Human papillomavirus type 11 and 16 E5 represses p21(WafI/SdiI/CipI) gene expression in fibroblasts and keratinocytes

Here we report that the E5 proteins of human papillomavirus type 11 (HPV-11) and HPV-16 suppressed the expression of the p21(WafI/SdiI/CipI) tumor suppressor gene in NIH 3T3 cells and immortalized human keratinocytes. The promoter activity of p21 was repressed by E5 of HPV-11 and -16, suggesting that p21 gene suppression by E5 was at the transcriptional level. Using an inducible system, we demonstrated that increased induction of HPV-11 E5 in NIH 3T3 cells and keratinocytes led to increased repression of p21 promoter activity. The repression of p21 promoter activity by a series of E5 mutants was somewhat correlated with their respective transforming activities. Previously, we and other investigators showed that the E5 proteins of HPV-11 and -16 can activate the expression of c-jun. The repression of p21 gene expression might be a mechanism of oncogene-mediated growth promotion, since the expression of c-jun also led to a reduction of the levels of p21 RNA and protein in keratinocytes. This is the first demonstration that E5 proteins of HPV-11 and -16 repress p21 gene expression, and this might be one of the mechanisms by which E5 stimulates cell proliferation. In addition, this is also the first report of c-jun repression of p21.

Helicobacter pylori infection and duodenal ulcer in children and adolescents

To investigate the relationship between H. pylori infection and duodenal ulcer in children and adolescents, the markers of H. pylori infection were studied in 22 children and adolescents who had duodenal ulcers and were followed prospectively (Group A). Another 36 patients with gastrointestinal symptoms, but without ulcer, were also studied for comparison (Group B). Antral and duodenal tissues were biopsied and analyzed for the presence of H. pylori using three standard methods: urease test, culture and histology. The specific IgG antibody against H. pylori positivity using the ELISA method were also analysed. By these three methods, H. pylori positivity in the antral tissues, chronic active antral gastritis, and seroprevalence rate were found to be much higher in Group A than Group B. However, a similar trend was not found in the duodenal tissues. H. pylori was found in four of five patients during postoperative follow-up for duodenal ulcer. Among the four patients, no duodenal ulcer but chronic active gastritis was detected endoscopically in three who received vagotomy. Only the one who received simple closure of the perforated duodenal ulcer had a recurrent duodenal ulcer. It was concluded that a close relationship among duodenal ulcer, chronic active gastritis and H. pylori is present in children and adolescents.

Continuous ambulatory peritoneal dialysis complicating with abdominal hernias in children

From May 1991 through December 1995, 10 uremic children ranging in age from 3.6 years old to 14.4 years old underwent insertion of 13 peritoneal dialysis catheters for continuous ambulatory peritoneal dialysis (CAPD). Eight abdominal hernias developed, associated with five catheters (38.5%) in four of the patients. Three hernias were inguinal, three were umbilical, one was epigastric, and one occurred at the catheter insertion site. Six hernias, including one umbilical hernia developing incarceration, were repaired. After operations because of recurrent hernias, two patients were switched from standard CAPD to night intermittent PD (NIPD) using low volumes of dialysate. Male sex and age younger than six years were possible associated risk factors (P = 0.19). In conclusion, hernia in young children undergoing CAPD is not unusual, and early surgical repair is advisable to avoid complications.

Fertilization and embryo cleavage after intracytoplasmic spermatid injection in an obstructive azoospermic patient with defective spermiogenesis

OBJECTIVE

To achieve fertilization and cleavage by spermatids without tails from testicular biopsy.

DESIGN

Clinical trial.

SETTING

Reproductive unit of a university teaching hospital.

PATIENT

A patient of obstructive azoospermia with defective spermiogenesis.

INTERVENTION

Testicular biopsy after scrotal exploration and spermatid injection into the cytoplasm of oocyte.

MAIN OUTCOME MEASURES

Fertilization and cleavage.

RESULTS

Four of 13 spermatid injections achieved normal fertilization and 2 of them cleaved.

CONCLUSION

Intracytoplasmic spermatid injection may be a possible treatment for patients of defective spermiogenesis who have no viable spermatozoa available.

Expression of MDR-1 gene in transitional cell carcinoma and its correlation with chemotherapy response

PURPOSE

Expression of the mdr-1 gene has been correlated with the chemoresistance mechanisms of some cancer models. In the present study, we tried to evaluate mdr-1 gene expression in transitional cell carcinoma (TCC) in both cultured cells and clinical tumors. The expression status of mdr-1 was further correlated with the response to chemotherapy in both systemic and intravesical models.

MATERIALS AND METHODS

We evaluated mdr-1 expression levels by reverse transcription polymerase chain reaction and Southern blotting (RT-PCR-SB) and the activity of P-glycoprotein (P-gp) by flow cytometric rhodamine-123 retention and efflux study in 10 TCC cell lines, 2 doxorubicin-resistant sublines (RLs), T24/A and NTUB1/A, and 2 cisplatin-RLs, T24/P and NTUB1/P. Eighty-eight clinical tumors with their benign counterparts were also assayed by RT-PCR-SB to determine mdr-1 expression status. Of the 88 TCC cases, 28 were treated with systemic and 60 with intravesical chemotherapy. Response to chemotherapy in either form was correlated with mdr-1 expression status.

RESULTS

By RT-PCR-SB, mdr-1 expression signals were observed in only 2 of the 10 TCC cell lines; only 1 of these had a strong signal and active P-gp function. The other, bearing a weak signal, was negative for active P-gp function. All of the 4 RLs studied showed elevated mdr-1 transcript levels as compared with their mdr-1 negative parental cell lines. Doxorubicin-RLs showed much stronger expression signals than cisplatin-RLs. Active P-gp functions were observed in the 2 doxorubicin-RLs but not in the 2 cisplatin-RLs. The efflux of rhodamine-123 in cells with active P-gp function can be significantly inhibited by 10 microM. verapamil. Of the 88 clinical tumors, 62 (70.5%) were positive and 26 (29.5%) were negative for mdr-1 expression by RT-PCR-SB. All benign counterparts of the 88 tumors were positive for mdr-1 expression. However, no differences in chemotherapy responses were found between the positive and negative mdr-1 expression groups in either systemic chemotherapy (p = 0.32, one-tailed Fisher's exact test) or intravesical chemotherapy (p = 0.52, Cox-Mantel log rank test).

CONCLUSIONS

Expression of mdr-1 was not commonly seen in TCC cell lines but can be significantly induced by chronic exposure to doxorubicin. Benign transitional cell epithelia seemed to universally express the mdr-1 gene. However, clinical TCCs lost mdr-1 transcript expressions in about 30% of cases. Most important, it appeared that mdr-1 expression status did not correlate with the response to chemotherapy in either systemic or intravesical models.

The regulation mechanism of c-jun and junB by human papillomavirus type 16 E5 oncoprotein

In this study, we show that HPV-16 E5 induced anchorage-independent growth in immortalized human epidermal keratinocytes and that HPV-16 E5 in human keratinocytes had higher expression of c-jun and junB; also, we investigated the role of transcriptional initiation pathways in the expression elevation. In addition, Ras-dependent pathway, as well as PKC-dependent pathway, leads to HPV-16 E5-induced c-jun gene expression.

Retroperitoneal fibrosis and juvenile rheumatoid arthritis

We describe a 13-year-old girl with juvenile rheumatoid arthritis who developed obstructive uropathy and renal failure. Retroperitoneal fibrosis (RPF) was confirmed by surgery. Although the renal failure and hydronephrosis resolved after surgery, the symptoms of vascular occlusion persisted. We consider that early diagnosis and treatment are essential. In cases of autoimmune disease, RPF should be considered when there is acquired obstructive uropathy accompanied by vascular occlusion syndrome.

Dimercaptosuccinic acid renal scan in children with urinary tract infection

The hospital records of 247 children less than 16 years old, who had had UTI and received dimercaptosuccinic acid (DMSA) renal scans during the period October 1991 to October 1993, were reviewed. Abnormal DMSA renal scans were found in 207 kidneys (207/494, 41.9%) and in 163 cases (163/247, 66%). The appearance of an abnormal DMSA renal scan is correlated with fever and vesicoureteral reflux, but not with age or sex. Because the prevalence of upper UTI in children is high, DMSA renal scan is undoubtedly a valuable tool for pediatricians as a guide in giving appropriate antibiotic therapy and to prevent further renal damage.

Combined cytotoxic effects of tamoxifen and chemotherapeutic agents on bladder cancer cells: a potential use in intravesical chemotherapy

OBJECTIVE

To evaluate whether tamoxifen enhances the cytotoxicity of chemotherapeutic agents on bladder cancer cells, and the possible mechanism(s) of action.

MATERIALS AND METHODS

The in vitro inhibition of cell growth was examined in a model simulating intravesical chemotherapy using two bladder cancer cell lines (TSGH-8301, HTB9) and three commonly used intravesical cytotoxic agents (doxorubicin, mitomycin C, and thiotepa) in the presence or absence of tamoxifen or verapamil as modulators. The expression of the multi-drug resistance-related gene mdr-1 was evaluated by reverse-transcription polymerase chain reaction and Southern blotting (RT-PCR-SB) to determine its transcript level, by flow cytometric analysis of the P-glycoprotein (P-gp) product level with C-219 monoclonal antibody and by the rhodamine-123 retention and efflux assay for P-gp activity. Transforming growth factor beta-1 (TGF beta-1) levels in tamoxifen-conditioned culture medium were determined with enzyme-linked immunosorbant assay (ELISA).

RESULTS

Tamoxifen at concentrations > or = 30 microM significantly enhanced the cytotoxicity of the three chemotherapeutic agents to both cell lines, as shown by a marked reduction in the drug concentration which inhibited growth by 50% (IC50). The enhancement of cytotoxicity was significantly dependent on the concentration of tamoxifen. However, tamoxifen alone caused significant toxic effects to TSGH-8301 at > or = 40 microM and to HTB9 at > or = 30 microM. Median-effect analysis showed additive or less-than-additive combination effects between tamoxifen and chemotherapeutic agents and only a minimal synergism in a narrow range of maximal cytotoxicity (fraction affected > 0.9). Thus, the reduction of IC50s by tamoxifen was mostly because it was cytotoxic to the bladder cancer cells used. No enhancement of cytotoxicity was observed in verapamil-modulated cells. Transcripts of mdr-1 could not be detected by RT-PCR-SB, nor was P-gp detected by flow cytometric analysis in the two cell lines. Furthermore, no active P-gp function was detected by the rhodamine-123 retention and efflux study, indicating that the primary chemoresistance mechanisms of the two cell lines were not mediated by mdr-1, nor could tamoxifen or verapamil act through modulation of the mdr-1 pathway in the two cell lines. Tamoxifen at 3 and 10 microM down-regulated the secretion of TGF beta-1 from TSGH-8301 in a concentration-dependent manner, in contrast to the findings that tamoxifen was cytotoxic to the bladder cancer cells used and that tamoxifen up-regulated TGF beta-1 in a breast cancer model, suggesting that there may be a different mechanism of response to TGF beta-1 in these bladder cancer cells.

CONCLUSION

Tamoxifen enhanced the cytotoxicity of chemotherapeutic agents largely through its toxic effects on the bladder cancer cells. The mode of action of tamoxifen was not through the regulation of TGF beta-1 or the function of mdr-1. Although cytotoxic levels of tamoxifen (> 50 microM) can be achieved easily in the intravesical model, further study is necessary before tamoxifen can be used clinically in intravesical chemotherapy.

Human papillomavirus 11 E5a delays the growth restriction induced by temperature shift in temperature-sensitive simian virus 40 T antigen-immortalized keratinocytes

The transfection with human papillomavirus type 11 E5a oncoprotein can cause longer and more active proliferation in the human keratinocytes previously transfected stably with temperature sensitive SV40 T antigen at 39 degrees C. Also, after the E5a transfection in parental temperature sensitive SV40 T antigen gene transfected cells, we observe a delay in the accumulation of p21 gene at 39 degrees C. Moreover, T antigen degradation did not occur at 39 degrees C in the E5a transfected cells as it did in the parental cells. We draw from these observations that E5a may transiently stabilize temperature sensitive T antigen and/or repress p21 synthesis.

Resolution of vesicoureteral reflux during medical management in children

A retrospective study was performed to evaluate the results of medical management of primary vesicoureteral reflux (VUR) in infants and children. The charts of 105 patients (74 boys, 31 girls) with 167 refluxing ureters were reviewed. The age at diagnosis ranged from 3 days to 9.2 years (mean 1.3 +/- 1.9 years). The mean duration of follow-up was 2.4 +/- 1.5 years. We found that the patient's sex did not influence the fate of VUR and its complications. Patients whose reflux improved while being managed medically were younger than those who did not improve, and the younger the patient the sooner the reflux resolved. Improvement and resolution of reflux were also related to grade, and the lower the initial grading the sooner the reflux resolved. Spontaneous resolution rates of reflux were 92.3%, 76.2%, 61.7%, and 32.0% for grades I, II, III, and IV, respectively. No ureters with grade V reflux resolved without complications. The most common complications in our series were renal scarring and secondary obstructive uropathy.

Small bowel volvulus

Two cases of small bowel volvulus with mild clinical symptoms in which upper gastrointestinal series, computed tomography, and magnetic resonance imaging were performed are reported. Angiography was also performed in one case. Neither patient received laparotomy and the diagnosis was based on imaging findings.

CT of the duodenojejunal junction

To determine the location of the duodenojejunal junction (DJJ) at computed tomography (CT), we retrospectively reviewed 309 consecutive CT examinations. These included 162 men and 127 women (mean age = 57 years old, range = 11-85 years old). Some people received more than one examination. The clinical indications included various kinds of neoplasms, inflammations, congenital lesions, trauma, and other conditions. The DJJ was defined as the first sectioned ascending duodenum whose major part lies to the right side of the crossing part of the inferior mesenteric vein over the immediate beginning of the jejunum. Forty-nine examinations were excluded due to distortion of the DJJ by contiguous pathologic processes or nonadministration of intravenous contrast medium. In 36 examinations, the junctions were not identified. In the successfully identified 224 examinations, the DJJ was located to the left in 75 (33.5%), in the left half in 87 (38.8%), and in the right half or to the right of the vertebral body in 4 (1.8%) examinations. The midline of the DJJ was along the left margin and in the midline of the vertebral body in 53 (23.7%) and 5 (2.2%) examinations. In the anteroposterior direction, it was totally in front of the aorta in 189 (84.4%) and within the projected contour of the aorta in 11 (4.9%) examinations. The midline of the DJJ was along the anterior margin of the aorta in 24 (10.7%) examinations. Its cephalocaudal position was at the upper L1 in 36 (16.1%), lower L1 in 70 (31.3%), upper L2 in 75 (33.5%), and lower L2 in 21 (9.4%) examinations even though it ranged from upper T12 to upper L3.(ABSTRACT TRUNCATED AT 250 WORDS)

Tamoxifen enhances the chemosensitivity of bladder carcinoma cells

PURPOSE

Chemosensitizers, which enhance cellular chemosensitivity and reduce chemoresistance, are expected to substantially improve response rates of systemic chemotherapy for patients with metastatic bladder cancer. Tamoxifen is a nonsteroidal antiestrogen that has been shown to reverse drug resistance in vitro in some cancer models through pathways not related to its antiestrogenic effect. In this study we tried to evaluate its possible effect on chemosensitization of bladder cancer cells.

MATERIALS AND METHODS

In vitro chemosensitivity tests were done with 3 bladder cancer cell lines and 4 cytotoxic agents (methotrexate, vinblastine, doxorubicin and cisplatin) in the presence or absence of graded concentrations of tamoxifen. Verapamil was used in parallel experiments to compare the degrees of chemosensitization. The transcript and protein product [P-glycoprotein, (P-gp)] levels of the mdr-1 gene were also examined in the 3 cell lines by reverse-transcription polymerase chain reaction (RT-PCR) and flow cytometric assay, respectively.

RESULTS

Tamoxifen at 5 and especially 10 microM. concentrations, which were minimally toxic to the 3 bladder cancer cell lines used, enhanced the chemosensitivity of bladder cancer cells in most drug combinations in a dose-dependent manner. In some combinations 10 microM. tamoxifen did better than 5 microM. in chemosensitization. The effect of chemosensitization was more evident in cells treated with 10 microM. tamoxifen plus methotrexate and vinblastine in which 12.9 to 95.4-fold and 12.4 to 21.3-fold IC50 reduction was observed, respectively. A less prominent, but still significant, effect could be seen in doxorubicin- and cisplatin-treated cells. Verapamil, although used at concentrations up to 10 microM. which are higher than systemically tolerable, was not able to enhance chemosensitivity of the 3 bladder cancer cell lines. By flow cytometric analysis of the P-gp level and by RT-PCR assay of the mdr-1 gene transcript level, it was shown that little if any mdr-1 gene expression could be detected in the 3 cell lines. This implies that the mdr-1 gene function may play a minimal role in drug resistance mechanisms of bladder cancer cells and that tamoxifen exerts its chemosensitization effect through pathways other than mdr-1 gene function modulation.

CONCLUSIONS

Tamoxifen was shown to be a good chemosensitizer in a bladder cancer cell model and may well be tried in combination with systemic chemotherapy for metastatic human bladder cancers in the clinical setting.

Effect of body tilting on physiological functions in healthy term neonates

The effect of body tilting on physiological functions was studied in 32 healthy, full-term neonates at 2 and 24 h of age. The neonates were placed in the supine position and the physiological functions were measured in the sequence of -30 degrees (head-down), 0 degree and 30 degrees (head-up) tilts. Arterial oxygen saturation and respiratory rate were comparable in the vaginal delivery and caesarean section groups. The baroreceptor responses were similar in the neonates delivered vaginally and by caesarean section. Mean heart rate increased on 30 degrees up tilting and the responses tended to be larger at 24 h compared with those at 2 h of age, but these differences were not significant. At 2 h of age, mean systolic and diastolic blood pressures decreased on 30 degrees up tilting. At 24 h of age, mean systolic and diastolic pressures decreased on up tilting (from -30 degrees to 0 degree) and the values were sustained on further up tilting (from -0 degree to 30 degrees). The present results indicate that baroreceptor reflexes are present from birth and the responses tend to be less developed at 2 h than those at 24 h of age.

Successful medical treatment for staphylococcal vertebral osteomyelitis complicated by spinal epidural abscess, psoas abscess and meningitis: a case report

A 42 year-old farmer was transferred to our hospital for recently exaggerated lower back pain. Neurological examination revealed an L4 radiculopathy on the right side. Meningitis developed after admission. MRI showed L4-5 osteomyelitis and discitis with contiguous spinal epidural abscess and right psoas abscess. Blood culture and CSF culture both grew Staphylococcus aureus. Because the patient refused to receive a drainage procedure, we gave him antibiotics which resulted in a favorable outcome.

Computed tomography and magnetic resonance imaging of intracranial ependymomas

We evaluated the neuroimages of 18 pathologically proven cases of ependymoma, 15 cases by CT evaluation and 9 cases by MRI evaluations. In 7 cases of supratentorial ependymomas, 4 were intraparenchymal and 3 were intraventricular ependymomas originating from the ependymal lining layer, the floor of the lateral ventricle, which was best demonstrated on a sagittal MR image. For the cases of infratentorial ependymomas, all were intraventricular. Evidence of seeding through the cerebrospinal fluid pathway to the basal cisterns, spinal cord or ventricles was presented in 6 cases which were particularly well demonstrated in the sagittal section with gadolinium-DTPA enhanced MR imaging. On CT scan, isodense tumors with various portions of high enhancement within a moderate enhancement mass were the most frequent features. In MRI, isointensity relative to gray matter on T1-weighted images and hyperintensity on mild and heavy T2-weighted images were most frequently seen. The signal heterogeneity representing soft tissue, small cysts, necrosis, calcification, vessels or hemosiderin was better visualized in MRI which offered a better assessment of the character of tumor compositions. The soft tissue mass, calcification and cysts as revealed in both CT and MRI are nonspecific, but the location, ages, CSF seeding and particularly, superior MR images can offer very important clues for the diagnosis of ependymoma.

The VATER association: analysis of forty six cases without karyotyping

Forty-six patients with two or more features of the VATER association admitted to the Mackay Memorial Hospital from May, 1983 to Mar, 1992 were retrospectively enrolled in this study. We compared the incidence of major features with that reported in the literature. Imperforate anus, congenital heart disease, and renal anomalies were the three most common major features in our study. Thirteen patients died. Heart failure was the major cause of mortality. We noted many patients associated minor features, and among them there was a relatively high ratio of cleft lip, cleft palate, and hypospadius. The overall outcome and development were good among the survivals. We suggest that children who have any congenital anomaly included in the VATER association should get a careful examination and evaluation of their heart, genitourinary tract, limbs and vertebrae. Early correction if possible is indicated in such patients.

Tuberculous peritonitis in a child undergoing continuous ambulatory peritoneal dialysis

We present a 13-year-old girl with Arnold-Chiari syndrome and uremia secondary to neurogenic bladder. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) for 13 months prior to the development of peritonitis. The patient demonstrated no improvement with a 3-day therapy of intraperitoneal vancomycin and netilmicin. Meanwhile, smear of centrifuged dialysate revealed acid fast bacilli on two occasions. We, then, started anti-TB therapy with oral isoniazid (INAH), rifampin and ethambutal. The symptoms subsided within three days. In the first week, the patient lost her peritoneal ultrafiltration and needed daytime automatic peritoneal dialysis. At the last follow-up examination, 12 months after treatment, she remained well on standard CAPD.

Intractable hiccup due to multiple sclerosis: MR imaging of medullary plaque

We describe a 31-year-old man with clinically definite multiple sclerosis who presented with intractable hiccup for one month prior to admission. The responsible lesion was confirmed by magnetic resonance imaging to be a plaque in the ventral paramedian portion of the medulla oblongata.

Urinary tract infection in infants less than 2 months of age

Ninety-five infants, less than 2 months of age, diagnosed as urinary tract infections, from July 1984 to June 1991, were reviewed. Their urinary cultures, obtained either by suprapubic puncture or via catheterization, all had bacterial colony counts of over 10(5)/ml. In this survey, males predominated (91.6%). Fever and gastrointestinal problems were the two most prevalent signs. E. coli was the most common causative organism, and gentamicin was the most effective antibiotic. Vesicoureteral reflux (VUR), the most common anomaly, was found in one-third (25/76) of patients on voiding cystourethrography, with 20% being high grade (Gr. IV or Gr. V). Eleven cases (11%) had bacteremia, and one case had bacterial meningitis. Sixty-seven cases were followed up in our hospital and seven of them had second infections within a year of their first UTI. The mean period between episodes was less than two months. All these patients had urinary tract anomalies and received oral chemoprophylactic drugs for variable lengths of time. Five of the seven recurrences were caused by resistant bacilli. Continuous oral antibiotic prophylaxis and regular follow-up examinations were the rules of prevention for further infection and future renal impairment. These preventive methods are especially important in young infants with UTI.

Ileal neobladder reconstruction after radical cystoprostatectomy

To improve the outcome and patient acceptance of bladder substitution, five male patients underwent O-shaped ileal neobladder reconstruction, after radical cystoprostatectomy for invasive bladder cancer, with a mean follow-up of 11 months. With only 40 cm of ileal segment, an O-shaped neobladder was constructed after complete detubularization. Bilateral ureters were implanted using the Le Duc-Camey method. Six months after operation, all patients were totally continent during the day time, and one patient suffered from mild incontinence at night, which could be overcome by waking to void once or twice. The satisfactory continence levels are in agreement with a urodynamic study of the neobladder which showed a low pressure, high-capacity (mean, 456 mL) reservoir in the cystometric tracings. The mean maximal flow rate was 22.2 mL/sec, the mean residual urine was minimal (10 to 20 mL), the mean maximal urethral closing pressure was 74.4 cm H2O and the mean functional profile length was 2.9 cm. All renal units do not have neovesico-ureteral reflux. Two patients showed unilateral hydronephrosis which subsided later, one patient sustained bilateral hydronephrosis and died of jejunal perforation five months postoperatively. There were few perioperative complications and no patient expressed regret at having undergone the procedure. We consider bladder substitution to be the treatment of choice in male patients requiring radical cystoprostatectomy.

[Metastasis involving the leptomeninges and ventricles of the brain--CT evaluation]

The diagnosis of leptomeningeal or ventricular metastasis by cranial computerized tomography (CT) contributes to earlier treatment and sometimes alters the management of patients with intra- or extra-cranial malignancy. In 20 cases whose metastasis were spreaded via CSF seeding, the abnormal CT findings were 1) mass or nodule in the ventricles or subarachnoid space, 2) ependymal, subependymal enhancement, 3) sulcal, gyral or cisternal enhancement, 4) hydrocephalus not related to the obstruction of primary tumor, 5) falx or tentorial enhancement. In another 8 cases, the metastasis developed through hematogeneous spreading to the choroid plexus or paraventricular parenchyma. The mass or nodule within the ventricles could be well identified with enhanced CT scan. The involved ventricles, in order of frequency, were lateral, 3rd, and 4th ventricles in our series.