Human soluble IL-6 receptor: its detection and enhanced release by HIV infection

By using a fluorescence sandwich ELISA for the quantification of soluble human IL-6R, normal human PBMC were found to be induced to release IL-6R into culture supernatant by stimulation with PHA. Furthermore, certain promonocyte cell lines and human T-cell leukemia virus I (HTLV-I)-positive cell lines produced sIL-6R into culture supernatants constitutively. However, this was not found with HTLV-I negative T cell lines and Burkitt's B cell line. In addition, generation of supernatant IL-6R of the promonocyte cell line was significantly increased 27-fold after PMA treatment and sevenfold after infection with HIV. The released IL-6R molecules were characterized as an apparent m.w. of 50 to 55 kDa by both size-exclusion HPLC and immunoprecipitation of the soluble protein with IL-6R-specific mAb followed by SDS-PAGE analysis. Furthermore, increased levels of serum IL-6R were detected in blood donors seropositive for HIV. Moreover, the released IL-6R could bind efficiently to purified rIL-6 on solid phase and suppressed the proliferative responses of PBMC. These results suggest that the release of soluble IL-6R might be linked to regulatory functions of immune responses induced by IL-6 stimulation during normal and human retrovirus-infected cell growth and differentiation.

Human soluble IL-6 receptor: its detection and enhanced release by HIV infection

By using a fluorescence sandwich ELISA for the quantification of soluble human IL-6R, normal human PBMC were found to be induced to release IL-6R into culture supernatant by stimulation with PHA. Furthermore, certain promonocyte cell lines and human T-cell leukemia virus I (HTLV-I)-positive cell lines produced sIL-6R into culture supernatants constitutively. However, this was not found with HTLV-I negative T cell lines and Burkitt's B cell line. In addition, generation of supernatant IL-6R of the promonocyte cell line was significantly increased 27-fold after PMA treatment and sevenfold after infection with HIV. The released IL-6R molecules were characterized as an apparent m.w. of 50 to 55 kDa by both size-exclusion HPLC and immunoprecipitation of the soluble protein with IL-6R-specific mAb followed by SDS-PAGE analysis. Furthermore, increased levels of serum IL-6R were detected in blood donors seropositive for HIV. Moreover, the released IL-6R could bind efficiently to purified rIL-6 on solid phase and suppressed the proliferative responses of PBMC. These results suggest that the release of soluble IL-6R might be linked to regulatory functions of immune responses induced by IL-6 stimulation during normal and human retrovirus-infected cell growth and differentiation.

[Multiple intracranial aneurysms following radiation therapy for pituitary adenoma; a case report]

A report is made here on a rare case in which occurrence of multiple cerebral aneurysm was observed after radiotherapy. The case was that of a female aged 51 who was hospitalized with the chief complaint of consciousness disorder. The patient was discharged from the hospital 1 year before, after undergoing subtotal extirpation of a tumor through the transsphenoidal sinus in a case of pituitary adenoma, and post-operative radiotherapy (topical 50 Gy). Mild hyperlipidemia associated with hypothyroidism was observed by blood biochemical test during the patient's hospitalization, and multiple cerebral infarction was also observed by CT scanning and MR imaging. Therefore, conservative treatments including intensified endocrine-supplementing treatment, centering on thyroid hormone, were attempted. The patient's thyroid gland function and hyperlipidemia improved but the consciousness disorder persisted. Exacerbation of the consciousness disorder occurred suddenly 6 weeks after the patient's hospitalization. Subarachnoid hemorrhage and hydrocephalus were observed by CT scanning. Cerebral angiography detected a saccular aneurysm in the trifurcation of the right middle cerebral artery, 3 fusiform aneurysms in the periphery of the right middle cerebral artery, 2 fusiform aneurysms in the posterior cerebral artery and irregularity of wall width in the central artery including the terminal region of the internal carotid artery. These findings were not observed at the initial hospitalization and were considered to have been formed newly afterwards. Further, these findings were observed unexceptionally in all the radiated fields. The patient died 8 weeks after hospitalization, and no autopsy finding was obtained. From the above, we presumed that radiation vasculopathy caused by the radiation therapy made one year previously, had led to the formation of multiple cerebral aneurysms.(ABSTRACT TRUNCATED AT 250 WORDS)

[MRI findings of closed head injury in children; with special reference to the effect of central shearing force]

It is considered that shearing effect as introduced by Holbourn may produce central concussion, diffuse brain swelling and diffuse axonal injury according to its grade of force. MRI was performed in 38 children who had been admitted to our hospital during the previous 1 year for the treatment of closed head injury of varying severity. In 8 out of 38 cases, abnormal high signal intensity was observed in the medial and para-medial brain parenchyma on MRI. All of these 8 cases suffered from head trauma caused by motor vehicle accidents. They included 2 cases of cerebral concussion, 1 of diffuse brain swelling, and 5 cases of diffuse axonal injury. In 2 cases of cerebral concussion, MRI (T2 weighted) revealed only localized high intensity in the corpus callosum, while CT showed normal and subarachnoid hemorrhage only at the interposium. These two children had been unconscious for periods of 20 to 30 minutes. In one case of diffuse brain swelling, MRI (T2W) showed a slightly obscure border between gray and white matter due to generally increased intensity. In 5 cases of diffuse axonal injury, most of these cases manifested lesions at the corpus callosum, deep white matter, periventricular gray matter, pons, midbrain and the cerebellum as demonstrated by high signal intensity on MRI (T2W) while CT in the acute stage showed small hemorrhage at the corpus callosum, corticomedullary junction and mid-brain and in the ventricles. Among these, two cases also demonstrated subdural hematoma and cortical contusional hemorrhage. At 3-4 weeks after injury, the area of high intensity previously demonstrated in the deep white matter and the corpus callosum on MRI (T2W) was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Antitumor activity of synthetic oligonucleotides with sequences from cDNA encoding proteins of Mycobacterium bovis BCG

Thirteen kinds of 45-mer or 30-mer synthetic oligonucleotides with sequences randomly selected from the cDNA encoding three kinds of protein of Mycobacterium bovis BCG were tested for their antitumor activity in a murine tumor system. Six out of the 13 single-stranded oligonucleotides which contained one or more hexameric palindromic sequences showed strong antitumor activity while the others without palindromic structure did not. Namely, repeated intralesional injections of 100 micrograms of the 6 oligonucleotides caused regression of the established tumor but the other 7 were ineffective. When tumor cells were mixed with 100 micrograms of an effective oligonucleotide and injected into mice, tumor growth was markedly suppressed. These results suggested that palindromic structure is essential for the antitumor activity of the synthetic oligonucleotides.

Evidence for postjunctional release of ATP evoked by stimulation of muscarinic receptors in ileal longitudinal muscles of guinea pig

The origin of the ATP release evoked by muscarinic agonists and veratridine from longitudinal muscles of the guinea pig was assessed with muscarinic antagonists. Acetylcholine (ACh) (1 microM) and bethanechol (10 microM) produced an immediate and marked ATP release, which was almost completely blocked by atropine (0.3 microM) and by the M3 muscarinic antagonist 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP) (1 microM); release was only slightly affected by tetrodotoxin (0.6 microM). The bethanechol-evoked release of ATP was partly, but not significantly, inhibited by pirenzepine, a M1 muscarinic antagonist. Veratridine, an ACh releaser, also elicited a delayed ATP release, in a concentration-related manner. This ATP release was greatly antagonized by atropine and by Ca++ removal from the medium, implying mediation by endogenous ACh released after depolarization. In contrast, electrically evoked ACh release was enhanced by atropine and 4-DAMP. Bethanechol, unlike veratridine, failed to elicit measurable ACh release from the tissue. The contraction evoked by bethanechol was notably inhibited by atropine and 4-DAMP, but not by pirenzepine and AFDX-116, a M2 muscarinic antagonist, at a concentration of 0.3 microM. These findings suggest strongly that ATP is postjunctionally released from the ileal smooth muscles after stimulation of postsynaptic muscarinic receptors, presumably M3 receptors.

[Emergency manual aspiration for severe hypertensive cerebellar hemorrhage]

We treated 16 patients with hypertensive cerebellar hemorrhage and coma, or deep coma. Their ages ranged from 44 to 79 years (mean age: 66.3 years). Manual aspiration was performed in 9 patients and suboccipital craniectomy was performed in 7 patients. The difference in outcome between the manual aspiration group and the suboccipital craniectomy group with severe hypertensive cerebellar hemorrhage was then evaluated. Manual aspiration was performed for 4 patients in coma, and 5 in deep coma, with a mean age of 69.0 years. The average size of the hematoma was 48.7mm and the mean volume was 31. 7ml on CT scan. The mean interval from admission to operation was about 60 minutes. The mean aspiration rate was 79.6% and 7 patients (77.8%) had a good response to drainage. The suboccipital craniectomy patients included 5 in coma, and 2 in deep coma, with a mean age of 63.4 years. The average size of the hematoma was 51.1 mm and the mean volume was 33.1 ml on CT scan. The mean interval from admission to operation was about 112 minutes and the mean evacuation rate was 86.4%. The results were as follows: 1) After manual aspiration, 5 patients (55.6%) had a good outcome and 2 patients (40%) with deep coma showed good recovery. In contrast, after suboccipital craniectomy only 2 patients (28.6%) had a good outcome and all of the deep coma patients showed poor recovery. 2) The outcome may be most strongly influenced by the duration from admission to operation. 3) All patients with a hematoma volume of over 30 ml had a poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Synthetic oligonucleotides with particular base sequences from the cDNA encoding proteins of Mycobacterium bovis BCG induce interferons and activate natural killer cells

Thirteen kinds of 45-mer single-stranded oligonucleotide, having sequence randomly selected from the known cDNA encoding BCG proteins, were tested for their capability to augment natural killer (NK) cell activity of mouse spleen cells in vitro. Six out of the 13 oligonucleotides showed the activity, while the others did not. In order to know the minimal and essential sequence(s) responsible for the biological activity, 2 kinds of 30-mer and 5 kinds of 15-mer oligonucleotide fragments of an active 45-mer nucleotide were tested for their activity. One of the 30-mer oligonucleotides, designated BCG-A4a, was active, but the other 30-mer was inactive. All of the 15-mer oligonucleotide fragments were inactive. The BCG-A4a also stimulated the spleen cells to produce interferon (IFN)-alpha and -gamma. An experiment using anti-IFN antisera showed that the NK cell activation by the oligonucleotide was ascribed to the IFN-alpha produced. It was noticed that all of the biologically active oligonucleotides possessed one or more palindrome sequence(s), and the inactive ones did not, with an exception of a 45-mer inactive oligonucleotide containing overlapping palindrome sequences (GGGCCCGGG). These findings strongly suggest that certain palindrome sequences, like GACGTC, GGCGCC and TGCGCA, are essential for 30-mer oligonucleotides, like BCG-A4a, to induce IFNs.

Existence of ATP-evoked ATP release system in smooth muscles

Effects of stable ATP analogs such as alpha,beta-methylene ATP (alpha,beta-mATP) and beta,gamma-methylene ATP (beta,gamma-mATP) on ATP release and contractile response were evaluated in the vas deferens and ileal longitudinal muscles of guinea pig. In these smooth muscles, administration of alpha,beta-mATP (10, 30 or 100 microM) produced an ATP release accompanied by a transient contraction, but alpha,beta-methylene ADP (30 or 100 microM) or adenosine (30 microM) failed to elicit both the ATP release and the contraction. However, the peak responses of ATP release and contraction to alpha,beta-mATP (100 microM) in the vas deferens appeared around 2 min and 2.62 sec, respectively, after the injection of the drug. Beta,gamma-mATP (10 or 100 microM) caused an ATP release from the vas deferens. The ATP release as well as the contraction evoked by alpha,beta-mATP or beta,gamma-mATP were effectively inhibited by 300 microM suramin, a P2 purinoceptor antagonist. By contrast, ATP release and contractile response to norepinephrine in the vas deferens and those to bethanechol in the ileum were virtually unaffected by this antagonist. Veratridine and ouabain at (30 or 100 microM) caused markedly acetylcholine release from the ileum and norepinephrine release from the vas deferens, respectively. However, alpha,beta-mATP, even in a high concentration of 100 microM, did not elicit any release of acetylcholine or norepinephrine. These findings suggest that alpha,beta-mATP and probably beta,gamma-mATP evoke ATP release from not neuronal but mainly smooth muscular sites by activating suramin-sensitive P2x receptors, implying that "ATP-evoked ATP release system" exists.

Development of a new host vector system in mycobacteria

The hybrid plasmid pYT72/pYT92 constructed from an Escherichia coli plasmid pACYC177 and mycobacterial plasmid pMSC262 isolated from Mycobacterium scroflaceum strain W262 transformed both E. coli and BCG. Phage-sensitive mutants S-10 and S-20 isolated from BCG Tokyo strain showed higher frequency of transformation than the wild-type strain. Frequency of transformation was dependent on age of the culture and the electroporation condition used. Several deletion mutants were generated from pYT72/92 to determine the minimum region for the replication in the mycobacteria. A 2.3-kb fragment of pMSC262 was found to contain an essential region. Using this fragment and pACYC177, a small shuttle vector pYT937 containing two drug-resistance markers, kanamycin- and ampicillin-resistance, was constructed. pYT937 contains AatII, BamHI, BbvII, GsuI, HincII, PstI, ScaI and XbaI cloning sites.

Clinical usefulness of serum squamous cell carcinoma antigen for early detection of squamous cell carcinoma arising in mature cystic teratoma of the ovary

Squamous cell carcinoma arising in mature cystic teratoma of the ovary is rarely diagnosed preoperatively. We measured the pre-treatment serum levels of squamous cell carcinoma antigen in three stage I patients in order to evaluate its usefulness as a tumor marker for early detection of the disease. The serum levels were elevated in each case, to 26.9, 5.1, and 3.2 ng/mL, respectively, and rapidly dropped to within the normal range after treatment. All patients are recovered and show no evidence of recurrence, and the levels of serum squamous cell carcinoma antigen have remained within normal limits. These results suggest that measurement of the serum squamous cell carcinoma antigen level may be useful in diagnosing an early-stage primary squamous cell carcinoma arising in a mature cystic teratoma of the ovary. An elevated preoperative serum level of squamous cell carcinoma antigen may indicate the need for a rapid pathologic examination of the tumor to look for malignant elements and may influence the surgical regimen.

[Establishment of a host-vector system in Mycobacterium bovis BCG]

The recombinant plasmids, pYT72 and pYT92, were generated from a mycobacterial plasmid, pMSC262, and a Escherichia coli plasmid, pACYC177. These plasmids were capable of replication, and of stable maintainance in Mycobacterium bovis BCG when introduced by electroporation technique. Efficiency of transformation was about 10(4) transformants/micrograms DNA, and was the highest in the phage sensitive mutants (S-10, S-20) isolated from BCG Tokyo strain. We have also isolated transformable mutants from rapidly growing bacterium, M. smegmatis strains Jucho and TMC1533. By isolating deletion mutants from pYT72/92, we could determine the location of replication region of pMSC262 within a 2.3 kb Pst I-Hind III fragment. Using this fragment, we constructed "mini" shuttle plasmid pYT937 (5.9 kb in size) which possesses kanamycin and ampicillin resistance markers and replicates in both E. coli and Mycobacterium. Nucleotide sequence analysis of the replication region revealed that there are 2 potential coding regions which contain more than 200 amino acids. The largest one (ORF1) which codes 311 amino acids, however, lacks Shine-Dalgarno like sequence in the upstream and therefore may not be functional. The other coding region (ORF2) contains 260 amino acids and was preceded by Shine-Dalgarno like sequence. Upstream of the ORF2, there were several repeat sequences which may be important in the plasmid replication. GC content of the 2.3 kb fragment was 69.8%.

Granulocyte-macrophage colony-stimulating factor promotes the proliferation of human alveolar macrophages in vitro

The effects of granulocyte-macrophage (GM-CSF) or macrophage-CSF on in vitro proliferation of human alveolar macrophages (AM) were evaluated. AM of healthy volunteers incubated with recombinant human GM-CSF revealed incorporation of [3H]thymidine in vitro. The maximum incorporation was observed at 20 U/ml of GM-CSF on day 3. The proportion of proliferating cells incubated with 20 U/ml of GM-CSF from day 3 to day 4 was 8 to 11% of the total, whereas 3 to 5% of cells proliferated without GM-CSF. The number of cell nuclei increased 1.30- to 1.68-fold in the initial 7 days during incubation with 20 U/ml of GM-CSF, whereas there was a 1.07- to 1.13-fold increase without GM-CSF. Conditioned media obtained by the incubation with human lung tissue exhibited similar effects as recombinant human GM-CSF on macrophages. The effects were completely abrogated by antibody against human GM-CSF. Immunohistochemically, GM-CSF was detected in lung cells including AM, alveolar epithelium, alveolar interstitial cells, and endothelial cells. In contrast, recombinant macrophage-CSF did not induce the proliferation of human AM, although it has been known to promote the proliferation of murine AM. These observations suggest that GM-CSF plays an important role among the regulatory factors that locally support the population of AM in human lungs.

Granulocyte-macrophage colony-stimulating factor promotes the proliferation of human alveolar macrophages in vitro

The effects of granulocyte-macrophage (GM-CSF) or macrophage-CSF on in vitro proliferation of human alveolar macrophages (AM) were evaluated. AM of healthy volunteers incubated with recombinant human GM-CSF revealed incorporation of [3H]thymidine in vitro. The maximum incorporation was observed at 20 U/ml of GM-CSF on day 3. The proportion of proliferating cells incubated with 20 U/ml of GM-CSF from day 3 to day 4 was 8 to 11% of the total, whereas 3 to 5% of cells proliferated without GM-CSF. The number of cell nuclei increased 1.30- to 1.68-fold in the initial 7 days during incubation with 20 U/ml of GM-CSF, whereas there was a 1.07- to 1.13-fold increase without GM-CSF. Conditioned media obtained by the incubation with human lung tissue exhibited similar effects as recombinant human GM-CSF on macrophages. The effects were completely abrogated by antibody against human GM-CSF. Immunohistochemically, GM-CSF was detected in lung cells including AM, alveolar epithelium, alveolar interstitial cells, and endothelial cells. In contrast, recombinant macrophage-CSF did not induce the proliferation of human AM, although it has been known to promote the proliferation of murine AM. These observations suggest that GM-CSF plays an important role among the regulatory factors that locally support the population of AM in human lungs.

Pathology of the fallopian tube

Tubal carcinoma and serous adenocarcinoma of the ovary are remarkably similar in biologic characteristics and tumor markers, which suggests that the management for tubal carcinoma would be based on that for ovarian carcinoma. The cases with rare histologic features, including endometrioid carcinoma, mixed müllerian tumor, and malignant fibrous histiocytoma have been reported. In the genesis of tubal pregnancy, microscopic evidence of silent inflammation has attracted special interest recently. With the development of sophisticated diagnostic tests and the progress of medical management, it has become possible to treat unruptured tubal pregnancies by pharmacologic approaches, laparoscopy, or transvaginal sonographic control. This review briefly outlines the conspicuous pathologic and etiologic features of neoplasms, ectopic pregnancy, and abnormality of the fallopian tube, and discusses some recent observations regarding these disorders.

[A case of bacterial aneurysm following Hardy's operation]

Intracranial mycotic aneurysm of extravascular origin is reported. A 64 year-old male developed headache and visual disturbance. Computed Tomography (CT) revealed high density mass lesion with contrast enhancement in the intra- and suprasellar lesion. He was then admitted to our hospital under the diagnosis of pituitary adenoma. But he suddenly complained of headache and loss of vision during hospitalization. An emergency operation using the transsphenoidal approach was performed. The pathological diagnosis was craniopharyngioma. Postoperative radiation therapy was carried out using a tumor dose of 50Gy. Two months after the operation, he suffered from rhinorrhea and high fever. He was admitted again and treated with high doses of antibiotics. Two weeks after admission, he suddenly lost consciousness. A CT scan revealed an aneurysm of the anterior temporal artery. Immediately, removal of the hematoma and resection of the aneurysm were performed. Microscopic examination showed that inflammatory cells had infiltrated the aneurysmal wall, and lymphocytes and plasma cells had gathered around the microabscess. This rare case is discussed with other related cases in the literature.

Preexposure of macrophages to low doses of lipopolysaccharide inhibits the expression of tumor necrosis factor-alpha mRNA but not of IL-1 beta mRNA

LPS is known to be a potent activator of macrophages and induces the production of TNF-alpha and IL-1. However, the signaling events and regulatory mechanisms required for the activation of macrophages by LPS have not been resolved precisely. We show that LPS modulates its own response in macrophages. Proteose peptone-induced murine peritoneal macrophages (P-PEM) produce significant amount of TNF-alpha and IL-1 after stimulation with LPS. However, preexposure of macrophages to low doses (less than 1 ng/ml) of LPS renders them refractory to stimulation by a second round of LPS, as evaluated by production of TNF-alpha. The loss of sensitivity to a second round of LPS was selective for TNF-alpha production as the LPS-primed macrophages retained the ability to produce IL-1. Northern blot analysis was performed with total RNA obtained from control and LPS- (1 ng/ml) primed P-PEM after 3-h stimulation with a second round of LPS. The expression of TNF-alpha mRNA was inhibited in LPS-primed P-PEM, whereas the expression of IL-1 beta mRNA was the same in control and LPS-primed P-PEM, consistent with the data of biologic activities of these two cytokines. Zymosan-induced TNF-alpha production was the same in control and LPS-primed macrophages, indicating that not all of the pathways required for TNF-alpha production were affected by LPS priming. Monokines such as human (h) rIL-1 alpha, hrTNF-alpha, hrIL-6, and murine rIFN-beta could not substitute for the action of low doses of LPS, and addition of indomethacin could not restore TNF-alpha production. These results suggest that exposure of macrophages to low doses of LPS suppresses the production of TNF-alpha, but not of IL-1, by inhibiting the expression of mRNA through a noncyclooxygenase-dependent mechanism. Thus, LPS-induced production of TNF-alpha and IL-1 in macrophages are differently regulated.

Preexposure of macrophages to low doses of lipopolysaccharide inhibits the expression of tumor necrosis factor-alpha mRNA but not of IL-1 beta mRNA

LPS is known to be a potent activator of macrophages and induces the production of TNF-alpha and IL-1. However, the signaling events and regulatory mechanisms required for the activation of macrophages by LPS have not been resolved precisely. We show that LPS modulates its own response in macrophages. Proteose peptone-induced murine peritoneal macrophages (P-PEM) produce significant amount of TNF-alpha and IL-1 after stimulation with LPS. However, preexposure of macrophages to low doses (less than 1 ng/ml) of LPS renders them refractory to stimulation by a second round of LPS, as evaluated by production of TNF-alpha. The loss of sensitivity to a second round of LPS was selective for TNF-alpha production as the LPS-primed macrophages retained the ability to produce IL-1. Northern blot analysis was performed with total RNA obtained from control and LPS- (1 ng/ml) primed P-PEM after 3-h stimulation with a second round of LPS. The expression of TNF-alpha mRNA was inhibited in LPS-primed P-PEM, whereas the expression of IL-1 beta mRNA was the same in control and LPS-primed P-PEM, consistent with the data of biologic activities of these two cytokines. Zymosan-induced TNF-alpha production was the same in control and LPS-primed macrophages, indicating that not all of the pathways required for TNF-alpha production were affected by LPS priming. Monokines such as human (h) rIL-1 alpha, hrTNF-alpha, hrIL-6, and murine rIFN-beta could not substitute for the action of low doses of LPS, and addition of indomethacin could not restore TNF-alpha production. These results suggest that exposure of macrophages to low doses of LPS suppresses the production of TNF-alpha, but not of IL-1, by inhibiting the expression of mRNA through a noncyclooxygenase-dependent mechanism. Thus, LPS-induced production of TNF-alpha and IL-1 in macrophages are differently regulated.

Effect of a synthetic adjuvant for inducing anti-tumour immunity

An acylated derivative of muramyl dipeptide (MDP), 6-O-(2-tetradecyl-hexadecanoyl)-muramyl-dipeptide (B30-MDP) is a strong adjuvant effective in inducing cell-mediated immunity. We used B30-MDP as an adjuvant for induction of anti-tumour immunity. Guinea-pigs which were injected repeatedly with a mixture of X-ray-treated leukaemic cells and B30-MDP dissolved in phosphate buffered saline resisted a challenge of leukaemia cells and showed no sign of leukocytosis. The immunity induced was tumour-specific and retained for more than 100 days. These results suggest that B30-MDP is useful as a simple but potent immunotherapeutic tool.

Multiple primary brain tumors of different histological types--report of two cases

Simultaneous development of histologically different primary brain tumors aside from phacomatoses or previous irradiation is rare, and its preoperative diagnosis is still difficult. We report two such cases, a 49-year-old male with an acoustic neurinoma and a cerebellar hemangioblastoma and a 69-year-old female with a parietal convexity meningioma and an ipsilateral frontal lobe astrocytoma. The tumors in the first case developed closely, so some local stimulation probably acted as a developmental factor. However, the tumors in the second case developed in distant areas and were considered coincidental.

[Entirely suprasellar symptomatic Rathke's cleft cyst]

Two rare cases of entirely suprasellar Rathke's cleft cyst were reported. Case 1. A 62-year-old man was admitted to our hospital on the 14th of January, 1988, complaining of headache and diplopia. A plain skull x-ray showed the sella turcica was normal. CT scan and MRI demonstrated a lesion mass located entirely in the suprasellar cistern. Right frontotemporal craniotomy was performed, and the cyst wall was resected subtotally. Microscopic sections of cyst wall showed ciliated single layer with focal stratified epithelium. Case 2. A 51-year-old man was hospitalized complaining of visual impairment in the left eye. Endocrinological examination showed no abnormalities. CT and MRI demonstrated a lesion mass located entirely in the suprasellar region. Right frontotemporal craniotomy was performed. The mass was opened and a large amount of yellowish fluid was released. Histologically, the specimens were simple ciliated cuboidal epithelium. Postoperative courses of these patients were uneventful. The findings on CT and MRI of the cases located entirely in the suprasellar region were varied. The histopathogenesis and embryological pathogenesis of Rathke's cleft cyst in the literature, particularly the entirely suprasellar type, were discussed.

Multiple brain tumors of different cell types with an unruptured cerebral aneurysm--case report

A rare case of coexistent Burkitt-type lymphoma and meningioma associated with an unruptured cerebral aneurysm is presented. A 49-year-old male complaining of headache and right hemiparesis was admitted to our hospital. Neuroradiological examination revealed a multinodular mass in the left frontal convexity and an unruptured cerebral aneurysm at the M1 portion of the left middle cerebral artery. He underwent an operation for tumor removal and aneurysm clipping. Histological examination revealed the tumor to be a typical meningotheliomatous meningioma without malignancy. However, a second operation was necessary for another tumor invading into the left frontal lobe, which proved to be a Burkitt-type lymphoma. The second tumor may have been resulted from irritative effect of the first tumor, but the aneurysm was considered purely coincidental.

[A case of intraosseous meningioma]

A case of intraosseous meningioma at the posterior fossa was reported. Intraosseous meningioma is very rate and only six cases have been reported in Japanese literature. A 64 year-old woman complained of progressive headache and was admitted to Ichinomiya Neurosurgical Hospital. On admission, neurological examination did not reveal any abnormalities. However, plain skull X-p showed a hyperostotic lesion in the right posterior fossa. CT scan demonstrated homogeneously enhanced mass by contrast medium. MRI showed a mass lesion of the posterior fossa on T1 and T2 weighted images. The right vertebral angiogram showed an avascular area in the right posterior fossa and no tumor stain. The tumor, which was partially attached to the underlying dura, was successfully removed surgically. The operative finding confirmed an intraosseous meningioma which had arisen from the right asterion. The post operative course was uneventful. Histological examination revealed fibroblastic meningioma.