ganglioside type, in which GM2 was the most strongly labeled in 7 out of the 10 glioma cell lines. On quantifying the chemical content of GM3 and GM2, the GM3/GM2 molar ratio of above 2.0 was arbitrarily classified into GM3 dominant type (KG-1C and Mewo); the ratio below 0.5 was designated as GM2 dominant type (H4, U138MG, U373MG, T98G and A172); and the ratio between 0.5 and 2.0 was regarded as GM3 and GM2-co-dominant type (U87MG, Hs683, SW1088 and U118MG). Subsequently, the capabilities of the antibody binding to these gangliosides were examined in native forms in the cell membrane and in chemically-isolated forms. The intensity of reaction against chemically isolated GM3 and GM2 gangliosides was dependent on the quantity, and GM2 was more reactive than GM3; however, the reactivities on the cell surface did not correlate with the chemical content indicating other factors to influence their immunoreactivities.

Experimental brain injury induces expression of amyloid precursor protein, which may be related to neuronal loss in the hippocampus

Previous reports have demonstrated that some focal brain injuries increase amyloid precursor protein (APP) immunoreactivity in the region surrounding the injury where it was localized, in damaged axons and in pre-alpha 2 cells of the entorhinal cortex. However, to date, APP expression in the hippocampus remote from the impact site has not been comprehensively studied. Therefore, we have evaluated APP expression not only in the locally injured cerebral cortex but also in the hippocampus remote from the impact site. In the present paper, diffuse axonal injury was induced in rats in midline fluid percussion injury. APP expression was examined post injury using Western blot analysis and immunohistochemistry. Western blot analysis demonstrated that the expression of 100-kd APP was increased in both the cerebral cortex and hippocampus 24 h after injury. It then decreased in the hippocampus, but did not change in the cerebral cortex, 7 days after injury. Immunohistochemical studies showed increased immunoreactivity of APP in the neuronal perikarya and reactive astrocytes near the region of injury in the cerebral cortex 24 h to 7 days after injury. In the hippocampus, APP accumulated in the CA3 neurons 24 h and 3 days after injury, although no hemorrhagic lesions were seen at that site. The APP positive neurons in CA3 showed shrunken cell bodies and pyknotic nuclei 3 days after injury, and some of the neurons in CA3 had disappeared by 7 days postinjury. The results of present study suggest that traumatic brain injury induces overexpression and accumulation of APP in neuronal perikarya and that these events are followed by degeneration of CA3 neurons. Further, the decline in APP expression in the hippocampus is thought to be due to neuronal loss in CA3 subsector.

Characterization of a newly established human acinic cell adenocarcinoma cell line (HACC) originating from the salivary gland: morphological features and role of various growth factors on the growth of the HACC cell line

Human acinic cell adenocarcinoma cell (HACC) line was established from the pleural effusion that contains metastatic tumor cells of acinic cell adenocarcinoma of papillary and microcystic type originating from the parotid gland. The HACC cells grew in an adherent monolayer with a doubling time of 66 h. Implanted tumor of SCID mice revealed similar histological findings to that of the primary tumor. The HACC cells produced mucin and expressed epithelial markers as well as alpha1-antitrypsin and lysozyme, whereas salivary peptide P-C was expressed in cultured HACC cells but not in the primary and implanted HACC cell tumors. S-100 protein was also expressed in both the primary tumor and HACC cell line. Neither amplification of common oncogenes nor expression of p53 was observed. The receptor for epidermal growth factor (EGF) was expressed, indicating EGF and transforming growth factor-alpha (TGF-alpha) enhanced the growth of the HACC line. Unexpectedly, tumor necrosis factor-a (TNF-alpha) also enhanced the growth of the HACC line significantly. However, there was no evidence of autocrine growth using these growth factors. In contrast, TGF-beta1 inhibited the growth of the HACC cell line through apoptosis. The HACC cell line has features similar to both acinar and intercalated ductal cells of the salivary gland. Epidermal growth factor, TGF-alpha and TNF-alpha are potential growth factors for the HACC cell line. The HACC cell line may be a good model for studying the biological behavior of salivary gland neoplasms.

Color duplex ultrasound in the assessment of primary venous leg ulceration

METHODS

To determine the extent and severelity of venous reflux, color duplex ultrasound was used in 370 limbs of 303 patients with primary varicose veins. The clinical findings were classified according to the CEAP (clinical, etiologic, anatomic, pathophysiologic) clinical classification.

RESULTS

Of 370 limbs, 32 showed previously healed ulcer (Class 5) and active ulcer (Class 6). Overall reflux in the superficial venous system was seen in 28 limbs (87.5%), and solitary superficial vein incompetence was detected in 13 (40.6%). Reflux was detected throughout the length of the superficial vein system, and the retrograde peak velocity was greater than 30 cm/second in these limbs. Reflux in the perforating veins was detected in 14 limbs (43.8%), but isolated perforating vein incompetence was seen in only one limb (3.1%). Deep vein incompetence was detected in 12 limbs (37.5%). Concomitant superficial and perforating vein reflux was evident in 4 limbs (12.5%) and 2 limbs (6.3%), respectively, but isolated deep vein incompetence was detected in only one limb (3.1%). The operations indicated were selective stripping of the long saphenous vein in the thigh, high ligation of the short saphenous vein, subfascial ligation of perforating veins, and compression sclerotherapy for varicose tributary veins. Healing of the ulcers was achieved within 1 month after surgery, and the postoperative color duplex scanning revealed correction of deep vein incompetence.

CONCLUSIONS

These data suggest that ablation of the superficial vein system and the perforating veins is an appropriate method for the management of patients with primary venous leg ulceration.

Cognitive dysfunction and histological findings in rats with chronic-stage contusion and diffuse axonal injury

The Morris water maze (MWM) technique is well known as a prominent method of evaluating learning acquisition and memory retention impairments in rats. We previously reported on a modified fluid percussion device that is able to consistently produce experimental cortical contusion (CC) and diffuse axonal injury (DAI) in separate groups of rats. The purpose of the present protocol is to evaluate the differences in learning acquisition and memory retention impairments between these two types of injured rats in the chronic stage using the MWM technique. CC and DAI rats are respectively induced by lateral and midline fluid percussion. We also compare the histological differences between these two different types of traumatic brain injury. The results show statistically significant differences in learning acquisition impairment between the sham and CC rats and between the sham and DAI rats. However, a difference in memory retention impairment was expected to be seen only between the sham and DAI rats. Histologically, the loss of CA3 pyramidal cells in the hippocampus was observed ipsilaterally in the CC and bilaterally in DAI. Neuronal cell loss was observed in bilaterally in layer II of the entorhinal cortex in DAI, but not in CC.

Functional reconstruction of forehead with microneurovascular transfer of attenuated and broadened gracilis muscle

Reconstruction of the frontalis muscle is difficult because it is very thin and broad. A technique is described to reconstruct the frontalis muscle with microneurovascular transfer of the gracilis muscle broadened and thinned. This technique is applicable to cases with a large, full-thickness skin defect of the forehead after tumour excision or trauma.

Intracranial facial nerve neurinoma: surgical strategy of tumor removal and functional reconstruction

BACKGROUND

Three cases with intracranial facial neurinoma underwent tumor removal and facial nerve reconstruction with or without tympanoplasty. Surgical strategy for each case was tailored to: (1) the site of main tumor mass, (2) its extension along the facial nerve, and (3) involvement of the auditory organs.

METHODS

Surgeries adopted in the three cases were: transpetrosal approach with intracranial-intratemporal facial nerve anastomosis, middle fossa and transmastoid approach with intratemporal facial nerve anstomosis and tympanoplasty, and middle fossa and transmastoid approach with intracranial-intratemporal facial nerve anastomosis and tympanoplasty. The greater auricular nerve was used as the nerve graft for all three cases.

RESULTS

In the follow-up period of 8-13 months there was no tumor recurrence; facial function was scored 20/90 in modified May's scoring system in each case, but two are still in the process of functional recovery. One of the two cases who underwent tympanoplasty showed complete recovery of hearing within 1 month, and the other showed worsened hearing, which was not serviceable at 3 months postoperatively.

CONCLUSION

Systematic surgical approach for tumor removal, facial nerve reconstruction, and auditory reconstruction should be considered in cases with intracranial facial neurinoma due to its varied clinical features.

Deletion of complex gangliosides of human glioma cells during mitotic cell division

Glycolipid compositions of the human glioma cell line T98G were studied during each phase of the cell cycle to see if those cell surface molecules are concerned with cell proliferation. In vitro cultured non-synchronized T98G cells are composed of ceramidemonohexoside (CMH), ceramidedihexoside (CDH), ceramidetrihexoside (CTH) and neolactotetraosylceramide (nLc4Cer) as neutral glycolipids, and of sulfatide (CS), gangliosides GM3, GM2, GD1a and several other gangliosides as acidic ones. While total glycolipid content per cellular weight was shown to be increased during the M phase, deletion of complex gangliosides particularly b-series gangliosides was recognized (p < 0.05). The glycolipid profile in other phases was fairly consistent, and there was no glycolipid molecule specific to a certain phase of the cell cycle. Relative enhancement of simple gangliosides with a decrease of complex ones during mitotic division may imply the functional involvement of complex gangliosides in cell-cell or cell-matrix attachment, which may have to be abandoned during the process of detachment from the matrix or cellular cleavage.

Mucinous adenocarcinoma arising in a giant urachal cyst associated with pseudomyxoma peritonei and stromal osseous metaplasia

An unusual urachal lesion, which is a mucinous adenocarcinoma arising in a giant urachal cyst and is associated with pseudomyxoma peritonei and stromal osseous metaplasia of the cyst wall, was examined in a 45-year-old male. The cyst was encapsulated, measured 22 x 20 x 20 cm and weighed 3800 g. The unilocular cavity was filled with mucin. Most of the cystic cavity was lined with tall, simple or stratified columnar epithelium with a focus of papillary projection into the cavity. These findings suggest that this cystic lesion represents cystadenoma rather than a simple cyst. Foci of invasive moderately differentiated mucinous adenocarcinoma were detected in the area of macroscopic papillary fronds. Carcinoembryonic antigen and CA19-9 were immunohistochemically positive for tumor cells and their serum levels were also elevated. Stromal dystrophic calcification was extensively observed in the cyst wall with foci of osseous metaplasia. Mucinous implants, which histologically demonstrated adherent mucinous masses without epithelial components on the surface, were observed in the pelvic and abdominal cavity, indicating pseudomyxoma peritonei.